Health inequalities in 2040: future governments will need to think locally when designing policies Q&A with Steve Webb and Jonathan Pearson-Stuttard

What do the projections mean for the government’s ambition to tackle health disparities?

Steve:

All the data we've seen to date, including in this new report, suggests that despite the government’s focus on levelling up, it’s simply not happening yet on any meaningful level. That’s not surprising because a lot of the causes of health disparities are really deep seated and not amenable to a quick fix approach.  

A lot of this is structural, and without preventative action things could get worse. Any future government will need to commit to long-term interventions to tackle health inequalities and be willing to think locally when designing policies.  

Jonathan:

Absolutely. The report shows that 80% of the projected increase in major illnesses in working-age adults will be in the more deprived areas. That will have a big impact on the local economy.

And ​​the more you drill down to small geographical areas, the more unequal it gets when it comes to how long people can expect to live in good health.

Most factors driving those inequalities sit well outside the power of the NHS – whether that’s preventable risk factors like smoking, or broader social determinants of health, such as education, and housing. The only way we will get on top of inequalities is by shifting towards a more preventive approach. And that's much easier for current or potentially incoming governments to say than it is to actually do.

What concerns you most about the UK’s health in 2040, based on the Health Foundation’s projections, and why?

Steve:  

Growing prevalence of long-term health conditions obviously increases demand on health and care services, but it also has significant implications for the number of people who will require financial support from the state. We know that the longer you are on a benefit, the longer you are likely to stay on it, so I’m concerned about how this might impact at two different ends of the age scale.  

Firstly, people in their early 60s. At LCP we published a report last year showing that unless steps are taken to improve the health of working-age people, a significant number risk spending a decade or more in retirement in receipt of disability benefits. That would mean a substantial growth in the UK’s benefits bill. Our report showed that without action, the total number of pensioners on Personal Independence Payments or Disability Living Allowance is likely to rise by around 60% in the next decade – taking the total cost, in current price terms, from around £6bn to £10.5bn.

Secondly, and perhaps more worryingly, is the young people at the very start of their working lives who are already in receipt of benefits. Without relatively early intervention, people can stay on benefits forever.  

What steps need to be taken to close the gap in widening health inequalities in the UK? 

Jonathan:

I think there's still a window where we can intervene with preventative approaches. Otherwise, we’ll end up with a huge group of people who are left behind due to their health conditions. That will have implications for them, but also for their local economies and for society as a whole.

One key thing will be finding a way to routinely measure progress across all the drivers of health inequality. Currently, even when you look in health policy documents, there’ll often be a direct quantified target for something like reducing smoking in the population, and then something vague about reducing inequalities. There's never a quantified target. We need a unit of currency that can help us understand both what the current problems are, and how to prioritise action.  

That’s why initiatives like the ONS Health Index are so important. They measure some of the things that affect health that are outside the sphere of control of the NHS, but very much within the remit of other government departments, including education, work and pensions and transport. This data can help all parts of government do their bit to improve the health environment which will then improve the stock of health and prosperity.  

With the knowledge we have of these projections, what do you think leaders need to do to prepare for the implications, especially in more deprived areas, for the working-age population?

Steve:

We need to do what we can to keep people in work. It’s about moving away from the traditional job centre model. There’s now a growing recognition that the barriers to work are often much more complex, including health-related issues, among other things, and that people need more tailored support.  

There are some relatively cheap preventative interventions which come at a fraction of the cost of someone getting stuck on benefits for 20 years. Personal support workers, for example, can stand alongside people who’ve got stuck in economic inactivity and help them navigate the system and get the support they need, medical and otherwise. This tailored individual approach can reap rewards – both for people’s mental and physical health, but also for the local economy.  

There’s early evidence from pilots that some of these interventions are quite effective. But inevitably the Treasury is often sceptical of this approach to ‘spend to save’, especially when the money comes out of different pots. More evaluation is needed to prove that these approaches do actually save money and have a positive impact on the wider economy.  

Employers have an important role to play too. We know that in the future there won’t be as many younger people available in the workforce. Attitudes to employing older people will have to change as there’ll be a new commercial imperative to become an attractive workplace for people in their 50s or 60s. And as older people are more likely to have long-term health conditions, employers will have to learn how to be better at providing the appropriate support.  

Jonathan:  

I think there’s more we could do to use the data we have about working-age people who receive benefits to work out where and how to provide focused support. What are the main long-term health conditions behind the claims? And what preventative work can we provide to others with that condition earlier on, to avoid them being in the same position later where they feel they have to give up work?  

One example of this is that for someone with type 2 diabetes, it’s possible to spot six or twelve months out who is on a downward health trend and finding it difficult to manage their glucose levels. If left unchecked, that will lead to significant adverse health effects. It’s very predictable. But as this example of work with type 1 patients shows, with the innovative technologies we have now for continuous glucose monitoring, one nurse can follow large numbers of patients in real time and provide focused support to those who are struggling the most. A similar approach with type 2 patients could produce interesting results. This is another area where evaluation will be key to show the Treasury that this kind of intervention is spend today that really does help us save tomorrow. 

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