Substantial improvements in life expectancy over the past 100 years mean that people are living longer, healthier lives than ever before.
However, England lags behind other countries on many key health outcomes, improvements in life expectancy have stalled and health inequalities are widening. To address this, we need to move away from a system just focused on diagnosing and treating illness towards one that is based on promoting wellbeing and preventing ill health.
Population health is an approach that aims to improve physical and mental health outcomes, promote wellbeing and reduce health inequalities across an entire population. This report outlines The King’s Fund’s vision for population health, our reasoning for why such a vision is needed and the steps required to achieve it.
Our vision is to reduce inequalities and achieve health outcomes on a par with the best in the world by focusing on population health locally, regionally and nationally. The report outlines a framework for population health centred on four pillars: the wider determinants of health; our health behaviours and lifestyles; the places and communities we live in; an integrated health and care system.
We call for action at national, regional and local levels. This should include: ambitious and binding national goals to drive progress; a cross-government strategy for reducing health inequalities; stronger political and system leadership; greater clarity on the roles and accountability of national bodies and local organisations; and increased investment in prevention, public health and spending that supports population health.
In recent years, The King’s Fund has played a key role in promoting integrated care and supporting place-based systems of care. This report marks the next stage in our journey and signals that population health will be a key focus of our work in future.
A vision for population health
Over the past 100 years, in common with other developed countries, England has made a great escape from poor health and short life expectancy. This has been due to improvements in sanitation, medicines and health care, underpinned by economic growth, improved living standards and the establishment of the welfare state. Life expectancy has improved and, although inequalities in health have been ever-present, as a population we are healthier than ever before.
However, progress against many key measures has stalled and risks going into reverse. Data shows that there has been little or no improvement since 1990 in how long people live with illness and disease. England lags behind comparable nations on many key measures of health outcomes, and our obesity rates are among the worst in western Europe. Improvements in life expectancy have ground to a halt. Inequalities in health are widening, condemning some people to live much shorter lives, in poorer health.
An important shift is taking place in the burden of disease, from mortality to morbidity, with people living for many years with chronic conditions, in pain and with mental ill health. Much of this is preventable, yet the NHS remains, at heart , a treatment service for people when they become ill, and we lack a comprehensive approach to keeping us well.
NHS organisations have a critical role, not just as providers of health services but as employers, key players in their local economies and anchor institutions in their communities. However, these challenges cannot be addressed by the health and care system alone; a much broader approach is required that pays more attention to the wider determinants of health and the role of people and communities.
The Secretary of State for Health and Social Care has published a vision for prevention, identifying this as a key priority and signalling that a Green Paper will be published in 2019. This is encouraging, but previous ministers have arrived in office with good intentions and talked up the importance of prevention and public health only to end up not delivering as other challenges consume their time and political capital. It must be different this time.
What affects our health?
Our health is shaped by a range of factors, as set out in Figure 1 What affects our health? It is hard to be precise about how much each of these factors contributes to our health, but the evidence is convincing that the wider determinants of health in the outer ring have the most impact, followed by our lifestyles and health behaviours, and the health and care system. There is also now greater recognition of the importance of the communities we live and work in, and the social networks we belong to.
What is population health?
Population health is an approach that aims to improve physical and mental health outcomes, promote wellbeing and reduce health inequalities across an entire population. There is no single accepted definition of population health. We see it as a broad overarching concept, encompassing but going beyond the NHS, public health and population health management. Crucially, it focuses on the wider determinants of health and the role of people and communities.