With an ageing population, a rise in long-term conditions, growing health inequalities and a lack of political will to ensure that funding is increased in line with demand, the UK's National Health Service has been brought to breaking point. In this context, there is an urgent need to put in place policies that reduce healthcare need and make much better use of the resources available.
The problem will not be solved by new drugs or expensive high-tech equipment, important though these are. It will only be solved by large-scale behaviour change and this will not be achieved by continuing to rely on "common sense". That is the key message from a new report from the Campaign for Social Science, The Health of People.
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Four key areas are covered in the report. In all of these, there is clear evidence that we can and must do better to promote health and reduce health inequalities: encouraging and supporting the population to adopt healthier behaviours; improving the self-management of long-term conditions; improving the effectiveness of our healthcare systems; and making better use of "big data".
Behaviour change lies at the heart of all of these. Relying on common sense when developing policies has led to a litany of failure, and is no more likely to achieve our goals than it was to develop manned flight. We laugh at pictures of men in Victorian times jumping off piers attached to naively constructed flying machines; yet we too often continue with similarly naive attempts to achieve large-scale behaviour change. There is a science and technology of behaviour change and this must be developed and used.
The Health of People report shows how the use of social and behavioural sciences in the past has led to substantial gains in population health, but that much more can be achieved by creating better systems for putting research into practice, and building research capacity. For example, there is abundant high-quality evidence that when GPs take just a few minutes to discuss smoking with patients in a particular way, it can lead to increased attempts to quit and an uplift in population quitting rates.
And yet research shows that as few as 25 per cent of smokers receive this advice, despite incentive schemes for GPs that cost tens of millions of pounds each year. If these incentive schemes had been informed by knowledge about the application of rewards systems, they would have been much more effective.
While there have been dramatic improvements in the efficiency of our health services over the past 15 years, the "NHS England Five Year Forward View" recognises that quality of care can be highly variable and health inequalities are deep-rooted. We face particular challenges in areas such as mental health, cancer and support for frail older patients. Failures of communication within the healthcare system are of huge concern, and must be addressed urgently.
One of the key messages of the report is that relevant behaviours reside in a range of groups, including health professionals, managers and commissioners, as well as patients and the population. Moreover, they are influenced by a variety of motivational and capability factors that are in turn shaped by the social and material environment and systems within which people live and work.
The most effective interventions are those that recognise this complexity and operate at many levels – individual, organisational, community and population – simultaneously and in the long-term. England’s Comprehensive Tobacco Control Strategy is a good example of doing this, combining legislation for smoke-free public places, changes to cigarette taxation and packaging, and evidence-based support for those trying to quit. The record drop in teen pregnancies reported recently is another.
These examples drew on social science methods and expertise in developing and implementing policies.
The report has taken more than a year to produce and has been developed in extensive consultation with, and has strong backing from, key stakeholders including NHS England, Public Health England and representatives from local government and the third sector. Thirteen top-line recommendations come out of the report. Most important among them is a call for a national strategic co-ordinating body for research into population health.
Without such a body, the national effort lacks direction and coherence, involves undue duplication of effort, and relies on piecemeal attempts to implement research findings. With such a body, there can be a new impetus to build research capacity, prioritise areas of research, and use the fruits of that research to better effect in our public health and healthcare systems. Creation of this national body need not be costly in the grand scheme of things; failing to do so is likely to be very costly for society and its health.
Susan Michie is director of the Centre for Behaviour Change at University College London, and chair of the Health of People Working Group.
