Levelling up the nation: placing health at the heart

By Alice Vodden

A central role for any government involves improving population health and reducing disparities in health across different income levels, geographies, ethnicities and other disadvantaged groups. We have known about inequalities in the UK for decades. Yet despite the investment of considerable resources and ongoing prioritisation, the health gap remains substantial.

Between 2014 and 2016, the gap in life expectancy between the most and least deprived regions in England was 9.3 years for males and 7.3 years for females. The gap in healthy life expectancy is estimated to be approximately 19 years for both males and females, and has remained unchanged since 2011 and 2013. Between 2003 and 2018, approximately a third of deaths in England were attributable to socioeconomic inequality. Health inequalities account for productivity losses of approximately £31-33 billion per year, with lost taxes and higher welfare payments amounting to £20-30 billion per year. Costs incurred to the NHS directly as a result of health inequalities amount for more than £5.5 billion per year and are expected to rise between now and 2025. If everyone in England had the same mortality rate as that of the least deprived, the extra years of life which would likely be gained could amount to approximately 1.3-2.5 million years. 

Recognising the huge benefits to the wider society of narrowing the gap between the most and least deprived, in March 2021, the government announced a £4.8 billion legislative package designed to ‘level up’ the nation, designed to increase prosperity, widen opportunity and ensure that no region is left behind. Specifically, the agenda aims to improve standards of living, boost the private sector, improve education and policing, and strengthen local communities. An additional element includes policy and action designed to ‘level up the nation’s health’, however details have yet to be forthcoming. Indeed, despite the promising outlook, plans lack detail and some are concerned that they will focus on infrastructure and financial capital at the expense of health. For example, the role of the NHS in contributing to this agenda remains unclear. 

One of the criticisms of health inequalities research is that it has for too long focused on describing the problem, rather than finding solutions. However, there is already evidence that the previous National Health Inequalities Strategy that was developed and implemented in the 2000s made a difference. One study found that there was a six-month reduction in life expectancy during the strategy period and our recent analysis at the University of Cambridge using the Global Burden of Disease dataset showed similar findings. 

Action to tackle the upstream determinants of health inequalities is likely to prove much more effective in narrowing the health gap across multiple conditions simultaneously, rather than the implementation of simple solutions to address an inherently complex issue. A fundamental redistribution of resources would likely be required in order to truly tackle the underlying causes of health inequalities, whereby funding, resources, investment and power are allocated proportionate to need, rather than a one-size-fits-all approach across all geographies and populations.

Previous research has also found a time lag between policy development, implementation and population health impact; long term sustained investment is needed. Any targets set out to reduce health inequalities as part of the levelling up agenda strategy should account for the differential time to impact between specific clinical conditions and risk factors, alongside the requirement for multidisciplinary teams in the development of health-related targets.  Whilst levelling up may be possible, leaving such a task to the NHS and public health agencies alone is unlikely to effectuate change on the scale which is required. Rather, sustained cross-government action is required in order to truly level up health. The new Office for Health Improvement and Disparities set to launch on the 1st October is an important step in “driving the prevention agenda across government” and improving population health at a national level.  

At a time where, as a nation, we look to recover from an inequalities-compounding pandemic, tackling the health gap across the country has never been more important, and should be placed at the heart of the political agenda in order to ensure the well-being and productivity of the nation for generations to come.