Local government’s key role in improving health

If there is a conversation about good health, it’s easy for someone’s mind to turn to the NHS – and why wouldn’t it turn to that integral service that delivers health care to an estimated 1 million people a day? But if you step back and look at what makes and keeps people healthy, you realise that the NHS plays a much smaller role than people think. It’s actually things like high quality and affordable housing, access to green spaces and a good education that set people up for a long, healthy life.

When looking at these ‘wider determinants of health’, it’s clear that local councils play a critical role. These bodies have the power to invest in innovative and targeted services and opportunities to keep people healthy throughout their lives, and delay or even prevent the need to access the NHS. Investment, in the current climate, will be challenging. But looking ahead to 2023, the Health Foundation stands ready to make the case for local government action on health, to directly support and fund activity and to provide new resources and insights to help local government have the greatest impact.

April 2023 will mark a decade of public health responsibility and funding sitting with local government. It will be a great chance to step back and review how local areas have really made the most of opportunities to embed a health in all policies approach across councils. The rewards of taking a system-wide approach are clear, but it can be challenging to align all parts to work together – inside and outside of formal local authority structures. At the Health Foundation, we are working to support system-wide action to make these approaches possible and use our position to share insight. We are funding five local authority-led partnerships to take joined-up action to improve health and will be sharing learnings over 2023. The local authorities involved are Bristol, North Somerset and South Gloucestershire Councils, Doncaster Council, London Borough of Newham, Northumberland Council and Shropshire Council.

We will be celebrating success and sharing evidence on things that are working well by sponsoring a Municipal Journal award. Last year, we saw Newham win the first Health Foundation MJ award for place-based approaches to health equity. This year we are looking for councils demonstrating a whole-council approach to tackling health inequalities.

We will also be looking into what makes it difficult for local areas to take action. In the financial year before the pandemic, government spending attributed to England was £541bn, or £9,650 per person. But this money doesn’t always reach the areas that need the most support and a vital opportunity to level up and reduce inequalities is therefore being missed. We are making the case for investment in local government. One way we are doing this is by funding the recent report by the IFS, which finds that systems for allocating local funding are ‘not fit for purpose’. And through our analysis of the public health grant we have shown how the most deprived areas have received the biggest cuts, per person – contributing to the widening of health inequalities.

Building the case for investment would be easier if there was general public awareness and understanding of how the circumstances in which we live shape our health – from the support we receive during our early years, to our working conditions, housing, and local communities later in life. The public have a good understanding of health inequalities: 69% of people in a recent poll said they are aware of disparities in life expectancy and healthy life expectancy between areas. But the majority of people (53%) felt individuals are mostly responsible for their health, not recognising the wider factors.

We have been supporting local government to build public understanding of the wider determinants of health using our toolkit, produced in collaboration with FrameWorks UK. This document contains practical steps to help local authorities, and others, to communicate effectively on taking action to improve health. We will be doing more work in 2023 to share what works in reframing the conversation about health.

2023 is likely to be another challenging year, with the cost-of-living crisis taking its toll on communities. Now more than ever, it is important that local government has the investment, recognition and support needed to take action to improve people’s health and tackle health inequalities. And we, at the Health Foundation, are committed to increasing our support for local leaders to build healthy places.

Look out for further work in 2023. To stay up to date with all our local government activities, sign up here.

Katherine Merrifield (@KMerrifieldTHF) and Gwen Nightingale (@GNightingaleTHF) are job-share Assistant Directors in the Healthy Lives team at the Health Foundation.