Levelling Up the Health of the Nation

What we have in other sectors is massive customer centricity and convenience. Open banking, for example, was triggered by regulatory changes — GDPR, and then the PSD2 financial regulation saying, listen, big banks, you don't have a claim on all the customer data. You have to free up access. It doesn't belong to you — it belongs to the customer, i.e. people. And we want to make it easy for people to port their data wherever they choose to get better products and services. That helped trigger the whole fintech boom, all the challenger banks, because it was just easier for customers to choose whoever they wanted to bank with and move their data around at their convenience.

Our financial data is quite sensitive. We don't want it abused, obviously — but we managed to do it. So why can't we do the same with our health data? And I'm talking specifically about the data that resides in our NHS and care system. I only recently managed to get hold of my own medical records, and that was thanks to the NHS app, which was itself triggered by COVID. So we're now getting used to the idea of having some access to our records. But most people didn't even think, "should I have access to my medical information?" — because it was all within the NHS, who looked after you. And even if you do look at your records, you might get a limited list of your recent medications. It's not really geared to giving you control over your life and your health.

So these are rudimentary steps, and it's still quite difficult to share your data. There are some groups like Patients Know Best, which is brilliant — creating a mechanism so patients can take charge of their information and, in time, share it with other bodies. But it is like a dinosaur age when you think about what's already happening in the financial world, which has spawned a huge revolution in fintech to the benefit of both the customer and business. Why can't we take that thinking into health? Yes, we've got sensitive data, and yes, there are certain sensitivities around genomic data, for example — but we have the security mechanisms, and if you have the right governance, which is what we focused on in the Open Life Data Framework, we can take the lessons learned from other, much more convenient sectors of our lives.

That then deals with the behavioural change side of it — because if keeping healthy is difficult and you don't have the information, that's a real drag. So there's a massive opportunity for health: let's make it really easy to keep healthy and well. Let's incentivise, reward and nudge us towards healthier behaviours. That could be any mix of things — financial incentives, for instance. We've got interesting companies like the SMASH app, giving young people discounts on healthier food choices at whatever outlets they use. Let's make it really easy to stay healthier, but in a way that delivers positive health benefits.

We share data all the time — with Google and Facebook — but there we need different data models. Not just driving profits to the big tech firms, but harnessing data for the public good, which is where AI comes in. That's what we're looking at in Business for Health: how do we create that system change, those incentives, the metrics that will change how we use data and for what purpose, and make it more socially led rather than just profit led? And you can have both. You can make money and deliver health improvements and reduce health disparities. It's a win-win — you just need different models and different incentives as part of a system-change approach.

I think we're already seeing an opening up within government circles that the solutions to our health crisis don't just reside with the NHS and care system. We have a new Office for Health Improvement and Disparities, and I'm working with them. There's a levelling-up agenda, which is all about equalising access to opportunity, but also addressing the huge disparities in healthy life expectancy. It's literally a 20-year difference between the richest and poorest communities in the years lived in good health — which is pretty shocking when you think about what a wealthy society we are.

So some fundamental things are going wrong. We've been too focused on the NHS and care being the only solution to our health. That's partly cultural — we're all very attached to the idea of free healthcare for all who need it — but it's created a certain dependency, and I think that's part of the problem. Equally, thanks to all the research, including in longevity, we're realising how powerful the wider determinants of health are. Housing, for example: poor housing has a massive impact. If you look at COVID, it was overcrowded housing that created the circumstances for a lot of the communities that suffered most. There's fuel poverty, lack of green spaces, air quality — these have huge impacts. We need a cross-governmental approach to health, which is starting to happen.

In terms of relative impact, we all respond very differently to these forces. There's a concept I've been fascinated by called the exposome, which describes the wider environment in which human beings can thrive or not thrive — all the different determinants acting on us. Certain foods can trigger migraines for some people, for example. But take nutrition: we know ultra-processed food has a massive impact on our health, and yet we have a food industry that is very profitable precisely because of junk food. These things are tied in with wider inequality too. Why is it that when you go to a poor area, it has 20 times the number of fried chicken shops? You have to attack things on multiple levels — and that's exactly where the system-change approach is so fundamental.

No, it does make sense. We'd always want to help people who need help — that goes without saying, and that's where our healthcare system is vitally important. But on the extraordinary resource that goes into managing people at the end of life: it's normally in hospitals, and normally where people don't want to be in the first place. So what we should really try to do is compress that bit — when life is pretty intolerable, when you're suffering from all sorts of things and stuck in hospital, it's not the best way to go.

This is where your interview with Nir Barzilai was interesting. What he'll say is: let's compress that bit. That's the supercentenarian research he's well known for — they tend to have a very short period of ill health before they die. That would be the ultimate goal: squeeze that down, learning from all that research. Why do these supercentenarians have the luxury of a long, healthy life with a very short space of being really ill before they die? If you ask most people, they'd say, "yeah, that sounds pretty good, I'd quite like that." So how do we do it? We have to make the right decisions to focus research towards that goal, but also encourage a wider appreciation of how much we can each do individually, as communities and as a society, to extend that period of good health for as long as possible.

Now, it is difficult, because it takes a really long time before you see the benefits — if you take a life-course approach, right from before you're born. Epigenetically, sometimes a parent's lifestyle is carried through in their offspring. But if you did all the right things from the early days — a good, healthy start for children, good nutrition so they don't become overweight or obese, lots of physical activity, plenty of fresh air — ultimately you benefit in terms of improved health. There are fascinating new concepts like biological age, essentially a measure of your innate health. If people really understood it, they'd potentially do more to keep healthy — while recognising there are many environmental reasons why people can't. If you live in poverty, if you're not as well educated, if you don't have access to good housing, those are traps that make good health much harder than for someone with more advantage.

We need to get the balance right, and it's not just governments and healthcare systems — it's a wider stakeholder approach. There's a lot of work now on community health, spurred by the COVID experience, when communities really pulled together. Well-knit, multigenerational communities — grandparents and younger people living together — often do better from a health perspective. So it's about understanding all the different reasons to come up with the right formula: preventative health, married up with support when you genuinely need it. We need to shift the funding streams to focus on the areas that achieve the main impact, which is why the missions we set — to increase healthy life expectancy while minimising health disparities — are actually a very good goal. Everyone can get behind that, and you need that to drive a system-change approach.

Culture is the biggest thing to tackle for anything. If you go to a place like Japan, or the so-called blue zones — areas where people tend to live the longest, happiest lives, like Okinawa in Japan, or Sardinia in Italy — and you distil the ingredients, one thing that stands out is that they value age. The elder has a crucial role in the family, and they tend to be close-knit. The big trap in the UK, and in countries like the US, is that we don't see age as a positive thing. There's a huge amount of ageism — and we saw through COVID what happened with the care homes. As a society we really have to look at that carefully. In my world, working in healthy longevity and ageing, ageism comes up over and over again as a massive barrier to a positive older life.

Some of that I'm going to be tackling in a new role I'm about to take up with the National Innovation Centre for Ageing, looking at how we champion a positive cultural view of growing old — in the UK and beyond — and harness the latest scientific research and technology. The Centre has pioneered a concept around the Internet of Caring Things, which provides the basis for the longevity cities they champion: how do we create an environment where people can age well throughout their lives, ideally without needing to go to hospital or a care home? Living in their own homes, with all the care around them, with much more social connectivity with family and friends. Those are the ingredients. In the blue-zone countries like Japan, they live longer and healthier because they have everything that supports longer lives — good food, and exercise built into daily life. Not because they go to the gym, but because they walk to the local shops, they chat to people. Compare that with a car culture where you don't get any of that, and you're inactive.

So it's all these little things you need to tackle to promote a life-course approach to healthier ageing. But then you have to address the funding flows: how do you create the environments and infrastructure for significant projects dealing with the design of houses, neighbourhoods, cities, transport? This is where you need a whole-system view, a cross-governmental view — and to harness the power of the business world. Pension funds, for example, have trillions of capital sitting there looking for good projects. So we say: invest in projects that deliver healthier lives while making money, because that's the win-win for everybody.

COVID has been an interesting experience from that perspective, because it's really shifted the thinking on the role of business in society. I've seen a sea change. I do a lot of work in the NHS, and with the new integrated care systems springing up there's a huge opening up in attitudes about local NHS, local third sector and business working better together. There's a lot of talk about stakeholder capitalism and inclusive growth. It's not just about creating shareholder value — it's stakeholder value. Business as having a slightly different role than pure profit generation.

More and more, and especially younger people but older people too, they want to see their pension-fund money going into projects that aren't damaging the environment. We want capital invested that will not damage our health — so disinvest from tobacco, disinvest from food companies that are really harming us. We're taking a leaf from what's happened in climate and the whole net-zero agenda, which has been driven a lot by consumer pressure and now by investor pressure, because it makes commercial sense for them to disinvest from fossil fuels and coal and invest in clean energy. That campaign was largely driven by the activism community and has now become completely mainstream — we talk about ESG, UN sustainability goals, inclusive capitalism.

So the work I'm doing in Business for Health says: we want to bring health into ESG. We want health to be seen as important as climate. And I'm talking about the big money — the institutional community, the pension funds, which have a significant amount of capital. If you can make it commercially worth their while to invest in health and disinvest from ill health, they'll do it, especially with consumer power. You'll see increasing consumer pressure too — "we're not going to buy food from that company, we'll buy from this ethical one." You already see it with the younger population and low-alcohol drinks, veganism, a real movement towards healthier options.

So we use government, we use regulation, we create the right commercial incentives to show you can have social impact while making money — the two can go hand in hand. We're taking lessons from climate and trying to do better, because there have been accusations of greenwashing, where companies are more in it for their own gain, focused on climate risk to their business rather than what they're doing for the climate. We've got the Legal & Generals and AXAs of this world coming on board with the agenda. It's early days, but there's a significant shift coming out of COVID that can be very powerful, and hopefully will let us achieve the mission we're setting with government on levelling up health.

Governments are critical for setting the right environment — policy, regulation, all the rest. But business is important too. We always need entrepreneurs coming in with new ideas and new business models. Everything is important, but they have to work in concert. And mission-led approaches are very successful. Take the moonshots. The Human Genome Project was a huge government initiative — and not just the US government, it became a multi-country effort. It started, I think, around 1984, and just look at the benefits that came out of a government-funded initiative: it springboarded so much innovation and so many commercial enterprises. So there is a role for government. DARPA in the US has now got ARPA-H, which will significantly fund investment in health and the biology of ageing. We've got similar initiatives in the UK.

The Boris Johnson government is very focused on the science and technology agenda, moving away from a service economy towards a more scientific, innovation-led one coming out of Brexit — which makes a lot of sense, harnessing the skills of our nation. There's now something like £30 billion earmarked for the science and innovation agenda. UK Research and Innovation is investing significantly in areas like cyber, quantum, and health and wellbeing. That'll be a big focus of my work with the National Innovation Centre for Ageing — really putting healthy longevity on the map, because as an industry it could drive new thinking and make the best of our strengths as a nation while delivering public benefit. The Advanced Research and Invention Agency, ARIA, is another big body looking at these moonshot initiatives.

The problem with government is that it runs on short-term cycles, and it's always politically driven — we can't help that. So we have to look at the role of longer-term approaches, which brings us back to the business world. The investor community, the patient capital in institutional firms and pension funds — they could be a hugely positive, disruptive force working hand in hand with government. Look at New Zealand: they don't only measure the success of their society on GDP growth, which is a remnant of a profit-led, capitalistic society. They look at success based on wellbeing, so their government allocates spending around what they achieve as a society — poverty, homelessness, areas they've started to really invest in.

That's what we're trying to do at Business for Health, working with the Office for National Statistics on the health index — an asset-based view of health. We need to invest in health, and create the metrics to incentivise and measure the contribution of the business world, to make it worth their while to invest in really long-term projects — 20-year infrastructure projects that sit outside the political cycles. There can be a win-win for everybody; it ticks all the boxes for inclusive growth. Clearly the old model isn't working — we've now got an unsustainable health and care crisis. There's too much demand. We've got to curb demand, keep people healthier, while recognising that only so much can be done within short-term political cycles. So we need other drivers to create the long-term view.

The most important thing is to have a purpose — an overall vision of what you think is important. In terms of what we've been able to achieve with tiny, tiny resources — I run everything completely agile and flat, we've got no offices, it's all networks and people — one of the most important elements has been that mission-led approach. Focusing on big goals that no one can really argue with, that you can align behind, that have government support, and that get the business world behind them too. That's how you focus minds and dismantle the barriers — organisational barriers, egos, the ways people are performance-managed, the metrics.

Metrics are completely misaligned at the moment. They're not focused on health and wellbeing; they're focused on all the things that don't actually generate the real impact we want to see. So you have to get a lot of different people in the room, and that singular focus on a shared vision is absolutely vital. A lot of bloody hard work, persistence and drive. And then you have to find your people — the ones prepared to step outside the comfortable status quo, spot the gaps and make things uncomfortable. That's where the shared vision, the shared goal and the win-win for everybody are so important. Persistence is key, energy, passion, purpose. It's not about money — it's about singular focus, shared values, a shared purpose, and just driving through.

Most entrepreneurs — and I see myself as a social entrepreneur, I'm not motivated by making lots of money at all, I'm interested in social purpose — you need people who've got vision, who are prepared to step outside their comfort zones and do something a bit different, a bit brave, a bit bold. Some people think we're a bit nuts, taking on some sizeable vested interests. But that's what you have to do to drive change.

Stamina is very important, but stamina comes from belief in what you're doing — so purpose and passion go hand in hand with it. I also have to say that being in good health is absolutely critical to having stamina, because that's where you get your energy from. There are a few words that go along with stamina: perseverance and persistence are key. But to do that you have to be very focused on what you're trying to achieve, which is where purpose and passion are fundamental. I work very hard, no doubt about it, but I love what I do — and you do need to love what you do, because then you get the stamina and the determination to see things through.

Then I surround myself with people who are also like that, who really want to do stuff — that's where you get the magic. You're singly focused, you'll battle through. There's a lot of self-belief in it too. But you surround yourself with like-minded people who are in it with you on the journey, and that's where having a shared value system and shared purpose is so important. And health is also important for stamina — keep healthy for as long as you can, because once you don't have your health it's very difficult to keep the energy going. So I do what I can to stay healthy.