The health and wellbeing policy paradox


Judy Robinson at ALW13

One thing in public policy really puzzles me. Why it is that health, and especially public health, is driven by ideas about equality and deprivation but every other part of government seems to be going in the opposite direction! What’s going on?

One public health annual plan talks about “the importance of social determinants of health” and reducing differences (in health outcomes) “as a matter of fairness and social justice”. Others read in the same vein.

And yet… other government policies and practices are doing their best, it seems, to both deny the wider determinants of health and implement policies that make health and wellbeing worse.

Take, for example, the work that Involve has been doing with colleagues in Sheffield about the impact of food poverty and how the work of charitable organisations can be better factored into health intelligence and planning. One very striking finding was that in April of this year, as new benefit changes (aka cuts) came in, the demand for food parcels went up. Is that coincidence or cause and effect?

Take evidence about the impact of the bedroom tax. Chris Goulden, head of poverty at the Joseph Rowntree Foundation, said: “It is very difficult to see how this policy can work without causing severe hardship, particularly as many of those affected are disabled people.” Shelter makes a similar point about families with a disabled child.

Talking of children: there are more than 1 in 4 children in poverty in the UK and, if the current policy direction continues, child poverty is projected to rise from 3.5 million today to 4.7 million by 2020. (Child Poverty Action Group).

I could go on and on and on-young people, older people, homelessness, loneliness -the list is endless. Presumably, all this does not provide a tonic for good health, or am I missing something?

Coming up fast in the understanding of what shapes our lives and wellbeing is the idea that it isn’t just a job, any old job, that matters but the way employment is organised and the sort of labour market we develop in the UK. Leading this thinking is the Resolution Foundation. It has researched the low wage economy, zero hours contracts, the high cost of child care and how it affects family living standards. All factors that public health recognises as having a direct link to both physical and mental health.                                                                                               

Well, public health directors have often been refreshingly off message and outspoken about health, but even they must reckon they have an uphill task ahead.

This is why I can’t wait to hear what the new boss of Public Health England, Duncan Selbie, has to say at our annual conference in September: Health and Wellbeing: Making Equality a Reality. He too talks about those things – housing, isolation – that have a big impact on healthy lives. He says he wants to bring about a sea change in public healthcare.

But there’s not just one speaker to shine a light on all this; James Plunkett from the Resolution Foundation is also contributing and his thinking could well help to shape public policy in future governments.

So does any of this matter to the voluntary and community sector?

If you work in communities where ill health impacts on lives or if you work with the results of low wages and long hours you’ll know that community resilience, capacity to volunteer or to provide stable family support is tied up with these realities. So, yes, it does matter!

Perhaps the speakers will help me understand this policy paradox. They might help you too.

Find out more about the Involve Annual Conference here.

You can book a place at the conference by completing this booking form and returning it to by Monday 2 September 2013.

If you would prefer to post your form with a cheque, please send it to the Involve office address.

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