Our society is making us ill. Charging NHS patients won’t fix that

Making patients feel guilty about the cost of their medicine will worsen the nation’s health


Health secretary Jeremy Hunt’s ideas for reducing the strain on the NHS increasingly reveal his desire to move it towards the disastrous American model of healthcare.

Making patients feel guilty about the cost of their vital medicine and charging those who miss appointments is likely to worsen the nation’s health, as people stop taking the drugs they need and decide against booking crucial appointments for fear of missing them – and all for the sake of recovering a few pounds.

When I spoke on Thursday at the International Festival of Public Health in Manchester, I asked not what the NHS can do for us, but what we can do for the NHS. Extra charges was not what I had in mind.

It’s clear that even if we succeed in reversing the takeover of our broadly efficient and fair, publicly owned and run NHS by the failed privatised model – as the cross-party effort led by Caroline Lucas is trying to do with the NHS Reinstatement Bill – the  NHS will come under increasing pressure: from an ageing population, from the rise of expensive medical technology and from increasing levels of disability and illness.

To relieve that pressure, we must ask what we can do to create a healthy society. And of course we should be doing that for reasons of humanity, above cost.

We have here in Britain, in the world’s sixth-richest economy, a society that’s making many of its members ill. A society that’s failing to provide clean air, failing to provide adequate housing, failing to provide a healthy diet, failing to provide safe jobs and decent benefits, failing to provide opportunities for exercise and failing to provide an education that prepares pupils for life.

A society in short that’s failing its people.

The majority of people it’s failing fall into one group: the poorer and more disadvantaged; but the unhealthy society is affecting everyone to some degree.

In the worst areas of London 8 per cent of deaths are linked to air pollution. Around the country that’s 29,000 premature deaths each year. And children whose schools are near busy roads are seeing the development of their lungs affected – an impact that will last for life.

Having some of the longest working hours in Europe is deeply unhealthy and destructive. They have an impact on diet – we eat on average twice as many ready meals as the rest of Europe; and 45 per cent of men and 34 per cent of women say they are restricted in getting active by work commitments.

Add in the human and health cost of commuting long distances – whether in fume-soaked cars or crowded trains and buses – and there’s no doubt our employment arrangements are detrimental to our health.

Nineteen per cent of households are in fuel poverty – primarily because of poor structure and insulation – which is linked to one in five of our horrific excess winter deaths, and contributes to the development of the lifelong condition of asthma in children. A study by the chief medical officer showed that investing £1 in keeping homes warm saved the NHS 42p in health costs.

We’ve seen walking and cycling all too often actively discouraged by road structures, and cuts to public transport (particularly rural and local buses). A study published in December 2011 estimated that around around 3,400 cases of cancer every year in the UK are linked to people doing less than government guidelines for physical activity each week. It costs the NHS almost £1 billion a year.

Except around the edges – anti-smoking programmes, gym memberships and healthy food vouchers on the NHS – there’s little that the health service can do to influence any of these issues.

What we need are the transport policies, the housing policies, the education policies, the food security policies to turn things around – to create a healthy society.

Not all of these changes are big-ticket spending items.

Introducing a 20mph speed limit everywhere people live, work and shop could make our streets far more pedestrian and community friendly – a place to stroll, to chat, to play.

Strengthening the power of unions and giving workers proper access to redress for unreasonable treatment would help to cut unpaid overtime, reduce stress and improve safety in the workplace.

Making the minimum wage a living wage (which would save the Treasury more than £2 billion a year), and banning zero-hours contracts would reduce poverty.

Some moves towards a healthy society of course do require spending. The simplest way overall to improve health would be to tackle poverty – ensure everyone can put healthy food on the table, keep an appropriately-sized, energy-efficient roof over their head, be free from the fear of penury.

That of course would mean reversing the disastrous policy of austerity that’s seeking to make the poor, the disadvantaged and the young pay for the errors and fraud of the bankers.

But coming down to a more modular level, there is plenty we could do.

We could invest in walking and cycling infrastructure – and in public transport, which probably involves at least some walking at each end.

We could implement statutory PSHE education in all schools. Evidence shows this reduces childhood obesity, improves diets, reduces sexually transmitted diseases and unwanted pregnancies, and hospital admissions for self-harm.

Implementing an intensive programme of home insulation and energy efficiency would cut excess winter deaths particularly among the elderly, reduce asthma rates in the young – and create jobs and cut carbon emissions.

These are – in one of the favourite terms of government these days – joined-up policies. They fit together into the whole of a healthy society – a humane, decent society in which people can fulfil their potential and live the long, healthy lives that public health measures and modern medicine have helped to make possible.

If we really want to save our NHS, every government decision should be weighed for its impact on the health of the nation.

Natalie Bennett is the leader of the Green Party. Follow her on Twitter

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