Levelling up health: what cross-government action is needed?

Why do we need to tackle inequalities? 

Louise Marshall, Senior Public Health Fellow at the Health Foundation, explains why this work is so important: 

‘We, and an increasing number of other organisations, have previously set out the need for a cross-government approach to addressing the stark inequalities in health that exist in the UK. The gap in health between people living in the most deprived and most advantaged areas of the UK has risen over the last decade, and the COVID-19 pandemic has really shone a light on this, exacerbating pre-existing inequalities as well as creating new ones.’ 

Since 2010, the increases in life expectancy seen over recent decades have slowed, particularly in more deprived areas of the UK. Inequalities have increased between regions (with a growing gap between the north and south of England) and between the most deprived and most advantaged areas within those regions. Not only do people living in more deprived areas live shorter lives, they live a greater proportion of their lives in poor health.  

These inequalities in health, and the wider inequalities in social and economic circumstances that drive them, have contributed to a high and unequal death toll from COVID-19 in the UK.  

‘As the country emerges from the pandemic, we think there is a once-in-a-generation opportunity to create the conditions that enable everyone to thrive’, says Louise. ‘To “level up” health across the UK.’

A healthy population is one of the nation’s most important assets. It’s a vital input into a strong economy that improves people’s wellbeing, their productivity and their ability to participate in society. 

Why is a cross-gov strategy needed? 

Our opportunities to live healthy lives are influenced by the social, economic and environmental circumstances that shape the places in which we live. These wider determinants of health also drive the wide differences in health across the UK.  

While health care and public health services clearly have an important role to play in levelling up health, achieving significant improvements in the population’s health requires coordinated action across a wider set of determinants at national, regional and local levels. 

‘To address the wider determinants of health we need action across all parts of government’, says Louise.  

‘And while much of the action needed sits with local government, it still requires that prioritisation, funding and support at a national level.’ 

Seven goals and 25 priorities for action  

‘At the Health Foundation, we are moving forward from our previous calls for cross-government action by looking at policies that could realistically be implemented as part of a government strategy to level up health in the recovery from the pandemic.’ 

The Health Foundation is exploring 25 possible policy actions across seven key areas: 

1. Good health at the heart of decision making 
2. Giving children the best possible start in life  
3. Levelling up life chances through education and training
4. Great places to live and work 
5. Connecting the country, creating opportunities     
6. Health and the environment
7. Strengthening the public health agenda 

Suggested policy proposals range from incorporating health and wellbeing into any measure of government success, to introducing universal 30-hours free childcare to support families into work, increasing compliance with the decent homes standard, and ringfencing parts of the transport budget to spend on 'active travel'.  

The policies have been chosen from a long list developed by reviewing evidence and reports across sectors. The focus is on activity that will get to the root causes of health inequalities, and on areas where there is likely to be greater political will to act now.

Louise says: ‘we acknowledge there’s more that needs to be done than we’ve included in our list, but our suggestions are really focusing on the things that we think are most actionable by this government in the recovery from the pandemic. That might be because there’s already movement in that direction, or because there’s an existing government strategy that can be built upon.

‘We’ve also considered how cross-government action could be delivered. Because we need to think about the mechanisms necessary to make sure big ideas are enacted and monitored on the ground. To do this, we spent time reviewing previous cross-government activity, and identifying the features that seem to be linked with success.’ 

Uniting the call for cross-government action 

Louise says: ‘we’ve developed a working paper and will be consulting with a range of groups throughout April. We’ll also be running a week-long challenge panel, which will gather detailed feedback from members of the public, and people who work with those experiencing disadvantage – ensuring we include valuable input from a wide range of sources.’ 

The Health Foundation aims to publish a final report in the summer, covering policy proposals, a cross-government model, and methods for monitoring.  

‘I hope that this will help to unite and focus calls for cross-government action on health inequalities, and that organisations across sectors will join us in calling on a new approach to levelling up health.’ 

If you would like to respond to the consultation in April, please contact louise.marshall@health.org.uk for further details. 

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.