Meeting the Sustainable Development Goal targets on health will require efforts well beyond the health care system. Is enough happening to keep us healthy in the UK? Emma Spencelayh from the Health Foundation explores.
World Population Day has been observed on 11 July since 1989, seeking to focus attention on the urgency and importance of population issues in the context of overall development. This year’s World Population Day will celebrate the theme ‘Family Planning is a Human Right’ by marking the 50th anniversary of the Proclamation of Tehran, when family planning was adopted as a global human right. The UN resolution that established World Population Day noted the crucial importance of resource investments in health and education, especially for women. It is fitting therefore to have the chance to consider Sustainable Development Goal 3 (health and wellbeing) by reflecting on what we can do to promote better health and wellbeing across and within the UK population.
The opportunity for good health starts long before we need health care. So, there is a compelling case that responsibility for the health of the public should go beyond the health and social care system to span all of society. We can do more to enhance health and wellbeing for everyone rather than simply treating illness in individuals.
What does a healthy society look like?
Meeting the Sustainable Development Goal (SDG) targets on health will require efforts well beyond the health care system, given that it is only one of many factors contributing to health and wellbeing. Other factors (known as the social determinants of health), include access to education, work and leisure conditions and the environment people live in. A healthy society is not one that waits for people to become ill, but one that sees how health is shaped by social, cultural, political, economic, commercial and environmental factors, and takes action on these for current and future generations.
For a number of years, stakeholders in the health community have been advocating for a health in all policies approach. The SDG framework provides an excellent opportunity to go beyond this and embed a comprehensive, intersectoral approach in national policymaking. It also provides the opportunity to show that good health has a role to play in supporting sustainable development more broadly. The health of a population has a complex, multi-directional relationship with other social and economic outcomes. Good health is of course valuable to individuals but it is also a societal asset which can help enable people and places to flourish.
Tackling non-communicable diseases
One example that demonstrates this powerfully is Target 3.4 which sets an ambitious objective to reduce by one third by 2010 premature mortality from non-communicable diseases (NCDs) such as cancer, heart disease and diabetes. NCDs share four preventable risk factors: tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol. It is not enough to expect individuals to adopt healthy behaviours. We have to look deeper to understand the causes of poor diet or substance abuse and to consider what can be done at a population level to make it easier to make healthy choices.
The conditions in which we live will, in part, determine the choices and opportunities available. For example, it is harder to buy healthy foods in deprived parts of the UK and there is also a higher density of fast food outlets in these areas. Making progress against SDG 1 (no poverty) and SDG 10 (reduced inequalities) is likely to have an impact in supporting SDG 3.
While the health of the UK population has seen improvements in the last 50 years, the challenge of tackling NCDs remains formidable. The Prime Minister, in her recent speech, outlined that the government is committed to creating a renewed focus on the prevention of ill health. In order to do so, the government has to commit to a coordinated cross-sector approach where broader social and economic policy is designed to be health enhancing. In turn, evidence suggests that progress on target 3.4 would have a role in determining the outcome of at least nine SDGs. For example, reducing the mortality and morbidity from NCDs could lead to a rise in productivity and household incomes, helping to achieve progress against SDGs 8 (decent work and economic growth) and 10 (reduced inequalities).
In a world where ‘what measures gets done’, the inclusion of NCDs in the SDGs is a really important step. But, we need the UK Government to ensure this target is monitored and considered properly. While the Department of Health’s Single Departmental Plan does include initiatives such as the cross-government Childhood Obesity Plan, there does not appear to be a focus on meeting the SDG target relating to preventable mortality. This is disappointing and a missed opportunity to use the SDGs to galvanise momentum in achieving better population health. The Goal 3 chapter of Measuring up: How the UK is performing on the UN SDGs calls upon the government to develop a comprehensive plan to assess, monitor and achieve progress in reducing premature mortality by one third by 2030.