Why your health really is your wealth
Whenever we discuss how to improve health we invariably neglect the biggest factor of all in making us ill: poverty.
Perhaps we talk so little about the link between health and poverty because it’s not something that health ministers and the health service can do much about. Health professionals would tell you they have enough on their plate, under-resourced and in desperate need of reform as they are.
Yet poverty does cause illness and premature death. Reduce it and you automatically reduce the costs on the health service as well as prolonging economically active lives.
Yet it is one of many determinants of health which sits outside the health department’s portfolio.
Poor housing, inadequate diets, environmental pollution and educational underachievement are others, which are so often linked both to poverty and each other.
So whilst government might find it convenient to organise itself into departments with individual portfolios and budgets, the problems politicians are seeking to solve are not so obliging.
And when an issue falls into a different portfolio the resulting siloed thinking can be incredibly difficult to untangle. Especially when all budgets have been constrained with the exception of health.
And because civil servants tend to be so tribal about their departments there is often an unwillingness to accept that a department exempted from cuts is not secretly rolling in cash.
There is also a tendency for an organisation organised into silos to think in them too, to not see connections, even when they seem obvious, and even when they do see them to not act because it is not their job to, especially so if they happen to think it is, or should be, someone else’s problem.
Having a multi-party government complicates the matter even further: to put it starkly what is the benefit to their parties of individual Ministers collaborating on policy?
And as to poverty, that is a really difficult one because many of the levers to tackle it are not in Stormont’s hands. Growing, grinding poverty and a society built upon widening disparities and buttressed by a lack of social mobility has been driven and fostered by central government.
Health, or more specifically tackling the determinants of health is by no means the only so-called cross-cutting issue that government faces. Dealing effectively with matters that fall across departments, and indeed between devolved and central government is a perennial problem to which there is no easy solution.
But a great starting point would be to explicitly the impact of poverty in the new programme for government.
Northern Ireland has been far from unique in being slow to recognise the potential role economic development can have in improving health and reducing health inequalities.
But there is now a growing interest in the topic worldwide and evidence is beginning to mount as to what works.
A great starting point for this is the Inclusive Economies Report from the highly respected Health Foundation.
The report builds on one of the most important lessons from the pandemic: that people’s health and the economy cannot be viewed independently. Both are necessary foundations of a flourishing and prosperous society.
It goes on to show how economic development can be used to improve people’s health and reduce health inequalities in the UK. In many respects Northern Ireland is quite well placed to progress some of its proposals.
An important first step is to stop using GDP as the focus for economic growth and improvement and instead to focus more on inclusive and socially cohesive economic policies. In the longer term this will probably require a change of national government but we could make a start here by building in new measures of economic performance based on wellbeing – a prospect already envisaged by our previous draft PfG. We’ll obviously need a new government in place for that.
This would be followed by simple, practical measures, starting with a switch away from targeting inward investment towards a focus on ‘growing from within’: supporting locally-rooted enterprises to grow and succeed, especially those that pay well and create good jobs.
We’d also need to offload “economic development specialists” or consultants. Instead development should be informed by cross-sector priorities and collaboration, and citizen priorities.
Procurement policy needs to change as well so that local suppliers are prioritised meaning that money spent in the community is retained and re-cycled in the community.
The Department of Communities is already examining the potential of Community Wealth Building that does exactly that.
Developing a long term perspective that goes beyond electoral mandates.
This is another area where Northern Ireland is well placed, at least compared to England.
Our elections tend to be fought on constitutional lines. There is a surprising degree of consensus on many “domestic” issues, agreeing to combine targets around health, inequality and economic development as a central plank of government long term, might just be something parties can agree upon.
Once there is agreement on that shaping an agenda that works across departments would be challenging, but it would be achievable and much less likely to enjoy the same fate as debates on legacy, cultural identity and language.
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