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Social policy more important for health than medicines, conference told

Tessa Richards BMJ

Policies which improve people's social and physical environment should be pursued to promote public health in the next century, a group of international experts concluded at a meeting last week in London organised by the Office of Health Economics.

Spending more money on health care and measures to change individuals' behaviour is unlikely to have as much effect as investing in policies that promote sustainable development, protect the environment, promote equity, and tackle the social gradient in health.

Mortality in the United Kingdom has fallen steadily in the past 25 years, largely due to a continuing decline in deaths from infectious disease and ischaemic heart disease. Morbidity data suggest, however, that the longevity has been associated with an increasing burden of long term illness (particularly in children), disability, and a rise in reported ill health.

Recent data from the World Health Organisation show that a quarter of the total DALYs (disability adjusted life years) lost in countries with established market economies are due to neuropsychiatric disease. Imaginative policies, which reduce inequalities in child development and improve the quality of life for elderly people, could do much to improve the health of future generations, it was suggested.

Early intervention to promote future health is essential, said Professor Clyde Hertzman, director of the Population Health Programme at the University of British Columbia. He said: "In Canada we are piloting a children’s programme for 4-5 year olds. The aim is to identify groups of children who are at risk of going on to develop health and social problems. We are assessing the effect of interventions to support better parenting, enriched child care, and improved educational, and recreational opportunities."

There was also consensus at the conference that innovative policies to promote public transport were needed, because of their potential to have several positive spin-offs for health. Reducing the consumption of fossil fuel was necessary to slow global warming and improve air quality. Car free zones encouraged people to walk or cycle and hence improved physical health. They also made social interaction easier and safer and hence promoted social cohesion, which improved mental health, the conference was told.

Persuading politicians to adopt innovative population based policies was difficult, however, for there were no good longitudinal studies evaluating the effect of different interventions on health.

"Policy tends to be informed by narrow, short term cost effectiveness studies," said Professor Michael Marmot, director of the International Centre for Health and Society at University College London.

"Giving people control over their working lives may be just as effective as spending money on medical care. The problem is that we don’t know. Better data is needed—and more political courage and vision," he said, adding that there was currently understandable concern in the United Kingdom about improving train safety but the money being spent to that end would save more lives if it were spent implementing measures to discourage smoking.

"Governments should recognise that protecting the wellbeing of future generations is more important than implementing knee jerk policies that gratify narrow immediate public and political concerns," Professor Marmot commented.

Further information about the meeting is available from the Office of Health Economics, 12 Whitehall, London SW1A 2DY (tel 0171 930 9203, fax 0171 747 1419).  
 

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