Three: Moving upstream: the dilemma of securing health in health policy

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One of the most protracted and impassioned debates in health policy concerns the imbalance between the attention and resources devoted to health care as distinct from health. Virtually all the attention from policy makers, professionals, public and media, together with the bulk of resources available, are focused on ill-health, sickness and disease. It is a curious irony that few health systems pay much attention to health, focusing instead on ill-health and disease. They are diagnose-and-treat systems rather than systems designed to predict and prevent, and operate in such a fashion even when making a pretence of putting health before health care. A good example of this tendency can be found in a speech delivered by a former British health secretary, Alan Milburn. The lecture was given in 2002, two years after Milburn launched Labour’s 10-Year Plan for Health and Care, which, in contrast to the message delivered in his lecture, focused almost exclusively on health care services. His lecture was an impassioned plea for putting health before health care: ‘The health debate in our country has for too long been focused on the state of the nation’s health service and not enough on the state of the nation’s health’. He continued: ‘The time has now come to put renewed emphasis on prevention as well as treatment…. It is time for a sea change in attitudes’ (Milburn 2002: 1). But arguably, the issue is not a lack of strategies or policies. As Derek Wanless, special adviser to Brown and Blair on the future challenges facing the NHS up to 2022, wryly commented, ‘what is striking is that there has been so much written often covering similar ground and apparently sound, setting out the well-known major determinants of health, but rigorous implementation of identified solutions has often been sadly lacking’ (Wanless 2004: 3).

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