The Centre for Progressive Policy’s (CPP) latest analysis looks at data on life expectancy and healthy life expectancy at local authority level and models the impact that social and economic factors like income, unemployment, education, housing and crime, have on health inequalities between places. It is an update to some work we did a few years ago and it is largely based on the 2019 English Indices of Deprivation.
What it shows is that educational disadvantage is the biggest driver of differences in life expectancy and that economic drivers like unemployment and income are important drivers of differences in health.
This is important because both our health and life expectancy have been stagnating for years and both are much lower in less well-off communities. We were all reminded how much we value our own health in the Covid pandemic and at a societal level it is just as vital for inclusive growth because it enables people to reach their potential and reduces the need for expensive medical treatments.
As a thinktank, CPP champions inclusive economic growth. We believe everyone should have the chance to contribute to and benefit from economic prosperity. But at the moment we are seeing the opposite – poor health is shutting people out of the labour market amid record high levels of inactivity and huge pressure on our acute and emergency services.
So how can public services help reverse these trends, and what needs to be done differently? In the report, we’ve argued that we need to start thinking about the design and delivery of our services in a different way.
Both political parties have now demonstrated their support for expanding English devolution through combined authorities, something that CPP has long called for, in recognition of the fact that addressing complex challenges requires an approach that is tailored to individual communities and that many preventative services are delivered locally.
The growth of the mayoral combined authority model and the development of Integrated Care Systems in England present opportunities for local leaders to explicitly connect health and wellbeing with other policy areas. The North of Tyne combined authority’s wellbeing framework is a good example of how this can be leveraged in practice. The combined authority in Greater Manchester has also demonstrated the potential early benefits of a joined up local approach, with life expectancy growing more than expected in areas of high deprivation since devolution.
But a ‘local’ approach need not stop at combined authority or council level. In a recent talk for our Inclusive Growth Network, health and community power expert Dr. Pritpal Tamber argued that the communities affected by the social and economic conditions that we understand to contribute to poor health, have a role to play in determining the policies and services that address them. To support this, he suggests administrations get to know local community organisers, respond to the community’s agenda, think long term and are open to change. Through flexible funding mechanisms such as the UK Shared Prosperity Fund, some combined authorities are providing funding grants to community partnerships to support these efforts.
Integrated Care Partnerships, introduced last year to lead the design and delivery of integrated services that support local health and wellbeing, have the potential to be key forums for this kind of engagement. In October 2022, working with The Kings Fund, CPP called for poverty to be embedded into population health strategies to explicitly recognise the two-way relationship between social and economic factors related to deprivation and health. We suggested that health and care systems and their public and third sector partners jointly determine and monitor local metrics related to poverty and that they collect and share poverty data more systematically between partners.
This is not an easy task, particularly in a resource constrained environment, but national government need to recognise that investing in services to like those to support children, families, and those who are struggling with mental health issues or poor quality housing is critical for the future of our local economies.
Tensions do currently exist between different points of local leadership and accountability, but the introduction and expansion of place-based convening organisations like Integrated Care Systems and Mayoral Combined Authorities provide an opportunity which should not be wasted. We would like to see this acted on to put the social and economic drivers of health the forefront of the new local and regional health systems.
Rosie Fogden is head of research & analysis at the Centre for Progressive Policy
@CentreProPolicy
