Foundations for a healthy future

The evidence of current health inequalities in England is widely known and indisputable. And there is no more opportune time to shine a light on disparities in health than in the run-up to and the months after an election.

Our recent report on health inequalities in 2040 provided a sobering glimpse into the future. The work, carried out by the Health Foundation's REAL Centre, in conjunction with the University of Liverpool, found that in 2040, 700,000 additional working-age people in England will be living with major illness, including chronic pain, type 2 diabetes, anxiety and depression.

This increase in illness will not be spread equally: 80% will be in the most deprived half of the population, and people living in the 10% most deprived areas can expect to be diagnosed with major illness a decade earlier than people living in the 10% least deprived areas.

This is the exact opposite of what Michael Gove and his Department for Levelling Up, Housing and Communities civil servants hoped to see when they wrote the Levelling Up White Paper in 2022. That weighty document promised 'people everywhere living longer and more fulfilling lives'.

Instead, the REAL Centre report suggests stubbornly persistent inequalities between places, with a further clustering of disadvantage in areas already experiencing exclusion and poorer outcomes.

These are people whose lives are cut short or blighted by serious illness. Fewer people of working age will be employed, more will be receiving benefits, and more will require high levels of public services, including from the NHS and social care.

Creating a healthy society for everyone will need all of the right building blocks in place, including access to secure housing, good jobs with fair pay and a quality education. This will require bold, concerted action across all parts of the system, including central government, regional and local government, business, the voluntary sector and others.

Bold action from central government

Something different is needed from a new government: a coordinated approach that places prevention at its heart, with all departments maximising the opportunities to strengthen the building blocks of health.

A new approach must address barriers to long-term, cross-government policymaking, including Treasury spending rules. We also need to focus on population-level action regarding risk factors such as smoking, alcohol and unhealthy food – picking up the recent smoke-free generation legislation should be a key priority for the next government.

Additionally, we need to take action on the building blocks that help people stay healthy. This includes supporting people in getting into and staying at work and providing local government with the funds needed to support heathy places. There are already plenty of well-evidenced policies, such as Sure Start and work to reduce poverty that could be re-invigorated and make a real difference.

To support the next government in taking a radical new approach, we have convened an expert panel to develop credible, implementable proposals for how mechanisms within government, including targets, can best deliver the effective cross-government action needed to begin to head off the dire predictions of the REAL Centre's report.

Empowering regional and local government

Whitehall will not be able to tackle this issue alone. It should rely on local and combined authorities to foster employment opportunities and build transport and housing infrastructure.

As has been said for years, local areas are best placed to identify the solutions that work in their area and respond to the specific, different challenges across the country that the REAL report shows.

Whitehall must give local areas the powers they need to act and create a framework that provides the right incentives and support for different parts of the local system to work together. This includes focusing on inclusive economic growth, leaving no communities behind.

To enable local and regional government to be effective, the government must allocate sufficient, secure and stable funding to local authorities and address the ticking financial time bomb that exists in many, many councils.

Support from other parts of the system

It is not all about more work from the state: the rest of the system has a role to play, too. Businesses can play a vital role in improving health through their products and services, their role as employers and their influence on communities and wider society.

The REAL report suggests businesses should be particularly worried about the potential reduction in the size of their workforce and the impact increased sickness will have on their productivity.

As we move towards 2040, employers should consider the steps they can take to keep employees healthy. Over the next 12 months, the recently launched Commission for Healthier Working Lives, supported by the Health Foundation, will review evidence and make recommendations for employers and the government to promote workforce health and participation.

None of this is rocket science – we know what works, what roles different parts of the system need to play, and what government needs to do to make that happen. The latest REAL report, combined with the upcoming election, hopefully focuses minds on now turning rhetoric into reality and putting in place plans that start turning around the tanker of ill health. If not now, when?

This blog was originally published by the MJ on 11 June 2024.