The Health Foundation podcast

For the last decade, gains in life expectancy have been stalling. We’re living more years in poor health too, with a 20 year gap in healthy life expectancy between women living in the richest and poorest areas.  The biggest risk factors driving the UK‘s high burden of ill health are smoking, poor diet, physical inactivity and harmful alcohol use. All are socioeconomically patterned and contribute significantly to widening health inequalities.  There have been many policies proposed to help over the years, and the government has already set a target to increase healthy life expectancy by five years by 2035 and reduce inequality. But at the current rate of progress this will take nearly 200 years, not 12, to reach.  Is it time to get much tougher on the risk factors? And if so, how? A recent Health Foundation report showed that the government could do a lot more to be effective, but will politics allow national government to do what it takes? Our Chief Executive Dr Jennifer Dixon is joined by: Professor Kevin Fenton is regional director for London at the Office for Health Improvement and Disparities, having previously held the same position at Public Health England. He has also been elected to be the next President of the UK Faculty of Public Health and is due to take up the position in June 2022.  Richard Sloggett is the founder and director of Future Health. Between 2018 and 2019 he was Special Advisor to the then Secretary of State for Health and Social Care, working on the prevention green paper.  Show notes Anderson P, O'Donnell A, Kaner E, Llopis E, Manthey J, Rehm J. Impact of minimum unit pricing on alcohol purchases in Scotland and Wales: controlled interrupted time series analyses. Lancet, Volume 6, Issue 8, E557-E565; 2021 Everest G, Marshall L, Fraser C, Briggs A. Addressing the leading risk factors for ill health: A review of government policies tackling smoking, poor diet, physical inactivity and harmful alcohol use in England. The Health Foundation; 2022 Lewis T, Buck D, Wenzel L. Equity and endurance: how can we tackle health inequalities this time? The King’s Fund; 2022 Theis, D R and White M. Is Obesity Policy in England Fit for Purpose? Analysis of Government Strategies and Policies,1992–2020. The Milbank Quarterly, 99: 126-170; 2021 Javid S. Health and Social Care Secretary speech on Health Reform, 8 March 2022

Like many other countries, the UK has a growing drug problem. In England around 3 million people take drugs and drug deaths are the highest on record at nearly 3,000 a year. In the last decade, heroin-related deaths have more than doubled and cocaine-related deaths have grown fivefold. The situation in Scotland is even worse – now the drug death capital of Europe.   The UK government tackles drugs as a criminal justice matter focused on punishment, rather than a public health matter focused on support. But many countries are taking a different approach, most famously Portugal which in 2000 decriminalised all drugs and concentrated instead on public health and harm reduction. The result? From one of the highest drug death rates in Europe to one of the lowest.   How did they do it and what can we learn?   Our Chief Executive Dr Jennifer Dixon is joined by: Dame Carol Black, who was commissioned by the Home Office and the Department of Health and Social Care to undertake a two part independent review of drugs, to inform the government’s thinking on what more can be done to tackle the harm that drugs cause. Dr João Castel-Branco Goulão, a Portuguese physician and the current national drug coordinator for Portugal. He is credited as being the main architect of Portugal’s drugs policy established in 2000 and since then has advised on drug policy for successive governments. Show notes Independent review of drugs by Professor Dame Carol Black From harm to hope: A 10-year drugs plan to cut crime and save lives (December 2021) Ferreira, S. Portugal’s radical drugs policy is working. Why hasn’t the world copied it? (December 2017) National Records of Scotland, Drug-related deaths in Scotland in 2020 (July 2021) Nutt, D. UK drugs strategy promises to be tough on criminals, but evidence shows this doesn't work. BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n3066  The House of Commons Scottish Affairs Committee report on Problem drug use in Scotland (October 2019) includes an outline of some international case studies.

Those of us working in health often focus on the government as the main agent to get things done, especially when it comes to public health. But think of all the others out there with power, particularly commercial and investment power.  There are signs that businesses and institutional investors do seem to be getting more interested in health, with some businesses starting to consider their impact on health in their environmental, social and governance (ESG) reporting. Are we now at a turning point? Or is interest in health temporary? If businesses and investors really want to improve health, how do they best move forward? And can government do more to support them? Our Chief Executive Dr Jennifer Dixon discusses this with expert guests: Catherine Howarth joined ShareAction as Chief Executive in 2008. ShareAction coordinates civil society activism to promote responsible investment across Europe. Catherine also serves on HM Treasury's Asset Management Taskforce.  John Godfrey joined Legal & General in 2006 and is now Director of Corporate Affairs. John has worked in the City of London for over 30 years and from 2016-17 worked at Number Ten Downing Street as Head of Policy for Prime Minister Theresa May.  Show notes APPG on Longevity, Levelling up health, (April 2021) British Academy: The Future of the Corporation programme and reports Policy & Practice for Purposeful Business (2021), Principles for Purposeful Business (2019) and Reforming business for the 21st century (2018) Business for Health, Business Framework for Health: Supporting businesses and employers in their role to enhance and level up the health of the nation (October 2021) Health Foundation, Using economic development to improve health and reduce health inequalities (2020) Institute of Health Equity, Health Equity in England: The Marmot Review 10 Years On (2020) ShareAction, Health: An Untapped Asset – How investors can strengthen returns by improving health outcomes (September 2021) 

In another year shaped by the COVID-19 pandemic, we explore some key health policy developments and look ahead to what 2022 might have in store.  With Omicron dominating the headlines and a public inquiry into the handling of COVID-19 on the horizon, has government learned – and acted on – the lessons from the start of the pandemic?   As the NHS faces the huge task of COVID-19 recovery, how will the debate about NHS performance and funding play out? Will the Health and Care Bill going through parliament be ready to come into effect next April, and what might it mean for the health system?  And do the social care cap and recently published white paper move us any closer to the ‘fix’ that is so desperately needed for social care? Our Chief Executive Dr Jennifer Dixon is joined by: Lord Victor Adebowale, Chair of the NHS Confederation. Victor was awarded a CBE for services to the unemployed and homeless people and became a crossbench peer in 2001. Hugh Alderwick, Head of Policy at the Health Foundation. Hugh leads our policy team’s work to understand and inform national policies on health and social care in England. Useful links Read about the Health Foundation's COVID-19 Impact Inquiry, including the final report. Explore the Health Foundation's ongoing work on the Health and Care Bill. Lady Hallett was announced as chair of the COVID Inquiry following our recording. Read more. Taxes and health care funding: how does the UK compare? (The Health Foundation, 2021) Adult social care and COVID-19 after the first wave: assessing the policy response in England (The Health Foundation, 2021) New vision for social care will feel like hollow words without the money to deliver it (The Health Foundation, 2021)

For years public satisfaction with the NHS has been highest for general practice.  But even before the pandemic, rising workloads and workforce shortages had left many GPs dissatisfied and stressed. Then add a pandemic into the mix, with GPs instructed to move rapidly from face-to-face consultations to telephone or digital advice as a first step. As the pandemic eases, signs of public frustration are now spilling over to the tabloids, MPs’ in-trays and adding to demand to hospital A&E departments.  Is this a sign of general practice crumbling or are we seeing its rebirth as the old model of care enters the digital age? Do we need a fuller vision for the future of primary care? And what are the government and the NHS doing to manage the fallout from growing frustration among the public and GPs? Our Chief Executive Dr Jennifer Dixon discusses with three expert guests:  Professor Katherine Checkland is Professor of Health Policy and Primary Care at the University of Manchester and until recently was a practising GP in rural Derbyshire.  Shaun Lintern is Health Correspondent at The Independent.  Dr Rebecca Fisher is Senior Policy Fellow at the Health Foundation, leading policy work on primary care, and is a practising doctor, working two days a week as a GP in an area of high urban deprivation. Useful links Rebecca Fisher (2021) 'Levelling up' general practice in England  Rebecca Fisher, Ruth Thorlby and Hugh Alderwick (2019) Understanding primary care networks Martin Roland, HEE Primary Care Workforce Commission (2015) The future of primary care NHS England (2014) Five Year Forward View

Climate change is a global health emergency. What can we learn from how ‘green’ has gone up the agenda? And how might we apply useful lessons to getting further improvements in another complex and difficult challenge – improving the health of the UK population and reducing inequalities?    The increasing frequency and intensity of heatwaves, floods, droughts and storms is already devastating lives and livelihoods around the world. While other countries are far more vulnerable to the health risks of climate change, the UK is not immune.    The UK government and the health and social care system must actively contribute to climate change solutions as part of our global responsibility. In the weeks ahead the UK (along with Italy as a partner) will host COP26, and countries will be showing what action they are taking towards the Paris Agreement goal to limit global warming. Making progress on climate change will be very challenging. Like improving health, it is a complex problem needing long-term policy commitment and action. What can we learn from efforts and progress so far? And can going greener actually improve the health of people in the UK? In the latest episode of our podcast, our Chief Executive Dr Jennifer Dixon discusses these issues with two expert guests: Dr Fiona Godlee is Editor in Chief of the British Medical Journal, a post she’s held since 2005. Fiona is on the board and executive committee of the Climate and Health Council and the UK Health Alliance on Climate Change.  Professor Andy Haines is Professor of Environmental Change and Public Health at the London School of Hygiene and Tropical Medicine. Andy is a member of several major international and national committees, including the UN Intergovernmental Panel on Climate Change. Useful links: The Health Foundation (2021) What do the public think about the NHS and climate change? UN Environment Programme (2021) The production gap 2021 Academy of Medical Sciences and the Royal Society (2021) Climate change and health HM Government (2021) Net Zero Strategy: Build Back Greener  HM Government (2020) The Ten Point Plan for a Green Industrial Revolution Council for Science and Technology (2020): Achieving net zero carbon emissions through a whole systems approach

Being chief executive of the NHS is one of the most challenging jobs in the country.    Since the role started in 1985 there have been nine postholders, with Amanda Pritchard taking over from Sir Simon Stevens this year. Like her predecessors she faces formidable challenges ahead: managing the pandemic’s impact, tackling waiting lists, boosting technology, managing a growing population of older people with multiple conditions and dealing with workforce shortages to name a few.   The role means being a leader and a national figure, working with the NHS itself as well as with government, the media and the wider health sector. The bandwidth needed to do the job is huge. How is it doable? Our Chief Executive Dr Jennifer Dixon discusses with Sir Alan Langlands, NHS chief executive number four, from 1994–2000. After leaving the NHS, Alan went onto a number of roles including Principal and Vice Chancellor of the University of Dundee, chief executive of the Higher Education Funding Council, Vice Chancellor of the University of Leeds and chair of the Health Foundation (2009–2017).   Related content Listen to our podcast episode on the Wanless Review and read the related publication, The most expensive breakfast in history Listen to our podcast episode with Rt Hon Jeremy Hunt MP Read more about the role of health secretary in Glaziers and window breakers Explore NHS policy developments in the Thatcher years, Major years and Blair years in our Policy Navigator Read more about 'targets and terror' Read more about the NHS internal market (see 'the context' by Jennifer Dixon)

Food is crucial to our health, but it is also a driver of ill health, health inequalities, and damage to the environment.  The second part of the National Food Strategy, led by Henry Dimbleby, was published in July 2021. It is the most comprehensive review of the entire food and drink system in the UK for many years. It recognises the upsides of the food system in providing affordable, convenient food for a growing population. But it is strong on the downsides – the current system is unsustainable and the food produced and consumed is injuring health and the environment. The strategy made 14 radical recommendations for England’s food system – many requiring legislation. The government is currently reviewing the report and is due to produce a White Paper in early 2022.  In this podcast, we discuss two areas covered by the review – reducing the amount of junk food, and diet-related inequality – as well as viewing this alongside the government’s 2020 obesity strategy. What should the government do next to make a difference to these large and complex challenges? Our Chief Executive Dr Jennifer Dixon discusses this with two expert guests: Anna Taylor is Executive Director of the Food Foundation, where she’d been since 2015, and is a national and international expert in nutrition. She’s advised the Mayor of London and the GLA, on the food matters that affect Londoners, and also served as Chief Independent Adviser to Henry Dimbleby for the development of the National Food Strategy. Sarah Hickey has been leading the childhood obesity programme at Guys and St Thomas’s Foundation as Programme Director since 2016. This programme aims to close the inequality gap in childhood obesity in Lambeth and Southwark working with communities, schools business and others on the ground. She previously worked as a Senior Policy Advisor in the Cabinet Office. Related content Find out more about the National Food Strategy Find out more about the government's obesity strategy Listen to our podcast episode on the government's approach to tackling obesity Find out more about our podcast

If you think of health in the UK as a fabric, it is the most threadbare in Glasgow. Here, life expectancy is lowest, and one in four men will die before their sixty-fifth birthday. But even after adjusting for poverty and deprivation, next to comparable deindustrialised cities such as Liverpool and Manchester, Glaswegians have a 30% risk of dying prematurely. That’s from cancer heart disease stroke as well as deaths of despair: suicide, drugs alcohol. It isn’t getting any better, and that’s not even taking into account the pandemic. In this episode, we explore: What is fraying health to this degree in Glasgow? What is being done to help? And what can we all learn from Glasgow’s longstanding efforts to try to mend the health fabric, as we all attempt to build back better after the pandemic? Our Chief Executive Dr Jennifer Dixon discusses this with two expert guests who have for many years been central to this story: Dr David Walsh is Honorary Senior Lecturer at the University of Glasgow, and a senior academic at the Glasgow Centre for Population Health. Over the years David has carried out a large body of work aimed at understanding Scotland’s (and Glasgow’s) high levels of ‘excess’ mortality, deindustrialisation and health across European regions, and the impact of government ‘austerity’ measures on mortality.  Sir Harry Burns is the Professor of Global Public Health, University of Strathclyde. Harry was the Chief Medical Officer for Scotland for almost ten years from September 2005 to April 2014, and is well known for his tireless work on health inequalities. He is a member of the Council of Economic Advisers in Scotland. Recommended reading: Walsh D, Bendel N, Jones R, Hanlon P. Investigating a 'Glasgow effect'. Glasgow Centre for Population Health; 2016. Walsh D, McCartney G, Collins C, Taulbut M, Batty GD. History, politics and vulnerability: explaining excess mortality in Scotland and Glasgow. Glasgow Centre for Population Health; 2016. Walsh D, Lowther M, McCartney G, Reid K. Policy recommendations for population health: progress and challenges. Glasgow Centre for Population Health; 2016. Dixon J, Everest G. The government’s levelling up agenda: An opportunity to improve health in England. The Health Foundation; 2021. Suleman M, Sonthalia S, Webb C, Tinson A, Kane M, Bunbury S, Finch D, Bibby J. Unequal pandemic, fairer recovery: The COVID-19 impact inquiry report. The Health Foundation; 2021. Useful links: Wising up to levelling up - with Professor Diane Coyle and Sir Howard Bernstein [Episode 7] 'Deaths of despair': A tale of two countries - with Professor Sir Angus Deaton and Sarah O'Connor [Episode 4] Find out more about the Health Foundation podcast

It’s easy to forget the state the NHS was in 20 years ago – long waiting lists, heartrending delays in care, winter crises – and heated debate on whether the NHS model was obsolete.   But the Wanless Review set the NHS on course to receive record catch up funding. So in this episode, we ask, given the pandemic and the mounting challenges facing the NHS to deal with a huge backlog of care, is it time for another Wanless? Our Chief Executive Dr Jennifer Dixon discusses this with two expert guests and former Treasury officials, who were very close to the original Wanless Review: Anita Charlesworth, Director of the Health Foundation’s REAL Centre and our Director of Research. Anita led the secretariat for the original Wanless Review within the Treasury, where she was Director of Public Spending from 1998 to 2007. Nick Macpherson, Permanent Secretary to the Treasury from 2005 to 2016. Nick was Permanent Secretary to three chancellors, and managed the department through the financial and wider economic crisis which began in 2007. Nick joined the House of Lords in 2016 as Baron of Earls Court. Useful links: The most expensive breakfast in history. The Health Foundation, 2021. Find out more about the REAL Centre Find out more about our podcast A note on audio quality in this episode Unfortunately, we were unable to record this episode using our normal recording platform, so the audio quality is lower than we would like. We'll be back recording the podcast in our normal way next episode.