Why are we the sick person?

The UK’s worsening health —driven by preventable deaths from drugs, alcohol, and suicide—exposes a systemic failure to invest in preventative healthcare and address the social conditions fuelling despair.

A new report from the think tank the Health Foundation confirms we are the ‘sick person of the wealthy world’. Not only does the UK rank as one of the worst among a group of 22 of the world’s richest countries, it seems we’ve gone backwards. Deaths due to violence and drugs (no surprise that Scotland is doing a lot of the heavy lifting here) have ensured that our mortality rate is higher than it was several decades ago and, as such, much worse than many of our European peers.

It’s a troubling statistic that we’re going backwards in some regards. Advancements in healthcare and science have indeed made a difference — you can see that when it comes to deaths from the likes of cancer. We’re much less likely to die from cancer now than we were in 2000, something you would expect in a high-income country like the UK.

In a country as rich as this, you would think that improvement would be across the board — yet here we are. It seems that the male mortality rate for those aged 25–49 has increased multiple times in recent decades. As of 2023, mortality rates in the UK were 14% above the median for females and 9% above for males. For both genders, the disparity compared to the median was greater in 2023 than it was in 1990.

‘Deaths of despair’ is perhaps the most telling of all categories within this report. As already stated, drug-related deaths are much higher than the median, and Scotland is mostly the reason. It is once again embarrassing how high our drug death rate is compared to other wealthy nations and the rest of the UK. A sobering fact that means, as a nation, we continue to fail in our duty of care for the most vulnerable and continue to experience one of the slowest responses to a public health emergency.

I digress though, because it’s not just drug deaths — alcohol-related deaths are also higher than the median, and now, for the first time in 25 years, our suicide rate is higher than the median in both males and females.

With these three factors closely linked to socio-environmental issues such as socioeconomic standing, surely we have to take notice. Health is more than just the treatment you receive — if it weren’t, we know we would be doing much better, as shown by our cancer rates (though cancer is also affected by external factors). This once again strengthens the case that health should be viewed holistically, considering many interlinked issues.

Why have deaths of despair increased? Well, it’s no coincidence that a cost-of-living crisis has hit in recent years, that the much-predicted consequences of austerity are becoming apparent, that our housing is worse than before, and that the NHS is struggling to offer even basic GP appointments. Wages have not kept up with inflation, and the links between poverty and suicide are well established — meaning that suicide is, to some extent, preventable if we re-align economic policies with public health in mind.

However, that brings us to one of the most important yet constantly overlooked areas: preventative healthcare. We are painfully slow to recognise the absolute necessity of stopping people from becoming ill, both physically and mentally, in the first place. We haven’t always lagged behind in this area. Credit must be given for being one of the first European nations to ban smoking in public places. That decision was made by recognising the serious health impacts it was having on the population, and the millions it was costing the NHS annually. You could argue, however, that the research to support this action existed long before the legislation was passed — but at least it was something.

Yet, when we talk about prevention, we must not take a narrow view. So, although we were ahead with the smoking ban, it needs to encompass far more than that.

Since the Scottish ban in 2006 and the subsequent one for the rest of the UK nations the following year, we haven’t really been at the forefront of preventative healthcare. It’s not a new concept. Dutch scholar Erasmus said “prevention is better than cure” back in the 1500s. Its principles have been popularised throughout history, with Benjamin Franklin proclaiming “an ounce of prevention is worth a pound of cure”. Few words ring truer, yet our failure to truly embrace this mindset has set us back for some time.

Why did more people die in the UK during Covid? It was most likely because our population was generally more unhealthy to begin with, and therefore more at risk. If we look at diet, exercise, loneliness, work–life balance, and the popularity of hobbies among adults, we once again rank lower than many of our wealthy counterparts — though, obviously, not lower than the US.

Some factors are outside our control — the weather in Scotland doesn’t always lend itself to outdoor activity; in fact, it can strongly encourage people to stay indoors. On top of that, fresh fruit and vegetables often have to be imported. However, I would add that we could be much more innovative in our farming and embrace eating more seasonal and varied produce.

So, when Starmer attempts to justify his economic decision to cut benefits for those who aren’t in work, why doesn’t he consider the long-term benefit of creating a healthier population — rather than kicking people when they’re already down? The economic case for preventative healthcare is too convincing.

A report last year that examined six of the most common diseases in the UK found that implementing preventative measures could generate an estimated £26.3 billion in annual savings. That’s from just six diseases. Yet, our current fiscal approach doesn’t support investment in prevention. It fails to recognise the potential for such savings.

As for what preventative healthcare could look like — it could take many forms. We could be creative and learn from other countries. Some of it will involve reducing inequality through economic policy. But it could also include funded park runs, more available allotments, or a cultural shift that encourages men, in particular, to talk about their struggles — with greater promotion of support groups designed for that very purpose.

It could mean more cooking classes in schools or communities, a push for a four-day working week, or encouraging more adults to take up hobbies — something that is heavily promoted in countries like Denmark. There are so many possibilities, and with this new report, it is vital that we take them seriously.