The Case for Health
1.1 There are strong personal, social and economic arguments for making our health better. The Government intends to act on them. The Personal Case 1.2 Good health is the foundation of a good life. Our own health and the health of our families and friends underpin our ability to enjoy life to the full. When we are well we are able to make the most of the opportunities that life has to offer and to play a full part in family, community and working life. No matter what goes wrong in life - money, work or relationship problems - good health helps sustain us. How often have we all heard someone say that although things may not be going well - at least they have their health. Good health is treasured.
 1.3 Good health also means not living in fear of illness, constantly worried about our health or the health of those closest to us. It means being confident and positive and able to cope with the ups and downs of life. Better health for the nation is central to making a better country. 1.4 It's good that people are generally living longer and living healthier lives. But the level of illness remains a cause for concern. Estimates based on Government statistics show there are over 250 million visits to GPs and 70 million visits to hospitals every year. Now, in the 1990s, nearly 90,000 people die each year before they reach their 65th birthday. Of these people, more than 25,000 die of heart disease, stroke and related illnesses and 32,000 die of cancer. Many of these deaths could be prevented. 1.5 But good health is not just about how long people live. It is also about quality of life and how well people are during those extra years, so that they are not robbed of their dignity and independence in later life. Figure 1 shows that although both men and women are living longer, they spend many of those years in poor health. What we want is a healthier country where people spend as little time as possible burdened by sickness, pain and disability. The Social Case 1.6 In a modern and strong society, united by core values of fairness and compassion, it is vital that everyone gains from a national drive for better health. 1.7 A healthy country would be one where health was not dictated by accident of birth and childhood experience. Everyone should have a fair chance of a long and healthy life. 1.8 The general improvement in health stems largely from improved living standards. But not all have shared in growing prosperity. Surveys over the last few years have shown a growing gap in wealth between the best and worst off people and the best and worst off neighbourhoods. Predictably the most recent figures[1] from the Office for National Statistics show that the health gap is growing as well. 1.9 The poorest in our society are hit harder than the well off by most of the major causes of death. Poor people are ill more often and die sooner. The life expectancy of those higher up the social scale (in professional and managerial jobs) has improved more than those lower down (in manual and unskilled jobs). This inequality has widened since the early 1980s (see figure 2). 1.10 In the past this social dimension was frequently neglected. Poor health was put down to bad luck, unhealthy behaviour, or inadequate healthcare. 1.11 Yet it is clear that people's chances of a long and healthy life are basically influenced by how well off they are, where they live and by their ethnic background. A child's chance of surviving to its first birthday relates to the country of birth of its mother, as figure 3 shows. Figure 4 shows how men's social class can influence their chances of dying from lung cancer before the age of retirement. Figure 5 shows how some areas are hit harder by deaths before the age of 65. Parts of Tyne Tees, Greater Manchester, the West Midlands and London have some of the highest rates of early death, whilst most of East Anglia and the South West have the lowest.
Figure 2 1.12 The Government recognises that the social causes of ill health and the inequalities which stem from them must be acknowledged and acted on. Connected problems require joined-up solutions.This means tackling inequality which stems from poverty, poor housing, pollution, low educational standards, joblessness and low pay. Tackling inequalities generally is the best means of tackling health inequalities in particular. 1.13 Within our overall programme to improve the health of the whole population a key priority will be to improve the health of those who are marginalised and worst off. We will seek to improve the absolute and relative positions of those people and areas which are hit hardest by poor health and premature death. That will narrow the gap between them and the better off . 1.14 Moreover, social exclusion can be both a cause and an effect of ill health. If people are too ill to work or to participate in everyday social life, isolated from the mainstream opportunities by illness or disability, then they can become socially excluded. If they are not in society's mainstream, they are more likely to damage their health by smoking or they may seek comfort in activities like illegal drug-taking and so damage their health. The Economic Case 1.15 A healthy population is a key factor in a prosperous and modern economy. There are sound and hard-headed business reasons for making our health better. 1.16 To succeed in the modern world economy, the country's workforce must be healthy as well as highly skilled. The Confederation of British Industry has estimated that 187 million working days are lost each year because of sickness[2]. That's a £12 billion social tax on business every year, damaging to competitiveness and a brake on prosperity. 1.17 Cancer treatments cost the NHS an estimated £1.3 billion each year, whilst heart disease, stroke and related illnesses cost £3.8 billion. Treating accidents and other injuries costs some £1.2 billion and treating poor mental health in excess of £5 billion a year[3]. Illnesses caused by smoking cost the NHS between £1.4 and £1.7 billion each year. By preventing avoidable illnesses we can enable the NHS to concentrate its resources on treating those conditions which cannot yet be prevented. 1.18 Investing in the country's health is partly about working for a fair and decent society. It is partly about using the resources of the health service to best effect. But, equally importantly, it is also part of the Government's determined drive to improve England's economic efficiency and performance. Our Health Can Be Better 1.19 Our health today falls short of what we already know is possible. It is better here than in many other European countries. But it is hit harder than some countries by the big killer diseases. And, as figure 6 shows, people in England have less chance of a long life than people living in France, Italy or Sweden.
 1.20 Compared with other countries, many people - particularly older people - still spend much of their lives in pain or discomfort, dependent on others for support. At a time when they should be free to make the very most of their lives too many spend their retirement unable to enjoy the independence that people who are well take for granted[4]. We want to ensure a more comfortable retirement which gives people the ability to live independently and to do things for themselves for as long as possible. Our Healthier Nation 1.21 So there is an overwhelming personal, social and economic case, based on common sense, for improving our health. The Government is determined to play its part in a concerted effort to make our health better. 1.22 It is obvious that problems that have persisted for decades will not be solved overnight. The results of our efforts may take years to show through in better health. Improvements in health will not be easy to secure. They will have to happen at a pace which people can accept and which the country can afford. There will be hard choices to be made by us all. But this is no excuse for inactivity and in time our efforts can and will make a real difference. 1.23 The Government has two overriding aims for Our Healthier Nation.
1.24 The Government has identified four priority areas for action - heart disease and stroke, accidents, cancer and mental health - and proposes to set a national target for each of them. These targets will give purpose and direction to the strategy and help us to assess overall progress. 1.25 This Green Paper sets out the Government's proposals on how, together, we can achieve our two overriding aims, and asks for your views on them. When your views have been taken into account, we will publish later this year a White Paper setting out a strategy for action.
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