Improving Health Through Place: Why Better Health Is About More Than Healthcare
Healthy life expectancy in the UK has fallen by two years over the past decade, according to recent analysis from the Health Foundation. Meanwhile people living in England’s most deprived communities now spend almost twenty fewer years in good health than those in affluent areas. It seems increasingly clear that the NHS cannot solve these challenges alone and that collective action across public services and communities is key.
A couple of years ago, Dr Amar Shah, NHS England's National Clinical Director for Improvement, argued that the health system needed a different kind of leadership. Rather than leaders seeing themselves as the source of solutions, he suggested they should act as architects: framing the problems that matter and creating the conditions for others to solve them.
"That's the shift: unlearning that you are the source of the solution and learning that you are the ultimate architect of the environment in which others can solve problems."
That idea feels more relevant than ever. As government looks to devolve more power and responsibility to places, there is an opportunity to approach health differently. With Integrated Care Boards and Mayoral Strategic Authorities increasingly operating at the same geography, leaders have new opportunities to bring together the people, organisations and resources needed to improve health.
From healthcare to health
Health is created in places: through the quality of housing people live in, the jobs and opportunities available to them, the strength of their social connections, and the environments that shape their lives. Improving health therefore requires public services, local government, communities and businesses to work together.
Yet the systems designed to support health often struggle to take this long-term view. Funding cycles and performance targets encourage organisations to focus on immediate pressures rather than working together on the root causes of poor health and inequality.
Improving health starts with understanding how places work.
Poor health affects people's ability to work, learn, care for family members and participate fully in their communities. It constrains economic growth, increases demand for public services and limits opportunities across generations. Most importantly, it represents a profound loss of human potential.
Working across health, local government, housing, economic development and the voluntary and community sector has given us a practical understanding of how different parts of the system connect and what helps organisations work together effectively. In different places, we’ve seen leaders trying to answer the same question: how do you respond to today’s challenges while creating the conditions for longer-term change?
The challenge for place leaders
Leaders face significant pressures today. Places rarely have the luxury of choosing between responding to today's challenges and investing in tomorrow's solutions. They need to do both. That might mean reducing waiting lists, improving access to services or responding to financial pressures, while also taking a longer-term approach to improving health, reducing future demand and tackling inequalities.
Through our work with places, we’ve seen that progress is often made when leaders resist the temptation to separate short-term pressures from longer-term ambition. In Newham, for example, work to address immediate challenges around supported and specialist housing also created an opportunity to think more broadly about the future of health and care by developing a longer-term vision for a health and wellbeing campus. The most effective places are often those that can hold both perspectives at once.
We’ve seen similar themes emerge in other places. While working within the Norfolk & Waveney system, I supported the development of a Marmot Place approach, bringing together health, local government and the voluntary sector around a shared commitment to address the wider determinants of health and reduce inequalities. Experiences like this show what can be achieved when organisations commit to a shared mission over the long term. They also highlight how difficult it can be to sustain momentum when funding, capacity and priorities are under pressure. Ultimately, improving health depends on creating the conditions for partners to work together on shared goals over time.
Creating the conditions for collective action
We’ve seen that lasting change comes from collective action rather than a single organisation acting alone. It depends on different organisations, sectors and communities working towards a shared goal. Every place is different, which is why improving health starts with understanding local strengths, challenges and relationships.
Regeneration, growth and prosperity depend on people being able to participate fully in their communities and local economies. Good jobs, secure housing and thriving neighbourhoods create the foundations for better health.
If the task of modern leadership is to act as an architect, then improving health depends on creating the conditions for people, organisations and communities to work together and make change happen.