Read: Levelling up at risk if health inequalities are not addressed

The jury is still out on the Government’s plans to tackle health inequality in the UK.

Health Secretary, Sajid Javid, had already promised a new approach to public health in order to address the ‘disease of disparity’. The recently published Levelling Up White Paper clearly acknowledged that health inequality continues to be an insidious problem. Both a cause and effect of social inequality, it undermines economic productivity. The pandemic has exacerbated many of the poor health outcomes that were already entrenched in the most disadvantaged communities, with higher infection and mortality rates.

The White Paper also recognised the fundamental links between health, education and skills and their ability to improve human capital. And how those elements must work together to boost the country’s wider economy, and the prosperity and well-being of its people. It also acknowledged that the most effective outcomes will be achieved by working across government departments and with third sector partners. The cry for cross-government working is most certainly not new but has rarely been effectively achieved, to the frustration of many. We now have to see real action and a commitment to make this a reality in a way that hasn’t been seen before.

There were some positive indicators of the Government’s commitment to start that work now. There is an ambitious target to narrow the gap in Healthy Life Expectancy (HLE) between the highest and lowest areas by 2030 and increase Healthy Life Expectancy by five years by 2035.

Plans were confirmed to address one of the major drivers of ill health – poor diet and obesity. There are strong links between areas with the worst current health outcomes and those with the highest smoking and obesity rates – for example, smoking rates in England range from 8% in Richmond upon Thames to 23% in Blackpool. There also tends to be higher rates of obesity in towns and cities in the North of England and coastal communities which have particularly poor health outcomes.

There were further announcements on: a National Food Strategy White Paper to help everyone access, understand and enjoy the benefits of a healthy diet, including a new approach to school food standards; there will be a Tobacco Control Plan to reduce smoking in the most disadvantaged areas; and plans were announced to set up at least 100 Community Diagnostic Centres in England by 2025, mainly outside London and the southeast, improving access to diagnostic services to increase better outcomes. 

The current Government, like many before it, has recognised the complexity and size of the problem but the overall strategy for tackling it will be crucial. That is set to be revealed in a White Paper on Health Disparities in England, due later this year, which will present plans to reduce the gap in health outcomes, with a particular emphasis on prevention and disparities by ethnicity, socioeconomic background and geography.  

Action is long overdue and the need is urgent. NHS England recently revealed that a record number of people – 6.1 million – were waiting to start treatment in December 2021, the highest since records began in August 2007. The number having to wait more than 52 weeks to start their treatment was 39% higher than a year earlier. Waiting lists were growing even before the pandemic and, with people then delaying seeking medical help, figures are expected to grow.

Further evidence - if it was needed - of the differences experienced by communities was revealed in a recent Health Foundation report which found those in poorer areas faced worse GP services, with fewer staff and less funding. A GP practice serving the most deprived populations was, on average, responsible for almost 10% more patients than one in an affluent area. Those patients also tended to report a poorer overall experience and worse quality outcomes. It comes in the same week as NHS England reported that GP ‘advice and guidance’ requests  doubled in 2020/21. Two thirds did not need to be referred on for secondary care – good news for the individual and for hospitals – but if GP practices are to continue to fulfil this role in reducing the NHS backlog, they will need to be adequately resourced.

That dismal cycle of disadvantage – when people who most need health care are least likely to receive it – is a clear illustration of why levelling up health in this country matters so much. Individuals cannot take advantage of opportunity if they have poor physical or mental health, they are less likely to train or retrain, find and progress in rewarding jobs, and they are less likely to make a positive social or economic contribution to their communities.  The 12 missions set out by the Government in the White Paper will all be undermined if progress is not made on addressing health inequality. The failure to do so will risk stalling the Government’s wider levelling up efforts.

By Rt Hon Anne Milton