One political reality in particular could rise very quickly to the top of the Government's problem pile this autumn. The Conservative ‘red wall' seats won in 2019 are in areas with lower average healthy life expectancies than is the case in their traditional Conservative seats and in Labour seats.

This was highlighted by director of health at the Health Foundation Jo Bibby at a recent webinar convened by the charity, where the speakers considered what ‘levelling up' means in different places. They asked what local government needs to do to drive this agenda and looked at the barriers to making it happen. The role of national Government in enabling improving and levelling up health was also examined

Health should lie at the centre of any Government strategy to level up the economy, the Health Foundation believes. Why should the Government level up health? As well as underlining the political imperative caused by that ‘red wall', Ms Bibby says health and wealth are inextricably linked, and ‘it's not just during a pandemic when people's health affects the economy'.

What is the size of the current health inequalities challenge facing both central Government and local places? The latest Office for National Statistics (ONS) data shows a 7.7 year difference in life expectancy between women living in the 10% poorest versus richest parts of the country, and a 20 year difference in healthy life expectancy, according to Ms Bibby.

The Health Foundation has carried out analysis looking at employment patterns. This found that the employment rate for people with a work-limiting condition is 47%, compared with 81% for people without. In 15% of council areas in Britain, over a fifth of the working-age population has a work-limiting health condition or impairment.

Ms Bibby says there is a need to look beyond Gross Domestic Product (GDP) as a success measure, with the ONS ‘already starting to look at how we can bring together indicators and measure of factors that shape the conditions for healthy lives'. These cover ‘healthy people, healthy lives and healthy places' at national, regional and upper tier local authority level.

So, given the size of the challenge, and the Government's commitment to improve healthy life expectancy by five years by 2035 and close the gap between the rich and poor, what needs to be in the levelling up White Paper due later this month? She says the five tests are:

• Is improving health and health equity an explicit measure of success?
• Are local and regional government empowered and enabled to take action?
• Is the funding directed towards the places that need it most?
• Is improving health and health equity an explicit consideration of investment decisions?
• Is there visible action to support people with poor health get back into the workforce?

Greg Fell, director of public health at Sheffield City Council, says: ‘The big deal is the shift from unimorbidity to multimorbidity' – to more than two diseases or illnesses occurring in the same person at the same time – and that this is ‘more common in working age people than the elderly'.

Mr Fell points to a much younger age of onset of multimorbidity in the most deprived parts of his city and says that if the age of onset of multimorbidity is compared to retirement age ‘you can quickly see why health isn't just a health and care service issue, it's also an economic issue'.

Clearly the gap between ‘the haves and the have nots is a social justice issue and it's also a drag on economic productivity for the nation', he says.

Where do we go from here, in the context of recovery from a pandemic? ‘In previous significant economic shocks we've had an economic growth-led recovery which concentrated inequality and concentrated power.

‘Imagine if we had a health-led recovery and if we treated health as a national infrastructure project like HS2 and thought about it on similar timeframes. That would be an interesting thing to do,' Mr Fell adds.

Chief executive of Surrey CC Joanna Killian says people may have a perception of her county as being ‘a prosperous, wealthy place, absent of any need to discuss levelling up', but she emphasises that this ‘can't be a debate about London and the South East versus the North'.

She continues: ‘Across my area there is a significant difference in life expectancy and in healthy life expectancy as well. So there is an absolutely live and active debate with our residents and our councillors about what levelling up means for us'.

She says Surrey has ‘communities that suffer multiple deprivation, including extremes of health inequality, partly driven by affordability of housing'.

Ms Killian believes local government is ‘incredibly well placed' to respond to the levelling up agenda. She adds: ‘We have been working with our partners to think about the organising principles between health and social care, and with our housing partners, the police and others to be able to mobilise, to be able to respond to new health legislation that is coming, to put us into a good position.

‘This is so we understand our communities very well, address their health and care needs and also tackle the other things that drive health inequality, too.'

She is ‘anxious that we don't fall into the trap of just having a place-based discussion'.

It is about having a mindset of change, she believes. ‘If we are to deliver our levelling up agenda that must include improving health inequality. I think local government with our partners needs to put health improvement into everything we do, so that this isn't just a conversation between, say, public health professionals and adult social care professionals.'

It is about weaving into everything ‘a sense that by implementing specific strategies and actions it can improve health and wellbeing', she concludes.

‘We can tackle big climate issues, rethinking how we deliver sustainable transport and rethinking how we are going to deliver high quality housing.

‘Local government must push the need for the new strategic direction, be clear about the importance of addressing population health and tackling health inequality, and we need to do it with teeth.'

Health Foundation webinar: Levelling up health - a national strategy driven by local government