Health, wellbeing, and care should be top of everyone’s political agenda

Austerity kills

Differences in life expectancy are widening between rich and poor.14 Life expectancy is falling for older adults5 and particularly for poorer women.4 Cuts in social care are a factor in the drop in life expectancy among older people.15 More damning is the rise of infant mortality since 2013.6

The landscape of austerity UK features daily: 3700 people are using a food bank, 5400 suffering domestic violence, 4750 sleeping rough. The word “destitution” has been resurrected to define abject poverty.7 Policies have been implemented that work systematically against Michael Marmot’s 2010 proposals to reduce inequalities.8 Policies to control government spending have completely failed, and the poorest have borne the consequences of increased poverty and poorer services. Governments should borrow in times of recession to protect the poorest and assist recovery.9

Poverty and years of neglect of children, young people, and communities have played their part in the growth of knife crime, gang violence, and “county lines” drug trafficking in England. There have been multiparty calls for a public health approach to tackling violent crime.1011 Calls for more police on the streets, however, will have no effect on the 83% of emergency calls to the police that are not crime related or help respond to violence in the home, currently the biggest contributor to violent crime.12 Policies are needed that promote partnership approaches to policing and appropriate responses to mental health crisis, domestic violence, safeguarding, and addiction problems.1011

Climate breakdown

Climate breakdown has become a global emergency. The Inter-Governmental Panel on Climate Change has called for global warming to be kept to 1.5°C to protect lives and mitigate the mass movement of climate refugees.13 The UK Health Alliance for Climate Change has urged the government to reach carbon neutrality before 2050,14 which means substantially more ambitious targets for a net zero carbon economy. Other environmental initiatives to phase out diesel and single-use plastic must be accelerated if we are to reduce, even slightly, the threat to planetary health and the health of future generations.

Historically, politicians have ignored policies that might produce benefits after their term of office. Now, the UK should adopt the visionary Welsh policy for health and wellbeing of future generations.15 Policies with important implications for future generations include the houses we build, our plans for cities, active travel, protection of the environment, and our support for children in the first 1000 days of life, in preschool, and throughout adolescence.215

Service cuts

Austerity has made people poorer and cut the services on which they rely.2 Adult social care budgets were cut between 2010 and 2016 and have recovered only marginally in the past two years.16 The case for free personal social care at the point of need funded from central taxation grows ever stronger.17

Public health budgets have been cut by one sixth in England since 2015,18 and the UK Faculty of Public Health has called for an innovation fund of £1-2bn for new and expanded local public health services.19 Virtually all public health interventions at national and local level produce a positive return on investment.20 The Scottish Faculty of Public Health has set out an ambitious programme of recommendations for healthier, fairer public policy.21 Governments must be courageous in using fiscal and regulatory measures to reduce the health harms of alcohol, tobacco, highly processed foods, and gambling and must be willing to take on powerful commercial vested interests.22 Voters must expect the next government to honour and build on promising policy interventions, such as minimum unit pricing for alcohol.23

Brexiting health

The health community considers that leaving the European Union will be bad for population health and health services.2425 Whatever the outcome of this election and the subsequent Brexit negotiations, there will be protracted political lobbying to secure health and environmental protections gained through membership of the European Union. The public health community will continue to campaign for future trade agreements that do not harm the public’s health.26

The next government must learn the lessons of austerity and aim to create healthier and fairer communities and environments. We need a renewed commitment to value and respect all citizens, through properly funded commitments to the NHS, the care system, housing, and equal economic and educational opportunities. We need a national service for health.