As July finishes and we head into the holiday period, spare a thought for the civil servants who will be busy working on the government’s Levelling Up White Paper. What started as an election slogan has become two words carrying a great deal of expectation. More than anyone could have expected in December 2019.  

As the report of our COVID-19 impact inquiry, Unequal pandemic, fairer recovery, concluded, the inequalities in people’s working conditions, housing and underlying health across the UK became a significant factor in the differences in exposure to and outcomes from COVID-19.  

These were most marked in the under 65 population. While the proportion of COVID-19 deaths among this age group was a minority of the total deaths, these deaths were – if one was needed – the canary in the coal mine for inequalities. Among comparable countries, only Bulgaria reported a higher rate of excess deaths for people under the age of 65. In England, COVID-19 mortality rates were more than twice as high for people from the poorest 10% of local areas compared with people from the wealthiest, and almost four times as high for the working age population.  

But this figure points to something else. It points to a working age population that has a higher burden of avoidable ill health, which not only puts people at greater risk of poor outcomes from COVID-19 but that also limits their ability to participate socially and economically. Our subsequent analysis – What geographical inequalities in COVID-19 mortality rates and health can tell us about levelling up – shows that the employment rate for people with a work-limiting condition is 47%, compared with 81% for people without. And that in 15% of council areas in Great Britain, over a fifth of the working-age population have a work-limiting health condition or impairment.  

Our latest podcast (Low life expectancy in Glasgow, and what to do about it) explores the long-run events and decision making that lead to stark differences in life expectancy. Changing this will, in turn, require long-run strategies. In this episode Dr Jennifer Dixon discusses these issues with Dr David Walsh and Sir Harry Burns, with key themes and learning summarised in this article for the newsletter

As argued in our new briefing, The government’s levelling up agenda, the white paper will only meet its ambition to level up the economy if it also sets out to level up health. Without doing so, poor health among the working age population will continue to act as a brake on the economy and diminish people’s lives.  

The report from our COVID-19 impact inquiry identified the need for immediate action to provide greater protections for low-paid workers and targeted support for people whose mental health has deteriorated to get back into work. Longer term, it argues for investment to create good-quality jobs in areas with historically low employment, as well as for those hardest hit by the pandemic.  

The Levelling Up White Paper is an opportunity to deliver such plans, coordinating a cross government approach as well as resourcing and enabling local government to deliver. Those two words that captured the attention of voters in the dark days of December 2019 now need to be translated into evidenced and achievable plans with improving health an explicit objective. Those working on the paper may find it a long, hot summer. 

Jo Bibby (@JoBibbyTHF) is Director of Health at the Health Foundation.

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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