Will England’s new Office for Health Promotion follow Singapore’s example in using apps, gamification, and big brands to encourage healthy living? Nathan Hodson looks at the direction the government may be taking
This week Boris Johnson’s government announced plans to create a new Office for Health Promotion (OHP). After frustration with Public Health England during the pandemic, the new office will combine elements of the body created by the Lansley reforms with the wider policy expertise of the Department of Health and Social Care. Boris Johnson said the OHP would be “crucial in tackling the causes, not just the symptoms, of poor health and improving prevention of illnesses and disease,” but exactly how it will do this is still unclear.
We know that the OHP will aim to tackle mental health and obesity and that it will report to England’s chief medical officer, Chris Whitty, and the health and social care secretary, Matt Hancock. Intriguingly, it is modelled on Singapore’s Health Promotion Board (HPB). Specifically, the Department of Health and Social Care points to Singapore’s “digital public health schemes,” such as the National Steps Challenge, as an inspiration. A closer look at the HPB indicates what might be in store for public health in England.
Matt Hancock has made mobile apps central to his brand. He was the first MP to have his own app, and upon becoming health secretary he launched NHSX as an independent unit to promote technology best practice in the NHS. It is no surprise that HPB has caught his eye since it has developed the Healthy365 app to coordinate a range of different public health programmes.
The National Steps Challenge is one such programme. During the National Steps Challenge, Singaporeans aged over 17 are invited to use a phone or Fitbit to measure their steps each day over a time limited period. Participants accrue health points when they take more than 5000 daily steps and in the long run can exchange these points for up to $40 of vouchers.
The HPB similarly gamifies and incentivises healthy eating and healthy shopping. The Eat, Drink, Shop Healthy Challenge rewards users of the Healthy365 app for healthy choices in supermarkets and restaurants with health points that they can convert into shopping or transport vouchers. These public-private collaborations run through the work of HPB: it liaised with Nestle to develop alternative formulations before a ban on partially hydrogenated oils came into place and it has verified healthier options on Burger King’s menu.
Together, these conjure up the image of the OHP using apps, incentives, gamification, and big brands to make healthy living fun. But questions remain about the extent of the Department of Health and Social Care’s ambition. Beyond flashy apps, the HPB runs large advertising campaigns, works with faith groups, and coordinates community exercise sessions; will the OHP pursue those approaches as well? Moreover, recent victories for the HPB include working with the tobacco industry to introduce plain packaging and introducing the HPV vaccine in schools; with this low hanging fruit already achieved in England, what will the new body prioritise?
The question of ambition comes down to budget. The OHP budget will come out of the Department of Health and Social Care, presumably from the gap left by the Public Health England budget, which is currently about £1 billion per year (or around £18 per person). The Singaporean government spends $327 million on HPB each year, which is about $57.37 per person (or roughly £42). The Department of Health and Social Care will have to decide how serious it is about the HPB model; at present no new investment is expected but this may have to change if the government wants to create a body to equal its Singaporean counterpart.
The irony of this new announcement will not be lost on readers. The greatest failures of the pandemic arose when Matt Hancock tried to develop and launch an app outside of the NHS, which mimicked a South East Asian solution. The major success—speedy vaccination—happened because of local NHS infrastructure, and particularly the GPs we trust and have relationships with.
Yet when faced with an obesity epidemic, Matt Hancock once again bets on apps and overlooks the strength of the NHS primary care system embedded in every community in the country. We can only hope that those working for him at the OHP will recognise the value of linking technology into local healthcare settings, rather than relying on standalone tech solutions.
Nathan Hodson is an academic clinical fellow at Warwick Medical School. Twitter @nathanhodson
Competing interests: none declared.