Urgent action needed to tackle social determinants of health for a healthier future

BMJApr 16 2024

We must act on the social determinants of health (the conditions in which people are born, grow, live, work, and age) and place sustainability at the core of the NHS's future to ensure a healthy, prosperous and more resilient society, argue experts in two new reports from The BMJ Commission on the Future of the NHS.

Drawing on available evidence and existing work from other organizations, the authors urge political leaders, health workers, and the wider public to recognize the scale of the problem and commit to action.

The BMJ Commission brings together leading experts from medicine and healthcare to identify the key challenges and priorities and make recommendations aimed at ensuring that the vision of the NHS is realized.

In the first report published today, Lucinda Hiam and colleagues describe how health is deteriorating from the cradle to the grave in all four nations of the UK, linked to over a decade of austerity and a failure of government to provide enough money for people to live healthily.

But improving the NHS alone is inadequate, they say, and their recommendations include tackling poverty so that individuals and families can lead healthy lives, investing in sustainable housing compatible with good health, and prioritizing children and young people, giving every child the best start in life.

Action focused solutions include increasing child benefit and extending free school meals for lower income families, ensuring the national minimum wage and national living wage are sufficient to lead a healthy life, increasing the supply of affordable, good quality, sustainable housing, and reversing the deterioration in mental and physical health of children and young people.

To achieve these goals, they say urgent measures are needed to restore, revitalize and prioritize the public health system in the UK, particularly in England and Northern Ireland, which "is now arguably weaker than at any point in history."

And they refute criticisms of a nanny state, arguing that asking individuals to make choices that their circumstances do not allow almost guarantees persisting health inequalities.

"Improving the health of the population and reducing avoidable health inequalities must be a national priority," they write. "A common response is that we cannot afford such action—we argue, we cannot afford inaction."

"We call on all political leaders to acknowledge the problem and the urgent need for action on the social determinants of health. This action can be a story of hope: we can change the direction of health in the UK if we use the robust, broad evidence on how to act," they conclude.

In the second report, Rita Issa and colleagues set out how the combined threats of climate change and biodiversity loss are a global public health emergency, with far reaching health impacts from extreme weather events, threats to food and water quality, and exposure to air pollution.

As the NHS contributes about 5% of UK fossil fuel emissions and generates substantial waste, they say "sustainability must be at the heart of the NHS as we look to the future, both to improve the health system today and to make it resilient to future shocks."

Their recommendations are based on six key areas of focus within and around the NHS such as developing and investing in data, metrics, and research that drive NHS sustainability and integrate climate risk, as well as educating, embedding, and building networks for sustainability through the NHS workforce.

Others include promoting nature and action on the environmental determinants of health, and ensuring decisive and visionary NHS leadership, governance, and investment.

"Stewarding a sustainable NHS is a gift beyond carbon emissions, offering an opportunity for positive systems change across all aspects of society," they write.

"Rather than being viewed as a daunting task or one at odds with the achievement of health, interventions that consider climate change, sustainability, and nature as integral to health system functioning offer opportunities to streamline and deliver better services, support healthier populations at source, deliver cost savings, and ensure a flourishing NHS for a further 75 years and beyond," they conclude.