With the first inquiry session of the Levelling Up Commission taking place on 13th March, on the topic of Health and Social Care, we take a look at what we know about health inequalities in England, and their place within the levelling up agenda.
Levelling Up and Health Inequalities
Improving health inequalities is indeed a stated aim of the levelling up agenda, and indeed it should be. Insofar as levelling up is about equalising opportunity across the UK, health inequalities are a major barrier to this, that must be addressed.
However even the keenest observers of the work of the Department for Levelling Up, Housing and Communities (DLUHC) could be forgiven for forgetting or indeed not noticing this.
One of the medium-term missions stated in the Levelling Up White Paper is to “spread opportunities and improve public services, especially in those places where they are the weakest”, with a particular focus area on health. Here, the government aims to ensure that by 2030, the gap in Healthy Life Expectancy (HLE) between local areas where it is highest and lowest will have narrowed, as well as ensuring that HLE has risen by 5 years by 2035.
Without much indication of how much they want this gap to close by, this is hardly the height of ambition. Yet, there is clearly a distinct lack of focus on hitting even this low bar. While the Levelling Up White Paper promised a further white paper on health disparities from the Department for Health and Social Care, this was scrapped and replaced with the Major Conditions Strategy (which the Government states will seek to address regional disparities in health outcomes).
When this will be published, is anyone’s guess.
Health Inequalities: What do we know?
Most available indications show that health inequalities are growing rather than shrinking. A report from Health Equity and the Health Foundation found that, ten years on from the Marmot Review, health was getting worse for those in the most deprived communities, and health inequalities were increasing. The report also revealed that, for almost all of the recommendations of the Marmot Review, the country moved in the wrong direction.
Indeed, this is supported by available data from the Office for Health Improvement and Disparities (OHID), which found that the gap in male life expectancy between the most and least deprived areas in England grew from 9.4 years in 2017 to 9.7 years in 2020, while for female life expectancy, the gap widened from 7.6 to 7.9 years.
The geographical spread of health inequalities continues to be closely linked with wider indicators of deprivation.
The above graph shows the percentage of Integrated Care Boards’ (ICBs) population in the most deprived 20% of England’s population on the Health Deprivation and Disability rank, which is party of the Office for National Statistics’ Index of Multiple Deprivation.
As Integrated Care Boards only became operational in July 2022, this graph does not give a reflection of their performance, but rather an indication of the populations that they serve.
Some of the key takeaways from these graphs:
- London continues to surge ahead: Only six ICBs saw a 4% reduction in members of their population in the 20% most deprived on the Health Deprivation and Disability Rank, and four of these were in London.
- The correlation between multiple deprivations and health outcomes remains strong: 9 out of the 10 ICBs with the highest percentage of their population in the bottom of the 20% of the health deprivation and disability rank in England are also among the 10 ICBs with the highest percentage of their population in the bottom 20% of the IMD.
- It’s grim up north: All of the 10 most deprived ICBs by health deprivation and disability rank in the North West, North East and Yorkshire or the Midlands.
Where is the action?
Simply put, despite the ambitions of the Levelling Up White Paper on health inequalities, there is little concerted focus on health inequalities at the government level. And frankly, if there is one key lesson for policymakers on this topic, it is that, without a concerted focus, health inequalities are unlikely to improve.
The lack of focus is therefore a great shame. Indeed, the reasons for acting, both human and economic are incredibly urgent. At a human level, it is simply unconscionable that inequality is killing at the rate that it does. Economically, with an incredibly tight labour market, and sluggish growth, health inequalities and long-term sickness are a growing cause of economic inactivity.
The Levelling Up Commission will seek to re-establish a proper focus on health inequalities within the levelling up agenda, as well as considering other areas of public service design and delivery, including:
- Housing and Homelessness
- Education, Skills and Training
- Crime, Justice and Rehabilitation
About
If you would like to attend the virtual inquiry session, you can register for the event here.
If you want to know more or to get involved with the Commission, please get in touch at shivani.sen@chamberuk.com.
This article was supported with data insights from Vuit. To find out more about Vuit, click here.