Everyone agrees an improvement in the nation's health would take the strain off healthcare provision. Fiona Harris asks where the balance of responsibility lies
Although few disagree that everyone wants the best possible health, who should bear the responsibility for reaching this goal - employers, individuals or the state?
Earlier this year, six out of 10 doctors said the NHS could not afford to provide free healthcare for all and that some people should have to pay for services. They even called for NHS treatment to be withheld from the elderly and the obese.
This view was echoed by more than a third of the general public who said that those who do not look after their health should be charged for treatment of self-inflicted illnesses. When asked whether employers should take a tougher stance by monitoring sickness absence more effectively, 62% of the population said yes.
Employers have a key role to play in improving the nation's health, by encouraging people to get back to work after sickness and promoting wellbeing in the workplace. It is all too easy to overlook the important role played by basic healthy working practices such as workstation assessments, monitoring of working hours, ensuring staff take their full holiday entitlement and adherence to Health and Safety Executive regulations. These help to ensure the most committed and dedicated staff continue to make a contribution to a business.
Happy workforce
Workplace health initiatives offer a 'win-win' situation. Employees benefit from better support for their wellbeing, employers benefit from less absence and improved productivity, and society benefits from improved public health.
Britain's rising toll of long-term sickness is adding to the burden facing the state in the health and benefits systems. Ultimately, it is the taxpayer who picks up the bill. Yet there is increasing evidence that being in work is actually beneficial for an individual's health and wellbeing.
A study commissioned by the Department for Work and Pensions found overwhelming scientific evidence that being in work is good for physical and mental health, boosting self-esteem and quality of life. It is also good for the economy. A Cabinet Office report in December 2002 said a 10% increase in adult activity would prevent around 6,000 premature deaths, bringing economic benefits of at least £2bn a year.
However, for workplace health interventions to deliver maximum benefits, they need to be relevant and targeted properly. Employers allocate around 95% of their healthcare budget towards measures to help improve employees' physical health through exercise, better diet and smoking cessation.
There is increasing opportunity to focus on prevention and detection. This includes monitoring and understanding the root causes of sickness absence and implementing appropriate interventions to reduce these risks. Better understanding of employee health and regular measurement enables earlier identification and intervention of potential health issues.
It is not just about physical health as productivity is increased by a healthier and happier workforce. Psychological wellbeing is also majorly important, with work-related stress one of the biggest causes of sickness absence. The Health and Safety Executive highlighted the benefits of counselling services to help manage work-related stress. These can be significant: 63% of employees using Bupa's have reported the support provided by the service meant they ended up not taking any sick leave. Without the service, they said they would probably have taken time off.
State support
The Government has also got a part to play in workplace health. Removing the tax disincentives for employers providing workplace health initiatives would allow for the provision of more health benefits. With improved productivity and reduced ill health this creates dual benefit for the economy and the NHS. Corporate Britain is increasingly prepared to take some of the burden off the NHS but needs incentives to do so.
As it marks its 60th anniversary, the state-funded healthcare system is being reviewed to define its future direction.
It is clear that the significant growth in additional funding the NHS has received since 2002 will subside after 2008. The result will be a gap between demand for public healthcare and an insufficient budget to cover it. In 2006, Bupa's Mind the Gap report predicted there would be a funding shortfall of £11bn by 2015 for UK healthcare. Worryingly, Derek Wanless' report for the King's Fund earlier this year put this figure even higher at £15bn by 2010.
This means some challenging decisions need to be taken but it offers real opportunities for the NHS and private healthcare to work together. On the one hand, the current debate about co-payment is a good example of the challenge faced by today's NHS. On the other, private healthcare providers are already working with the NHS to promote its productivity by making their commissioning expertise available to NHS trusts.
Many commentators believe the cost of, and increasing demand for, healthcare present a serious challenge to the principle of unlimited, universal free healthcare at the point of delivery. The price of maintaining that principle for the majority could be that those who can should contribute towards the cost of treatment.
Of course, none of this will work unless the individual plays their part. There is a wealth of medical research that shows lifestyle choices can have a positive impact on health. But are the Government's attempts to make us more responsible via initiatives such as its obesity strategy and stop smoking campaigns good sense or an example of a nanny state? Should we take more responsibility for our health, not just because we owe it to ourselves and our families but because we owe it to the state system? Should we not burden it with repairing self-inflicted injury at the expense of those whose need to access NHS resources is viewed more sympathetically?
Frowned upon
Unhealthy behaviour is increasingly seen as being socially unacceptable, and whether it is binge drinking, smoking, weight management or eating five portions of fruit and vegetables a day, everyone seems more preoccupied by their health. A Bupa poll found four out of 10 people supported penalties for those with self-inflicted health problems and 8% said people who led unhealthy lifestyles should be denied treatment.
More than half of Britons believe individuals bear most responsibility for the nation's health and parents are responsible for the health of their children. They also strongly believe those in the public eye should act as role models and encourage the public to improve their health. Interestingly, sports people and celebrity chefs are seen as being the most influential role models on the nation's health with business people and models being the least influential.
Although people are generally of the view that individuals are ultimately responsible for their own health, they recognise this is made possible by the support around them. The public view government as the provider of a fundamental public service - free healthcare. Many would welcome greater intervention to improve the nation's health and advice to help them maintain healthy lifestyles.
Future generations may view things differently. Since 2000, personal, social and health education has been an optional part of the national curriculum. It aims to equip pupils with the knowledge, skills and understanding to take responsibility for themselves, show respect for others and develop the self awareness and confidence needed for life. Effective teaching in schools supports parents in helping their children to develop the ability to make informed, responsible and healthy decisions about their lives.
Bupa's research shows people believe individuals bear most responsibility for the nation's health. That given, the question remains as to who should provide the support needed to enable individuals to take that responsibility - the individual, the Government or employers?
- Fiona Harris is head of personal markets at Bupa.
