Health, communities and culture
by Steve Bishop
The isolation imposed upon the population due to the Covid-19 crisis has meant that many aspects of regular social life have disappeared. The most obvious and high profile is sport, with the absence of the Premier Leagues, Formula 1, Euro 2020, Wimbledon and the Tokyo Olympics leaving gaping holes in the summer calendar for many. Add to that the gaps left by high profile music events, such as Glastonbury, and the prospects for diversion in the months ahead, as the pandemic develops, look bleak.
While these high-profile, money spinning activities are the headline grabbers, support for the health and wellbeing of local communities is being affected in more subtle ways. More people visit a library every week than watch Premier League football. They will have no access to the wide range of books and learning on offer for an extended period. Many will simply miss the opportunity for social interaction which libraries provide. Museums, theatres, galleries and heritage attractions, usually preparing for holiday seasons, are mothballed.
The benefits of cultural activity for health and wellbeing have been the subject of much investigation and detailed research for many years. In July 2017 the All Party Parliamentary Group (APPG) on arts, health and wellbeing published its inquiry report Creative Health, outlining a ten point plan for the NHS, Public Health England and local authority services to work together to promote greater cultural activity, in order to increase general health and wellbeing.
The plan envisages inter-departmental collaboration across government to address the social determinants of health; a national centre for arts, health and wellbeing to promote research and collaboration; that local NHS boards and local authorities have an individual designated to take policy responsibility for arts, health and wellbeing; that Arts Council England makes health and wellbeing one of the priorities of its 2020-30 ten year plan; that the education and training of clinicians and other healthcare professionals includes accredited modules on the evidence base for the benefits of arts, health and wellbeing; and that Healthwatch and other patients organisations promote the benefits of the arts contribution to health and wellbeing.
As with much of the political landscape in the UK over the past three years, the impact of the report was blunted by the Brexit vortex into which other political discussion disappeared. In spite of this it was widely welcomed, acknowledged in the health world as a significant contribution to the discussion on prevention, and welcomed in the arts world as vindication of what many in the sector had been saying for years. Professor Sir Michael Marmot characterised the report in glowing terms saying,
“The mind is the gateway through which the social determinants impact upon health, and this report is about the life of the mind. It provides a substantial body of evidence showing how the arts, enriching the mind through creative and cultural activity, can mitigate the negative effects of social disadvantage. Creative Health should be studied by all those commissioning services.”
PREVENTION IS BETTER THAN A CURE
Given the increasing age profile of the population of the UK, investment in prevention will be vital if NHS resources are not going to be swallowed entirely at the acute end of the health spectrum. UK average life expectancy is currently identified by the Health Foundation as 79.5 years for men and for women 83.1 years (Mortality and life expectancy trends in the UK: stalling progress - Health Foundation 2019). However, the impact of poor investment in prevention is particularly severe for those living in poverty. The average expectancy for healthy life for men and women in the poorest 10% of the population is 52 years, with a life expectancy of 78.7 years for women and 74 years for men (Creating Healthy Lives - Health Foundation 2019). That means many years of life, in potentially preventable poor health, often reliant on increasingly expensive NHS resources. People born in the most deprived 10% of local areas are expected to live, on average, over 18 fewer years in good health than those born in the least deprived 10% of local areas.
It is perhaps surprising then that the NHS Long Term Plan (2019), its ten-year strategy for the service, running to 136 pages and 190 references, makes no mention of the APPG Creative Health report. The plan does place some emphasis on the need to support social prescribing, the latest strategy for diverting patients from GPs surgeries and into the community, but contains no assessment of how, after ten years of austerity, community infrastructure is in a position to cope with such an approach.
HEALTH AND AUSTERITY
Just before the Covid-19 pandemic wiped any other news from the airwaves Professor Sir Michael Marmot published his report, Health Equity in England: The Marmot Review 10 Years On (Institute of Health Equity 2020), assessing progress in tackling the social determinants of health since the original Marmot Review, Fair Society, Healthy Lives (2010).
Marmot is a key figure in the public health world and was a keynote speaker at the North East Public Health Conference, 2020 and beyond: time to turn talk into action, in March this year in Sunderland. Marmot, studiously non-party political, nevertheless eloquently outlined the impact of ten years of enforced austerity upon the health of the nation emphasising, in particular, the disproportionate impact of poverty upon the poor health of the most deprived communities. In a telling exposure of policy contradictions Marmot outlined how the cost of following Public Health England advice to eat healthily would take 74% of the weekly income of families living in the most deprived communities. The same families need to spend on average 35% of their income on housing costs. Tough choices have to be made.
In spite of the forensic detail contained in Marmot’s review, the 172 pages and over 500 references also fail to acknowledge the Creative Health report, or the significance of cultural activity in promoting health and wellbeing. It was especially surprising that Marmot had overlooked this aspect given his glowing endorsement of the report and his recognition of the role of the arts in addressing the social determinants of health.
There was some recognition of the cultural agenda at the Sunderland conference in the form of author Ann Cleeves (Vera, Shetland) who placed particular emphasis upon the role of libraries as focal points for local communities, promoting literacy, literature and learning. As another lifeline is shredded, and in some places cut entirely by austerity, Cleeves recognised the especially important role libraries have played over the years in working class communities, their function as ‘street corner universities’, giving access to learning and culture for those otherwise denied it. As a lesson in history it had an all too contemporary feel.
LESSONS OF COVID-19
The Covid-19 crisis has dramatically exposed the fragility of an NHS which has been under-resourced for over a decade and has been overwhelmed by the surge in demand brought on by the pandemic. It has brought to the fore the need for increased resourcing for the NHS, not only to deal with periodic crises but to deal effectively with the existing health demands of the population. The crisis has also brought into sharp focus the need for greater emphasis upon prevention as part of a holistic approach to how health and wellbeing are addressed. The implementation of the recommendations in the Creative Health report would by no means solve all of the problems facing the poorest communities in the UK; without the funding to support a wide range of community and cultural assets it will barely scratch the surface.
However, the Covid-19 crisis has shown that resources can be diverted, priorities changed and that a planned approach to addressing the health of the nation is possible. That should not only be the case in times of crisis. Health is not just a medical issue but a wider societal and class issue. It is an issue about how our community infrastructure and cultural assets are owned and resourced. It is, most significantly, an issue about the impact of austerity and the consequences of poverty. Under- resourcing and the creeping privatisation of the NHS have been starkly exposed by the present pandemic. The symptoms though have been presenting for a long time. The drama of current events is increasingly confirming that the cure for the recovery of health provision in the UK is only possible with the planning, investment and organisation necessary under socialism.
People born in the most deprived 10% of local areas are expected to live, on average, over 18 fewer years in good health than those born in the least deprived 10% of local areas.