The value of health creation

Source: NHE Sep/Oct 17

Dr Brian Fisher, vice chair of the New NHS Alliance, outlines the many benefits of investing in health creation.

We live in one of the richest nations in the world. Yet, those living in poorer areas die earlier and suffer more years of ill health than those living in wealthier areas.  

The New NHS Alliance’s Manifesto explains that to help tackle inequalities, we need health creation: expense and lives could be saved while enhancing equity.  

Health creation is the enhancement of health and wellbeing when individuals and communities achieve a sense of purpose, hope, mastery and control over their own lives and environment. It comes when people have contact with others, gaining confidence and then control. How do we know this? 

Contact: social networks protect health  

Social networks (SNs) are the connections we have with others – friends, relations, acquaintances.  

A 2010 analysis of almost 309,000 individuals, followed for an average of 7.5 years, showed a 50% increased likelihood of survival for people with stronger social relationships, consistent across age, sex and cause of death, and comparable with risks such as reducing smoking, alcohol, BMI and increasing physical activity. 

Social participation protects against cognitive decline over 65. Low levels of social integration and loneliness significantly increase mortality; time banks improve mental health through their social networking; and social relationships can reduce the risk of depression.   

SNs are weaker in more deprived areas. Professor Sir Michael Marmot, director of the International Institute for Society and Health, recommends that a key approach to tackling health inequalities is reducing social isolation by building strong communities. 

Improving trust, confidence and control 

Areas with stronger SNs experience less crime and less delinquency. SNs improve employment and employability. The Healthy Communities Collaborative found a 12% increase in people showing concern for each other, with a 48% rise in participants feeling they could change things in their communities.  

Councils find community engagement saves time and money, creating more satisfied communities while statutory agencies can develop new, and improved service delivery. Making resources available to address the association between poor health and poor SNs and break the cycle of deprivation can decrease costs of health care. 

Cost benefit 

An analysis of community development initiatives suggested a return of 1:3.8 for the NHS, with additional savings through reductions in crime and anti-social behaviour, similar to others. The Lewisham project showed an ROI between 2:1 and 3:1. 

C2 Connecting Communities, a national network of connected communities with an academic hub at Exeter University’s Medical School, has repeatedly demonstrated how small investments in health-creating approaches deliver a big return – not just in physical and mental health improvement, but also in educational attainment and reduced crime. 

C2 Connecting Communities has improved physical health and mothers’ mental health and educational attainment. Violent crime dropped by 50% and unemployment by 69%. Independent analysis showed a return of 1:8 with about £650,000 annually in net benefits to the residents.  

Nesta summarises the impact of these kinds of interventions: 

  • Savings of 7% for CCGs at £21m per CCG, and £4.4bn across England
  • Reductions in A&E attendance, planned and unplanned hospital admissions, and outpatient attendance  

The New NHS Alliance website has stories and examples beyond statistics. We believe that health creation needs to become ‘business as usual’ across the NHS and local authority sectors. Join us and help make it happen.



You can read the Health Creation Manifesto here:



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