We can't wait for government to act on health inequalities

Events of recent weeks reminded me of a time, in 1995, when I was working at an earlier incarnation of NHS England. One of my colleagues had been seconded to the Cabinet Office to lead a ‘bonfire’ of NHS red tape. So high profile was this piece of work at the time, he was due to present the findings to Cabinet. However, on the day he was primed to do so, John Major resigned as leader of the Conservative Party, precipitating a leadership contest (in which he ran and subsequently won).  

It’s little more than 3 weeks since another resignation put the spanner in the workings of government. This time delaying – among other things – the long-awaited health disparities white paper. Widely tipped for publication the following week, the prime minister’s resignation put it firmly back in the freezer awaiting decisions by the new government. Of course, this isn’t the first time that political instability in the Conservative Party has got in the way of public health policy. Cameron’s resignation in 2016 led to the child obesity strategy slipping through the hands of policymakers. 

This is more than dispiriting for those concerned by the stark deterioration in the nation’s health. Our evidence hub is providing regular updates on the current trends in life expectancy and the wider factors that shape this. With a cost of living crisis squeezing family budgets, it will become harder for households to afford the building blocks for good health – keeping warm, keeping up rent or mortgage payments and keeping nutritious food on the table. 

But, as history shows time and again, waiting for government action is never the best recipe for change. Rather, we need to seize the opportunities that present themselves daily to do things differently, and, as was explored in our recent podcast, harness the wider assets that sit in communities. 

This month’s newsletter provides some practical insights. First, the guest blog from Jason Strelitz, the Director of Public Health for the London Borough of Newham, reflects on their lessons from the pandemic. He describes how a seemingly simple reframing of the ‘three Cs’ model to vaccine hesitancy was able to transform how they understood the challenge of reaching communities that were not taking up the vaccine offer.    

Framing is a wider theme in the newsletter as we publish our toolkit on how to talk about the building blocks of health. Based on our long running programme with the FrameWorks Institute, the toolkit presents findings from extensive ethnographic research on how to talk about health and health inequalities to engage public attention and inspire action.   

As the contest to be the next prime minister proceeds, the last candidates standing may do well to read a recent Public First report, funded by the Health Foundation, which set out to understand attitudes among the so-called ‘red wall’ voters. In these areas, there was a recognition of the lower life expectancy they faced, and insights into the action that can be taken locally through improving green spaces and neighbourhoods to build stronger and healthier communities. It was clear that they hadn’t forgotten the government’s promise to ‘level up’. 

There were a lot of hopes pinned on the health disparities white paper. Previous government policies had signalled that this was going to be the place they would set out the actions needed to meet their levelling up promise to increase healthy life expectancy by 5 years by 2035. A lot of uncertainty must now surround not just the white paper but wider government policies.  

However, what is certain is the opportunity to act locally. As Margaret Mead said: ‘Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has.’ 

Jo Bibby (@JoBibbyTHF) is Director of Health at the Health Foundation.

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