A policy on health service spending (Labour calls for OBR-style watchdog to assess NHS finances, 28 December) is meaningless without a policy on health creation. Most diseases are not random. Your chances of getting ill or dying are greatly increased by social and psychological adversity, some of which is preventable by early intervention. This means massive public investment in comprehensive perinatal health, in paid parental leave, children’s centres and early years education. But also the recognition that insecurity – especially in housing and employment – damages health through the physical stress it causes. Michael Marmot’s book The Health Gap (2015) chronicles this data in readable detail. NHS funding cannot be taken out of politics because its costs depend so much on the impact of other policies, especially those that aggravate inequalities. The Labour party knows this but must demonstrate that in its policy proposals.
Dr Sebastian Kraemer
London
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