In July the government published its long-awaited Prevention Green Paper. The principle is welcome and emphasises that preventing illness is as important as making people better when they’re already unwell. This is a sensible direction in policy terms and means we’ll get away from looking solely at yardstick measures like life expectancy towards a more holistic account of how many ‘good health’ years a person can reasonably expect.
Often, poor health is framed in the context of individual choices, and some of that framing was to the fore in the Green Paper – particularly the focus on ‘smart prevention’ and ‘targeted advice’. As part of a broader set of actions, this is fine and sensible. Of course, our own choices matter – but the real challenge is providing the conditions and the environment for people to be able to make good choices. It’s harder to make healthy choices if you’re poor - the worst off in our society will have 19 fewer healthy years than the richest. In other words, it really matters where you’re born.
We know that many barriers to ‘healthy choices’ are beyond a person’s immediate control. In community paediatrics especially, we see this reality every day. If you’re a lone parent, living in a poor area and struggling to make ends meet – it’s unlikely you’ll find it easy to make healthy food choices. It’s also not just about money. You may not have access to reliable transport, the nearest shop may be too far to walk from with heavy bags and the demands of your life may mean that you don’t have time to prepare meals from scratch. Good policy should be designed with real people in mind, and this is how life is for millions of people in the UK.
Good prevention can’t happen without addressing the roots of poverty and it is a lifelong project that begins before we’re even born. We’re in a bad place on several fronts. Last year we reported that if current trends continue, the UK’s infant mortality rate will be 140% higher than comparable countries in 2030. We’re also not doing nearly enough to tackle the root causes of poverty, which make prevention much more difficult. One in five (about 4.1 million) children live in poverty in the UK – these are young people that have no choice but to start in the deep end of life. This should be unacceptable to us as adults and it is all entirely preventable.
The foundation of this thinking is very straightforward. We don’t plant a seed in bad soil and expect it to thrive. We try to create the best conditions to improve outcomes. That’s why we’ve prioritised in our response policy issues that we know make a difference to outcomes and reduce inequality. This includes investing in mental health, creating the right conditions for healthy weight, regulating to tackle air pollution and improving oral health.
These issues are all interconnected. A healthy eating programme for young children improves parenting capacity and this leads to better relationships, which in turn builds up resilience and self-esteem to help meet the challenges life. These interventions work, and a rising tide lifts all boats.
We also need to be agile and responsive to new opportunities and risks, for example smart health tech on the one hand, and screen time and vaping on the other. Our job as a College is to take a scientific approach, being precautionary when necessary but also mindful of the unintended consequences of advice that may not be applicable to people’s everyday lives. We will continue to monitor the evidence on emergent public health issues and respond in such a way that helps members to address families’ concerns in a practical and evidence-based manner.