Levelling up featured prominently in several speeches at the Conservative Party Conference, where the Prime Minister acknowledged ‘aching gaps’ in life expectancy in some areas. Similarly, Sajid Javid has said, ‘We can only level up economically if we level up in terms of health too.’
So far, so good. But if the government recognises, in principle at least, how important a healthy population is to the country’s future prosperity, why is this focus so noticeably absent from the substance of its plans?
As we have argued previously, health has to be at the heart of the levelling up agenda if economic prosperity and inequalities are to be addressed. Good health improves wellbeing, economic participation, and the ability of individuals to contribute to their families, communities and wider society. In the areas of England with the lowest healthy life expectancy, more than a third of 25 to 64 year-olds are economically inactive due to long-term sickness or disability.
Unsurprisingly then, expectations around the imminent levelling up white paper are high. But will the white paper truly seize the opportunity to put health at the centre of efforts to level up? Having called for a cross-government strategy to improve health and health equity, the Health Foundation will be reading the small print and hoping to see recognition of the need to invest in health to create prosperity.
We are proposing five tests to assess the level of commitment in the white paper. These tests start from the position that improving health needs to be at the top of everyone’s inbox – whether in the Department of Health and Social Care, the Department for Education, a local authority or a combined authority.
The five tests
1. Health as a measure of levelling up success
First, we want to see improvements in health and health equity as a stated success measure of the levelling up agenda. Improving people’s health is a vital first step to increasing economic participation and prosperity. The white paper will need to make the link between health and prosperity explicit, with a focus on improving health. This will require a new target to improve health and health equity, and independent tracking of progress against a broad suite of measures that align with the new ONS health index.
2. A cross-government approach to improving health
Meeting the size of the challenge will depend on health equity being a key consideration in all policy and investment decisions. The vast majority of government policies have the potential to help or hinder efforts to improve health. All government departments should be aware of the ways in which they can contribute and join up efforts. We are calling for the government to take coordinated action and will be setting out a national framework for action to improve health and health equity.
3. Empower and enable local and regional government
A commitment to empower and enable local and regional government to improve health will be the third test. Almost every part of local government has the potential to maintain and improve health including through early years services, housing, planning and licensing, leisure services and social care. But cuts to funding limits their potential. This includes the 34% reduction over the past decade in central government grants (including business rate retention), and the real-terms per capita cut to public health funding since 2015/16 – equivalent to £1bn a year. The white paper, backed up by the Spending Review, needs to ensure that local government is adequately funded to take action to level up health. It will also need a commitment to give local and regional government increased flexibility in how they use funding, and increased certainty to enable them to make spending decisions over longer time periods.
4. Invest where it is needed most
The fourth test will be evidence that funding is going to the places that need it most. If there isn’t investment to address the factors that are eroding people’s health – such as poor-quality housing, work and limited green space – poor health will continue to act as a brake on recovery. Our analysis has shown that, to date, such investment isn’t reflected in the prospectuses for levelling up funds. We will be looking for health measures, including healthy life expectancy, to be included as a key criteria for distributing future levelling up funding streams. And for a more explicit focus on investing in social and human capital as well as infrastructure.
5. Support people back into work
Finally, there needs to be concrete action to support people back into work. Poor health and disability remain a significant barrier to workforce participation for many. Action is needed in the short, medium and long term to address the link between poor health and unemployment and low-quality employment. Local and national economic development strategies and skills strategies should focus on tackling health inequalities by providing good-quality local jobs. Health Foundation analysis shows patients in the most deprived areas of the country experienced more disruption to their diagnosis and treatment during the pandemic. The government needs to ensure that people in these areas are not further penalised as part of the NHS recovery, and that working-age adults with long-term conditions receive the treatment they need to remain in work.
There is a clear case for embedding health at the heart of the levelling up white paper. We will now be waiting to see if the white paper will recognise this and set out the action required to level up health and the economy.