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Beyond the Welfare State: Building the Health Society

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Given the recent turn in polling, it now seems that Labour could well win the next election with pledges to fix the damage left by the Tories. The pledges might include: end child poverty; rebuild the Welfare State; green energy, housing and communities; rebuild our democracy; regain respect for the UK.

However, for Labour to stay in power for the 21st century, it’s not only a matter of fixing damage. It’s also a matter of our vision. Here we argue for a 21st century vision to transform the Welfare State into ‘the Health Society’.

Throughout most of the last century Labour’s vision was to build the Welfare State. Its success is unquestionable. But this success raises the question of ‘what comes next?’ If, in the 20th century, Labour’s social goal was to create the Welfare State, what goals should be set now?

This question is not specific to British social democracy: it faces all social democratic parties in advanced economies. Failing to answer it risks stagnation or fantasy politics like Corbynism.

What makes social democrats special is precisely our emphasis on social goals. Others emphasize economic goals (e.g. trickle-down economics or the command economy) or political goals (e.g. nationalism or world revolution).

The goals of the Welfare State were to end Beveridge’s Five Giant Evils – disease, squalor, ignorance, want and idleness. These problems have diminished since 1945. It is time to be more ambitious.

Let us move on from the giant evils to seeking to optimise the satisfaction of human needs. Identifying these needs is a job for both political philosophers and scientists. Lawrence Hamilton identifies three types of need: vital needs (nutrition, shelter, rest, social contact), social needs (e.g. public transport) and agency needs (autonomy, mutual respect, creative expression)[1].

Satisfaction of these needs, he suggests, defines what ‘health’ is. Hamilton is asking us to think about health not in the usual negative way (absence of disease) but in a positive way (needs satisfaction). That provides a starting point for going beyond the Welfare State.

Importantly, these ideas are a re-phrasing, in a more systematic way, of existing scientific ideas from the World Health Organisation (WHO) and of proposals from the Organisation for Economic Co-operation and Development (OECD).

WHO advocates for ‘health in all policies’ – health as an item on the agenda in delivering all public policy. It defines health through meeting needs that all fall within Hamilton’s three types[2].

The OECD has developed a list of needs to enable ‘well-being’: income and wealth; housing; work and job quality; health; knowledge and skills; environmental quality; subjective well-being; safety; work-life balance; social connections; civic engagement;  and economic, natural, human and social capital[3]. Note how action to satisfy these needs has implications for every aspect of public policy.

If a society achieved optimal satisfaction of these needs, then this would prevent or delays serious illness and disability, thereby maximising healthspan and giving us all more years to fulfil our hopes, ambitions and dreams. We would also lead fuller, healthier and, crucially for the economy, more productive lives. It is these positive benefits that the Health Society can achieve.

One of Hamilton’s types of needs are agency needs such as our individual autonomy. Some may ask ‘how can autonomy improve health’? To answer this question, just look at the health inequality data on populations who endure structural racism or other forms of social exclusion and thereby have more restricted autonomy.

Others may ask ‘is this Health Society really so different from a Welfare State that seeks to meet our needs?’ There are two critical differences. First, the Health Society is obliged to break down departmental barriers – consider the WHO proposal for health in all policies. Second, the inclusion of agency needs means that the service provision model of the Welfare State has to be reformed so as to involve and empower individuals as active citizens. We have proposed one way of doing this through supporting ‘Health Society Champions’ for the improvement of population health through community action[4]. This contrasts with the 20th century Welfare State where individuals are primarily passive recipients of a service.

If all parts of national and local government are aimed at population health improvement then they have to work together as well as change the way they do things. That means having an enabling state that coordinates action but with leadership from the very top. Population health should become the responsibility of the Deputy Prime Minister (rather than some junior MP, as is the case today) coordinating action and policy across departments, regions and communities.

Our technological infrastructure for data management and biobanking also needs upgrading so as to be able to track quantitative changes in people’s risk factors for the epidemics in diseases and conditions such as obesity, diabetes, heart disease and depression/anxiety.

When the Covid-19 pandemic started, government was forced substantially to stop following its ideology. Instead it proclaimed it would ‘follow the science’. This is precisely what the Health Society is about: aligning the way we organise things in society with the needs that we identify through observation and reason.

Such a vision is today most timely: health is now a central concern sparked by the pandemic as well as by ongoing pandemics in preventable long-term diseases and conditions that cost some £160 billion every year[5]. All these pandemics pose systemic societal risks. These risks can only be controlled with sustainable, concurrent, concerted institutional, community and technological change.

Let’s follow the science, heed Keir Starmer’s pledge to ‘switch the focus from simply treating illnesses to preventing them’ [6] and build the Health Society.

[1] L. Hamilton, The Political Philosophy of Needs. Cambridge University Press. 2008

[2] WHO. What You Need to Know About Health in All Policies www.who.int/social_determinants/publications/health-policies-manual/key-messages-en.pdf See also: WHO. Ottawa Charter for Health Promotion First International Conference on Health Promotion, Ottawa. 1986. www.who.int/healthpromotion/conferences/previous/ottawa/en/.

[3] OECD How’s Life? 2020 Measuring Well-being. www.oecd.org/statistics/how-s-life-23089679.htm

[4] M. Yuille, B. Ollier. Saving sick Britain: Why we need the Health Society Manchester U Press. 2021

[5] Public Health England, NHS Health Check implementation review and action plan. 2013. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/224538/NHS_Health_Check_implementation_review_and_action_plan.pdf.

[6] https://www.theguardian.com/commentisfree/2022/jan/14/tory-party-nhs-labour-government-conservatives-keir-starmer