Diplomat magazine and Public Policy Projects hosted another session of their joint venture, World Economic Series on 12 May, sponsored by Cigna health insurance. Report from Lottie Moore
“It could not be a more timely moment to focus on the shared interest we have across the global community in addressing the causes of ill health.” The Rt Hon Stephen Dorrell, Chair of Public Policy Projects, opened the thirteenth session of the World Economic Series in partnership with Diplomat magazine and Cigna on Wednesday 12 May.
Inequalities in health are much less to do with health in and of itself, and much more to do with wider inequalities in education, housing, socioeconomic status and employment. The discussion focused on how employing the concept of ‘whole health’, which accommodates these wider social determinants, can improve the health outcomes of all.
Professor Sir Michael Marmot led the conversation, stating firstly that “health is not simply a matter of healthcare.” While global healthcare systems have been under immense pressure over the course of the pandemic, Sir Michael emphasised that it is the conditions in which people are getting ill in the first instance that primarily require our attention, not the conditions in which we make them better.
So close are the links between the social determinants of health and the health of a population that “if health has stopped improving, society has stopped improving.” Sir Michael asked the audience to reflect on the idea that within the developed world, we expect that health is improving all the time: the health of our children will be better than our own. “Once we see declining life expectancy, this is no longer an illusion we can hold onto,” he said. Using the example of the United Kingdom, Sir Michael noted that over the past 10 years, life expectancy in the UK has indeed halted, and among some groups, declined. Finally, referencing his 2020 report, Build Back Fairer, Sir Michael outlined his central recommendation for improving health inequalities post-pandemic: “my overall recommendation is to put equity at the heart of every government policy.”
As professor of population health at the University of Turin and lead of several international projects on health inequality, Professor Giuseppe Costa gave the European perspective on the issue of whole health. Professor Costa’s main point centred on the importance of place and locality in tackling health inequality. Using examples from the cities of Turin and Trieste in Italy, he compared the different demographics and unique challenges that come with taking a whole health approach at local, rather than national level. Explaining how it is both local professionals combined with local community actors “who are the real agents of change within Turin,” Professor Costa noted how essential it is for local governments – as well as national governments – to employ a whole health approach.
Turning to Trieste, Professor Costa explained that while good infrastructure for tackling health inequity already exists, the city has been hit hard by austerity. He noted how crucial to solving this problem again was understanding the local experience and how drivers at the community level really determined the success of taking a whole health approach.
Dr Peter Mills, Medical Director of Cigna, followed by homing in on the concept of whole health: “a concept that is not necessarily new but one that represents the thinking of our evolution as a global health insurer and role and responsibility within society.” Noting that the typical model of accessing healthcare can only go so far in improving population health, echoing Sir Michael, Dr Mills stated that “being healthy is much more than just meliorating disease.” As an insurer of people, Dr Mills emphasised Cigna’s commitment to playing a greater role in improving the whole health of the populations they serve.
Cigna is a global health insurer, and as such employers from across the world trust the organisation to look after their employees. Dr Mills noted how the pandemic had prompted these employers to be more invested in the whole health of their employees beyond simply providing them with a healthcare system. He said: “If we can look at an integrated approach to population health improvement, I think we have a real chance of reversing some the societal issues we have currently.” The key to this integration is collaboration between private/public partnerships. Stating that a healthy business cannot thrive in a sick society, Dr Mills finished by stressing how it is only if we work together societally, that the whole health of our populations can be improved.
The three thought provoking speakers prompted a lively Q&A. Again, focusing on how collaboration between the local and national and the private and public is key to adopting a whole health approach, comparisons were drawn between mental and physical wellbeing. One cannot be prioritised over the other if both are to thrive: people must be seen holistically. The question of Universal Basic Income (UBI) was raised. Would giving every person a basic level of income not be more efficient in solving the problems of health inequality? If we deployed a UBI approach, wouldn’t it be easier to take a whole health approach? The conversation developed to consider UBI against universal basic services: deploying UBI might mean scrapping current social security arrangements. While local community action does not let national governments ‘off the hook’ so to speak, UBI might detract from locally-led health services offering social security.
As the discussion progressed, it became clear that even in developing countries, a community preventative health model was key to successfully raising equity levels within population health. While the developed world is privileged to have good public health infrastructure, all three speakers emphasised community-led, place-based approaches were key to employing a successful whole health approach.
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VENETIA VAN KUFFELER, EDITOR,