Political leadership can drive a health-powered economy

What would happen to the economy if Birmingham stopped working? Half a million more people have left the UK workforce due to long-term sickness since 2019, more than the whole working population of the UK’s second city. While businesses struggle to recruit, there are now 2.5 million working-age people economically inactive due to poor health. Our economy won’t work unless the population is well. So if health is key to wealth, how should government make this a priority?

The Johnson government set a bold ambition to increase and ‘level up’ healthy life expectancy, but this has not been matched by ambitious policy. Actions on housing, work, healthy food and clean air have been delayed or watered down and the health disparities white paper will now be subsumed under a major conditions strategy. Meanwhile, Labour leader Keir Starmer has made positive noises about a wellbeing test for all Treasury decisions, and promised to make health inequalities part of his ‘missions’ for government. The words are there but we need the action. Leaders of all parties must show how they would actively drive, coordinate, be accountable for and ultimately bake the goal of a healthy UK into every government decision.

The Health Foundation has showcased global examples of a ‘health in all policies’ approach. Investing in the population’s health – from early years and education to housing, good work and an adequate safety net – would prevent health problems building up that the NHS is then left to deal with. We call for a whole-government approach to improving health, led by a Prime Minister with a clear plan. To inform the government’s major conditions strategy and Labour’s health mission, meeting these five tests would show political leaders are serious:

1. Drive health from the centre of government

Bold leadership from the Prime Minister championing the cause of a healthier Britain – and acknowledging the responsibility of government – is necessary. But we have learned that rhetoric is insufficient without bringing the whole of government with you. Looking at the net-zero ambition as an inspiration, a well-defined and measurable new health goal should be set that is scientifically robust, publicly relatable and practically actionable. The Health Foundation is commissioning a new set of health equity targets. We will also consider whether a statutory framework could give them stronger teeth.

2. Coordinate action across government departments  

A national strategy must be turned into action through the internal machinery of government.

Signs of serious coordinated progress would include a Cabinet committee reporting back to the Prime Minister (another plan that has been dropped), and a dedicated central unit to coordinate strategies, model the impact of policy options and report against progress. Central government-led initiatives have a mixed history but have at times succeeded in driving concerted, short-term focus on key cross-cutting priorities from rough sleeping to business burdens. We will work with partners like the Institute for Government to draw the right lessons from recent experience.

3. Create a strong independent watchdog  

There is much to be learned from climate change as another existential policy challenge requiring action across the whole of government and the wider economy. One factor behind the comparative momentum on net zero has been the external expertise and independent scrutiny provided by agencies like the UN Intergovernmental Panel on Climate Change, the Treasury-commissioned Stern Review and the statutory UK Climate Change Committee that sets and reports on the carbon budget. While politicians can game targets and skip committee meetings, external authorities can hold government’s feet to the fire and maintain a longer term focus. A similarly independent health equity watchdog, focusing on working-age health, could create a movement for change across government, statutory and voluntary services and the private sector.

4. Embed the value of health and wellbeing

While targets, units and inspectors can drive, coordinate and scrutinise short-term action, the long-term aim is to bake health into the bricks and mortar of government decision making so that it is as fundamental as balancing the books. The Treasury could set budgets that ringfence investments in both physical infrastructure (eg railways and power stations) and human capital (eg skills and workforce health), as a down payment for future productivity rather than a day-to-day cost. The Office for Budget Responsibility, having brought fiscal discipline into the centre of government, is now ripe for updating to rebalance towards the health of the workforce and wellbeing of society. The Biden White House explicitly pitched its budget for childcare as an economic investment and this thinking was reflected in Jeremy Hunt’s announcement last week.

5. Devolve powers and resources to invest in health locally

A final test is for health to be a key aim for localism as well as a focus for central government. The current national health mission aims to close the 10-year gap in healthy life expectancy between the richest and poorest local authority areas. Achieving this would require coordinating resources to address the building blocks of health identified locally – be they safer, greener neighbourhoods or quality housing. This will need more funding but should be seen as a long-term investment not a short-term cost.

The Health Foundation has invested in partnerships with local government and combined authorities to show the way. The strategy must avoid over-centralisation through direct performance management or Whitehall funding pots. It must also be prepared to pull national levers where these have the biggest impact, including tax and welfare, planning laws and regulation. A more meaningful target could aim to close the even-wider, nearly 20-year health gap experienced by the poorest small areas, including coastal towns and inner city estates that are outside the poorest larger, local authority areas. This raises the stakes for devolution and requires both broader and more targeted investment in levelling up.

Political leaders are rightly aiming to improve and level up the population’s health as a societal and economic goal. The government’s major conditions strategy and Labour’s health mission need to address national economic and social challenges and empower local places. Our country is being held back by sickness but there is no shortage of ideas for investing in health as an asset. Meeting these five tests would show the political will and action required to drive the economy powered by a healthier population.

Joe Farrington-Douglas (@joefd) is an Interim Senior Policy Fellow at the Health Foundation.