Once is a mistake, twice is a coincidence and three times is a pattern. This saying came to mind on hearing that the long-awaited health disparities white paper is no longer going to be published. While this is not a surprise, it is nevertheless a decision that is deeply disappointing. Particularly when we know that good health remains out of reach for far too many people in the UK, that deep inequalities in health between the poorest and wealthiest are widening, and that failing to address poor health and economic inactivity will slow the economic recovery the nation desperately needs.
Back in 2021, the mood was different: there was a feeling of hope around levelling up, and we were waiting for big policy decisions about how good health would be embedded into this work. The unequal impact that COVID-19 had on different communities was plain to see, bringing with it greater awareness of the inextricable link between health and prosperity. Politicians seemed to understand the issue, with health secretary Sajid Javid saying, ‘we can only level up economically if we level up in terms of health too’. It felt like there was the best chance in years for government to put action to address health inequalities at the heart of its agenda. However, when levelling up direction was set, any detail on promoting good health and reducing inequalities was noticeably absent. This was a mistake: at this point there was a clear case for government to set out the action needed to level up health through a new cross-government approach.
Fast-forward to February 2022 and the publication of the levelling up white paper. Was this the moment for the nation’s good health to be embedded into government plans? Some progress was made, acknowledging the need to focus on reducing inequalities and improving quality of life, and there was a repeated commitment to add 5 years of healthy life by 2035. However, we were concerned about the lack of detail, money or coherency. Our analysis showed that an additional 5 years of healthy life – if pre-pandemic trends continued – would miss the 2035 target and take almost two centuries. The lack of detail was beginning to feel careless.
However, there was a glimmer of hope: we were told a new health disparities white paper was on the way.
But the pattern has continued and despite waiting, the decision has been made to shelve the health disparities white paper, instead feeding the issues into a major conditions strategy. This has removed all the remaining momentum behind the health inequalities agenda: history shows us that focusing on medical conditions means activity gravitates towards early diagnosis and treatment within the NHS. This is critical activity, but it will not address the factors that shape our health and create inequality in the first place, including our early life, the work we do and the income we earn, the education we receive and the homes and places we live in.
So what next? The decision follows delays to the tobacco strategy and the watering down of obesity measures. And while the content of the major conditions strategy is still taking shape, it does seem that action to reduce inequalities and improve long-term health has been sidelined for more visible, immediate outcomes. Is this inevitable in the run-up to a general election? Or is the government missing a trick? Our research talking to people in areas of very low healthy life expectancy in ‘red wall’ constituencies shows that the public do care about the measures that keep communities in good health.
Government could show leadership and treat our health as an asset by investing for the long-term in the wider factors that shape our health. This would build a healthier nation which enables us not only to live happy fulfilling lives, but lives that fuel our prosperity and power our economy.