Intended for healthcare professionals


What are the best societal investments for improving people’s health?

BMJ 2018; 362 doi: (Published 30 August 2018) Cite this as: BMJ 2018;362:k3377
  1. Laura Webber, director of public health modelling1,
  2. Kalipso Chalkidou, director of global health policy2,
  3. Susie Morrow, chair3,
  4. Brian Ferguson, chief economist4,
  5. Klim McPherson, emeritus professor5
  1. 1UK Health Forum, London, UK
  2. 2Centre for Global Development, Imperial College London, UK
  3. 3Wandsworth Living Streets Group, London, UK
  4. 4Public Health England, London, UK
  5. 5New College, University of Oxford, Oxford, UK
  1. Correspondence to: L Webber laura.webber{at}

Healthcare alone cannot improve population health. Laura Webber and colleagues advocate a “health in all policies” approach, with protected funding for preventive interventions

The NHS has transformed medicine and improved lives.1 But the ageing population along with the burden of non-communicable, mental, and neurological diseases have put its financial viability and sustainability into question. The next decade is projected to be the most financially austere in NHS history,2 even if recent pledges materialise. Reorienting the NHS to invest in cost effective disease prevention is essential if the health system is to be sustained. Disease prevention has four key benefits that show how cost effective it is both in and beyond the health and social care system (fig 1). We focus on the role of the NHS in disease prevention and the role of cross government agencies in tackling the wider determinants of health.

Fig 1

The key benefits of disease prevention

Health in all policies

Social and environmental influences are thought to contribute to around 50% of the variation in health status, indicating that access to universal healthcare alone is not sufficient to improve population health.3 Strong preventive interventions tackling the social determinants of health often fall outside the usual scope of healthcare, yet accrue benefits for the health sector.45 Including health as a key outcome of policies and intersectoral governance on health is therefore an important step in improving population health and reducing health inequalities.6

The United Kingdom’s recent industrial strategy acknowledges the importance that infrastructure investments can have on society, with a focus on how investment can support the needs of an ageing population.7 The post-Brexit rewriting of laws and policies provides an opportunity for (public) health to be put at the centre of policy making8 and for health to be embedded in new institutional norms. …

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