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February 9, 2023
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Why the Major Conditions Strategy requires major conditions

Put simply, geographical differences in outcomes aren’t limited to six issues – they go far further and far deeper than that because health inequalities aren’t just about disease.

Prof. Jim McManus
ADPH President

Last month’s Government announcement of a new, Major Conditions Strategy gave cause for cautious optimism – a pledge to tackle the growing issue of supporting people who are living with more than one condition and to focus on addressing “clusters of disadvantage”.

As the representative body for Directors of Public Health in the UK, ADPH welcomed the news, especially the focus on reducing health inequalities and partnership working with local government – something we have long called for.

We were concerned though as to how – or indeed if – the strategy would link to the long-awaited Health Disparities White Paper. Then, 48 hours later, it was confirmed that the White Paper would not be published after all.

Another response then, though this time, one of disappointment and concern that the focus on creating real equity in health could be lost.

Of course, the commitment from Government to work towards a model of “preserving good health” is absolutely right but narrowing the field down to just six major conditions, and focussing on detection and treatment seems short sighted at best.

Put simply, geographical differences in outcomes aren’t limited to six issues – they go far further and far deeper than that because health inequalities aren’t just about disease. The root causes are driven by a range of other factors, not obviously defined as ‘health’.

What is needed to really reduce health inequalities is to provide everyone with an environment where there is equal opportunity to prevent disease from happening in the first place.

Without trying to address the underlying social, and increasingly commercial, determinants of health like where you are born for example, or how much alcohol advertising you are exposed to, there will always be, largely preventable, ill health – including the six conditions addressed in this new strategy.

Directors of Public Health have a wealth of knowledge about how to go about reducing these health inequalities. We work at a local level, addressing local needs, with local partners – both across council departments, the NHS and the community and voluntary sector.

Moreover, through an ongoing programme of sharing best practice, we are steadily improving public health across the country by replicating successful programmes in other areas with similar issues. Newham’s ‘Covid Champions’ are an excellent example of this: a solution (in this case, to improve community engagement) that was developed in one area and adopted by others once its effectiveness had been proven.

What’s needed now is for national policy to reflect and align with these local successes to not just ‘preserve’ good health but promote its creation – for everyone.

To do this, the Government need to explore the benefits of looking at these issues through an even wider lens than they are currently proposing. By recognising the positive impact that, for example, ensuring all children have a healthy start in life regardless of where they are born, or access to affordable, healthy food regardless of income would have on narrowing the equity gap, we would not only live healthier lives, we would be able to work more productively and put the NHS and social care system on a sustainable footing – a triple win.

The Major Conditions Strategy is clearly a step in the right direction and signals a move to look outside of the NHS to improve health. This is absolutely crucial, involves partnership and cross government working and investment with good health in mind and is definitely positive.

We need to go further though. It might feel uncomfortable to put the NHS to one side in this debate, but that is what we need to do. The NHS ‘fix’ us when we break, and they do an amazing job at doing it. However, they shouldn’t – and can’t – be expected to do the rest. That is where public health comes in – working collaboratively to improve our home, workplace and community environment, our access to goods and services, our education and knowledge, so we live longer, healthier lives.

In short, we need to create the building blocks for a society that makes preventable illness less prevalent, less likely, less impactful on society and therefore, less of a strain on the NHS and on the economy.

However, to achieve this Government must make sure that funding for public health services, like the provision of health visitors or sexual health clinics, for example, is increased. Currently, we are awaiting the decision on next year’s public health grant allocation and unless the consistent real-terms cut of 24% that we have seen since 2014/15 is reversed, some of these vitally important local services may be forced to close.

Similarly, the community and voluntary sector, who public health teams work so closely with on a local level, need more – and more stable – funding and resources or we will find ourselves without their vital support.

However, the Government deserve credit for starting that shift in focus. Trying to address the issue of comorbidity is a step forward, as of course, is continuing to work towards improving life expectancy across all regions. While the Major Conditions Strategy may lack scope, if delivered, it will make a huge impact on millions of lives. It may also provide that all important successful, evidenced model of good practice for the health system to replicate and expand on.

So, despite the major conditions and caveats, the Major Conditions Strategy does provide opportunity and by looking at people as a whole, tackling issues in tandem, and acknowledging the need for partnership, there is the potential to start to build a society where good health is considered the norm.

Originally published in The Municipal Journal.

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