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Improving population health relies on leadership not just in health and care

Many countries have seen health inequalities exacerbated and poorer population health outcomes since the start of the pandemic. Addressing the structural causes of these will require new leadership not just in health and care, but across the commercial and political sectors too. It is promising that good examples across these areas are emerging.

Last month health leaders from across the Europe convened for the European Health Forum Gastein (EHFG) 2021 to discuss how best European states can recover from the Covid-19 pandemic.

What quickly became apparent is that countries not just in Europe but across the world face many of the same barriers and enablers to ensuring strong and effective health and care systems.

Many of these will not come as a surprise. Workforce, for example, is set to be a critical barrier globally, with an expected shortfall of 18 million healthcare workers by 2030. In England, the Health Foundation estimates the need for nearly half a million extra health care staff to meet demand pressures and recover from the pandemic over the next 10 years.

However, on enablers there is one driving factor seen as essential across both settings and geographies: leadership. Fostering and rewarding collaborative leadership will be a prerequisite to meeting the manifold challenges faced by countries around the world as they seek to recover from Covid-19, improve access to care and address the wider determinants of health.

While it can often be difficult to quantify where and how leadership is lacking as we look to meet such challenges, it is clear we need to incentivise certain leadership styles and traits across multiple areas of civic life. Three examples can be identified.

Health and care leadership

Firstly, there has rightly been focus on the need for leaders in health and care to think in systems as integration replaces competition as the driving force of service improvement. In England, this should involve organisations working collaboratively with local partners to solve shared problems.

A key test for those leading integrated care systems will be whether they can develop, with partners, a compelling account of the specific and concrete value they believe system working can bring.

Commercial leadership

Secondly, however, we will need to look beyond the health and care sectors if we are to make real progress on improving population health outcomes. More specifically, incentivising commercial leaders to consider their own role in improving and maintaining employees’ health and wellbeing will be critical.

One company moving in the right direction in the UK, for example, is John Lewis, which recognises that looking after the health and wellbeing of its employees is good for staff and good for business. It supports its employees through a wide range of internal health and wellbeing services such as physiotherapy and counselling, on demand for whenever they are needed.

The benefits of such initiatives to the broader health and care system are clear. The more employers can be incentivised to take on more responsibility for the health and wellbeing of their staff, the more we can tackle health problems earlier and ease the significant pressures on stretched local services.

Equally, in-house health and wellbeing services could prove to be a powerful weapon to address health inequalities, if services – such as the physiotherapy offered by John Lewis – offer support for health problems that disproportionately affect those from low-income backgrounds.

Political leadership

Finally, political leadership at both domestic and international level will be a key determinant of whether and how population heath improves over the coming years. Domestically, the NHS Confederation and other organisations across health and care have long called for political leaders to adopt a ‘health in all policies’ approach. This would encourage all government departments to take seriously their role in achieving cross-sector action on addressing the wider determinants of health.

Internationally, the European Union will need to learn lessons from the pandemic. Speaking at the EHFG, Professor Agnes Binagwaho, senior lecturer at Harvard Medical School, argued that the world health system will continue to remain vulnerable to crises until structural barriers are addressed.

The developing world cannot remain dependent, for example, on vaccine handouts from rich states sitting on stockpiles. Rather, co-ordinated international action must be taken to improve health infrastructure and create a more level playing field in the international life sciences market, with better production opportunities in poorer countries.

Creating incentives

While there is a recognition that these types of leadership are key, the difficult question is how we can encourage them.

There is a strong argument that governments – through incentivising mechanisms such as tax relief, loans or grants – must do more to encourage the private sector to invest in occupational health and wellbeing programmes.

Part of the answer, though, will also lie in how we assess the performance of leaders. A key challenge will be to ensure that we have ways to evaluate leaders’ impact in the short-term while judging overall organisational performance, and especially the performance of integrated care systems, on improvements to population health in the longer term.

Incentivising changes to leadership ultimately requires the right support and takes time. In England, with the Secretary of State for Health and Social Care recently launching a review of NHS leadership, it will be especially important that this message is heard.

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NHE May/June 2024

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