Prosperous communities are built on good health. And good health needs strong neighbourhoods with employment opportunities, good transport links, safe accommodation and accessible green spaces, alongside access to health care. When these building blocks are missing or damaged, stark health and wealth inequalities occur.
We can see evidence that healthy life expectancy in England – after a century of gradual improvement – is declining in some of our most deprived areas. Unfortunately, this doesn’t come as a surprise; it is part of a concerning national narrative of entrenched health inequalities.
Recent Health Foundation analysis shows that life expectancy for men living in the poorest areas of England is 74.1 years compared with 83.5 for men in the wealthiest areas. And life expectancy for women in the poorest areas of England is 78.7 years compared with 86.4 years for women in the wealthiest areas. This stark divide has significant health costs while perpetuating regional imbalances in economic growth.
Improving people’s health is vital in promoting prosperity and ‘levelling up’ between and within regions by increasing economic participation – a topic the chancellor will likely focus on in this month’s spring statement.
We know it doesn’t have to be this way. Early findings from research funded by the Health Foundation suggest that devolution in Greater Manchester has had some impact on life expectancy, particularly in more deprived areas.
While more research is needed on the impact of devolution, combined authorities are in a unique position to take brave and bold action to shape and drive policy to improve health and tackle health inequalities at a regional level, using the powers devolved to them by the Government.
Elected mayors and combined authorities must be at the heart of work to improve health and wealth. While councils hold many levers to improve the health of their residents, more structural influences on health – employment opportunities, transport, spatial planning etc – are often shaped at the regional level. This provides a platform to create opportunities to improve health and increase economic participation.
Recognising this potential, the Health Foundation is funding a major new £1.6m programme to support combined authorities to make the most of the levers they have to bolster their capacity to improve health.
The West Midlands Combined Authority will lead the programme and work with other combined authorities and the Greater London Authority to drive action to shape and drive policy to improve people’s health. They will do this by providing direct support, advocating for all the combined authorities, and offering support to the authorities involved through consultancy activity.
A learning partner will also be commissioned to bring together and distil the key insights for regional and local government and their partners.
This programme will build on the previous three-year Cities Health Inequalities programme funded by the Health Foundation. It was led by the Greater London Authority and began exploring how combined authorities could use their newly devolved powers to improve health and reduce health inequalities.
The programme enabled those working in combined authorities to identify new opportunities and share learning on action already taken. During this period, the landscape changed, with interest growing in creating further combined authorities, alongside heightened awareness of health inequalities through the Covid-19 pandemic.
Devolution remains very much part of the political conversation. Bespoke regional devolution deals already cover more than 40% of the population, and there is a Government commitment to offering a devolution deal to any area that wants one by 2030.
We have seen negotiations to devolve power to more English regions in the 12 months since the Levelling Up White Paper was published. Trailblazer deals are being negotiated to extend the powers of the metro mayors in Greater Manchester and the West Midlands.
Devolution commands cross-party support, and the Commission of the UK’s Future report, led by Gordon Brown, places it firmly on the Labour policy agenda.
Strong networks, clear learning on how to act and ways of embedding new practices will be crucial to capitalise on the opportunities created by devolution. We hope this new programme supports the metro mayors and combined authorities to make the most of their powers to build healthy, prosperous communities.
Sign up for more information about the Health Foundation’s work on regional and local government at https://www.health.org.uk/form/local-government.
Katherine Merrifield and Gwen Nightingale are assistant director (job-share), Healthy Lives Team at the Health Foundation
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