Wales is investing in sickness not health, the Future Generations Commissioner is warning, as he joins calls for a dramatic shift in the way we spend our budgets. 

The Chief Medical Officer for Wales recently warned inequalities are widening, while Wales spends half of its budget on the under-pressure NHS and is not investing enough on root causes. 

Spending on prevention returns £14 for every pound invested, according to Public Health Wales, while more than £10bn is spent on the NHS every year.  

Derek Walker said until we treat prevention as a shield not a competing priority, we’re condemning the NHS to fight multiple crises with one hand tied behind its back, especially in the difficult winter conditions.  

Mr Walker, who gave evidence to the Senedd Finance Committee last month, called for increased investment in prevention as a matter of urgency, and said public services and other public institutions including the NHS fear bankruptcy, and generations will judge us if we don’t act now on the systemic causes of inequality. 

His team is working actively to address causes of ill-health such as the lack of investment in prevention, lack of community health programmes, or the lack of availability of accessible healthy food.  

Last month, in collaboration with Food Sense Wales, he co-produced guidance for local councils in Wales on how they can improve local food systems, and said ill health prevention was the business of all public bodies, not just health boards. 

Mr Walker said: “Investing in the things that prevent poor quality of life for the most deprived in our population especially, slashes avoidable hospital admissions and frees beds and clinicians, yet we’re condemning the NHS to fight crises with one hand behind its back. 

“Connected communities, clean air, fair jobs, accessible healthy food, and access to nature and green spaces are some of what keeps us well, while healthcare treats only a fraction of our health issues and gets half of our budget. 

“The way Wales spends right now is a breach of future-proof planning and our current budgeting is not meeting the Well-being of Future Generation Act’s requirement to improve health equity for our current and future generations. 

“Some public bodies have told me they fear bankruptcy. Generations will judge us if we don’t act now on the systemic causes of inequality.”  

The warnings in the latest Chief Medical Officer for Wales’ report echo the Well-being of Wales Report published by Welsh Government in October, and the Future Generations Commissioner’s Future Generations Report. 

Mr Walker welcomes Welsh Government’s commitment to become the first Marmot Nation and has called for more investment in prevention programmes to reduce health inequalities, like Public Health Wales’ all Wales Diabetes Prevention Programme which has shown early signs of effectiveness in improving blood glucose control, but is struggling to secure long term funding.  

His Future Generations Report recommends several policy areas in prevention, from a Real Living Wage to a plan to reverse the rate of obesity within 10 years, free school meals to all children up to age 16, and a bigger focus on prevention across public services.  

Mr Walker cited an initiative in North Wales helping healthcare providers make the link between cold and damp homes and poor health, as an example of preventative investment.  

People in areas of deprivation in Flintshire, live 11 years less than those in wealthier regions and Warm Wales’ Healthy Homes – Healthy People (with 2025 Movement, a collaboration of more than 600 people and organisations),  is working with GPs and pharmacies to identify people whose living conditions might be affecting their health, focussing on identifying early signs like chest infections, skin issues, and mental health challenges.  

One resident said: “It helped with energy and warming our home, we received an electric blanket which helped to keep us warm, plus food bank support. My fibromyalgia has improved, my stress has reduced and it’s helped with warming our home.” 

Wrexham University played a key role in the initiative through leading the Community of Practice for social prescribing across the region via the North Wales Public Service Lab.   

Preventing Fuel Poverty and Health Inequality in Wales

2025 Movement is working to end avoidable health inequalities caused by social inequalities. 

As part of a collaboration with more than 600 people and organisations, the programme supported more than 2,000 people and helped them save more than £546,000 by helping them access affordable heating solutions. 

Warm Wales’ Healthy Homes – Healthy People initiative addressed the link between fuel poverty and poor health, driven by the stark life expectancy disparity where those in deprived areas in North Wales, particularly Flintshire, lived 11 years less than those in wealthier regions, and focused on improving the physical condition of homes. 

The project, which runs across Wales, began by prioritising the most vulnerable households in homes with poor insulation, which exacerbated health issues like respiratory problems and mental health challenges, by working closely with local authorities. 

Now 2025 Movement is working with GPs and pharmacies to identify people whose living conditions might be affecting their health, focussing on identifying early signs like chest infections, skin issues, and mental health challenges.  

One resident said: “It helped with energy and warming our home, we received an electric blanket which helped to keep us warm, plus food bank support. My fibromyalgia has improved, my stress has reduced and it’s helped with warming our home.” 

Lucy Leighton, Projects Director, said: “Healthcare providers know the links between cold, damp homes and health, but previously there’s been no clear path for referrals. We’re creating that service so health professionals can connect people directly to support. 

“By asking simple questions about whether their home is cold or damp, or if they’re struggling with heating, we can help address the root causes. Building homes that are both sustainable and affordable is key to making sure future generations have a secure and supportive environment to thrive in, without the stress of unaffordable housing costs – something that’s very much at the heart of the Future Generations Act” 

Wrexham University played a key role in the initiative through social prescribing via the North Wales Public Service Lab.  

Nina Ruddle, Head of Public Policy Engagement at Wrexham University said the project demonstrates that early intervention and addressing social determinants of health can alleviate future burdens on the healthcare system.