“I saw the doctor today, and he prescribed me some loft insulation…”

It’s 2025 and GPs are as likely to prescribe exercise, healthy eating vouchers and home improvement regimes as curative treatments. Green Gyms are all the rage, everyone has an electronic health passport and citizen scientists take a key role in disseminating public health information to their communities.

These are all aspects of our vision of what the health system could look like in 2025, in a world which focuses first and foremost on the social determinants of health – such as food, housing, physical activity, education and access to the natural environment – as key to ensuring a healthy society. 

Forum for the Future created this vision for England’s health system in 2025 as a contribution to the Strategic Review of Health Inequalities in England Post 2010 (The Marmot Review), commissioned by the UK government. Currently – in England and elsewhere – mortality and morbidity and mental health rates follow a social gradient. The higher up the social hierarchy an individual is (in essence, the richer they are), the lower their risk of ill health and premature death, and vice versa.

This injustice is an avoidable one. The aim of the Review is to propose an evidence-based strategy for reducing current health inequalities, by focusing on the social determinants of health. 

This focus makes sense. The World Health Organization states that ‘misdirected care’ whereby ‘resource allocation clusters around curative services at a great cost, [neglects] the potential of primary prevention and health promotion to prevent up to 70% of the disease burden’. By taking a holistic perspective, the money available can be used for early interventions, to tackle the inequalities that lead to ill health at their root.

Forum’s vision describes how, in 2025, shorter working hours, more contact with the environment, growing localisation of production and consumption, redistribution of wealth towards the poor, and greater service accessibility are all accepted as key drivers of health and well-being, and investment is targeted accordingly. 

This implies some fairly radical changes to the health system of today, changes that reach beyond the traditional remit of the NHS. Those responsible for making these changes will need a long-term view, and a willingness to make policy decisions today whose benefits may only become apparent tomorrow.  If the Marmot Review turns out to be the first step along a road paved with tangible action, then it will have done a good job. 

Download the report to read the full vision, including four stories of fictional characters living and working in 2025.

Click here for more information about the Marmot Review. The Review is due to report to the Secretary of State by the end of 2009 and the final report will be published early in 2010.