Election season is upon us and the aspiring communicator can only watch in awe as the main protagonists wheel out their proven strategists and presenters.

However, for the aspiring economist or policy purist preferring to deal with the realities of risk, there is going to be an inevitable gap. This gap will be most apparent and most tested in health, not least with the frontrunner declaring health as number one.

First take our ageing population, as the 1960s baby boomer generation leaves the workforce. There is no precedent for a population structure in which old people outnumber young people. While the Office for National Statistics continues to predict population growth, a drop in the birth rate or significant workforce emigration would be a challenge. The impact on long term conditions, health spending and demand for services will be disproportionate.

No institution can hope to survive unless it measures up to the standards set by international leaders

The strategy of all institutions, including the NHS, should be based on the assumption of a shrinking population of working age. Reflecting on the work by Derek Wanless, it is clear we have barely initiated the scenario where public engagement in relation to their health is full.

Second, we need to face the hard choices on spending. Where the shares of disposable income are spent is the foundation of all economic information as well as the most reliable foundation for a business strategy. The four sectors whose share of disposable income grew during the 20th century were government, healthcare, education and leisure. The negative future for at least two of these in the medium term is clear, a third somewhat inevitable and the sacred cow of healthcare the key decision for the next Parliament. The 2009-10 UK budget deficit outturn could easily touch north of £200bn: 18 per cent of GDP!

The cumulative borrowing deficit to achieve even modest growth in GDP will exceed £500m by 2011. Remember, with a GDP of £1.2 trillion, 1 per cent growth secures just £15bn.

It is a big debt mountain initially to close an annual gap of over £175bn and then pay off the outstanding half trillion.

Third, we need to redefine success. In business, the emphasis on measuring performance is defined by how much it benefits shareholders. Government will need to learn how to balance short term results with immediate need and long range prosperity.

For the public and workforce, performance will have to be defined in a balanced framework not solely dependent on targets or finances. Once again the commitment and buy-in of the healthcare professions looms large, but most of all the transparent need for information will be key. Consumer demand for personalised healthcare is in touching distance; transparent comparative and trended data will drive the call for reform rather than localise objection.

Fourth, global competition is set to stay. No institution can hope to survive, let alone succeed, unless it measures up to the standards set by international leaders. Feeling brave? Then benchmark yourself against Johns Hopkins Hospital, recently voted the number one medical institution in the US. Above all else, healthcare must be based on the purchase of services to meet the needs of users.

Finally, don’t discount politics. The global economy may drive the flow of resources and information, but this must be tempered with both national and local realities. But politics should not be about intervening in place of the market to provide personalised healthcare. This would be unaffordable and not well served by state institutions.

Indeed, unaffordable state interventions dressed as reform may have been the Achilles’ heel of the Wanless fully engaged scenario. This might be the time for a different approach.

A friend shared the Frederick Herzberg principle of motivation: if you want your dog to move from A to B you can kick it from A until it gets to B, or you can put down a bone so it moves to B. When this is applied, who is motivated, you or the dog? While the strategic pressures and risks are economic, the decisions and solutions are above all political.

The direction of change must be to create the conditions for individuals in conjunction with employers and government for personal motivation to flourish. Now is the time for state policies on disease management, screening and wellbeing to be based on this new approach.

Let’s not forget that every accomplishment starts with the decision to try; for individuals and for governments.