The future of the NHS depends on creating health, not just treating illness

The NHS is one of the UK's greatest achievements. As physicians, we see every day the difference it makes to patients' lives. But we also see its limits.

The challenges facing the health service today cannot be solved by healthcare alone. Rising demand, widening health inequalities and growing numbers of people living with long-term conditions are symptoms of a much bigger problem: too many people are becoming ill in the first place.

That is why I was interested to learn about the work being led by the British Society of Lifestyle Medicine to promote prevention and support healthcare professionals to address the factors that influence health long before people need hospital care. After all, if we want a healthier nation, we need to focus far more attention on creating health, not simply treating illness.

This is not a new idea. Nor is it one that will surprise physicians. In clinics, on wards and in communities across the country, doctors witness the impact that housing, employment, education, transport and social connection have on people's health. We know that where someone is born, grows up, lives and works often has a greater influence on their long-term health than the care they receive once they enter the health system.

Yet national debate continues to focus overwhelmingly on how we respond once people become ill. Of course, the NHS must remain properly funded and supported to deliver high-quality care. But if our ambitions stop there, we will never get ahead of demand. We will continue to spend increasing amounts of public money dealing with the consequences of poor health rather than addressing its causes.

The RCP has long argued that prevention should be at the heart of health policy. Our work on health inequalities, air quality, smoking, obesity and population health has consistently highlighted the need to tackle the wider determinants of health alongside improving healthcare services.

The reality is that health is created far beyond the walls of hospitals and GP surgeries. A child growing up in safe housing, with access to good education, green spaces and opportunities to be active, is more likely to enjoy good health throughout their life. A working-age adult with secure employment and strong social connections is more likely to remain healthy, productive and independent. Communities that are connected, empowered and resilient are often better able to support health and wellbeing than any single public service acting alone.

The economic argument is equally compelling. Good health drives economic participation, productivity and resilience. Poor health does the opposite. At a time when policymakers are rightly focused on growth, workforce participation and reducing long-term pressures on public services, health should not be seen as a separate conversation. It should be recognised as one of the foundations upon which economic success depends.

The RCP has argued for a whole-government approach in which health becomes a shared objective across housing, education, transport, employment and environmental policy, rather than being viewed solely as the responsibility of government health departments. This could include investment in early years support, community-led health initiatives and local models focused on relationships, community assets and prevention, all underpinned by an important principle: healthier communities are built with people, not simply for them.

This resonates strongly with the increasing NHS focus on neighbourhood health and place-based care. As healthcare leaders develop more integrated models of care, we have an opportunity to think differently about health improvement. Neighbourhood health should not simply mean delivering existing services in different settings. It should mean working alongside local communities to tackle the underlying factors that drive poor health, preventable illness and inequality.

For physicians, this should feel entirely natural. Doctors will always have a vital role in diagnosing illness, delivering treatment and supporting people through some of the most difficult moments of their lives. But we also have a responsibility to champion the conditions that help people stay healthy in the first place. We see every day the consequences of poor housing, poverty, social isolation and unequal access to opportunity. We understand the cost, both to individuals and to the health system, when prevention fails.

The UK does not lack evidence about what drives health. Nor does it lack examples of places already putting these ideas into practice. What is needed now is greater alignment across government, public services and communities around a shared goal.

The NHS will always be there when people fall ill. But if we want a healthier population, a more sustainable health service and a stronger economy, we must devote at least as much energy to creating health as we do to treating disease. That means viewing health not as the sole responsibility of the NHS, but as a national asset that underpins prosperity, opportunity and resilience. It means giving communities a stronger voice in shaping the conditions that affect their health. And it means ensuring that every part of government understands its role in creating a healthier society.

Because the future of our health service depends on recognising a simple truth: health is created long before a patient arrives at our door.

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