Greater devolution is needed to tackle health inequalities

We have been living with a north-south health divide for decades, and the problem is getting steadily worse. The statistics are damning. A baby girl in Manchester can expect to live 15 fewer years in good health than a baby girl born in Richmond in London, while a baby boy born in the northern city has 14 fewer years of good health than his southern counterpart. Since 1965 this equates to 1.5 million excess premature deaths in the north compared to the rest of the country.

The clear picture is that health inequalities are stark. The causes of health inequality are broadly similar across the country, but the severity of these causes is greater in the north, where added austerity measures are making the situation worse.

A major report, ‘Due North’, has been published this week with the aim exploring new ways of addressing this longstanding problem.

The outcome of an ‘Inquiry on health equity for the north’, the report was commissioned by Public Health England and led by an independent review panel of leading academics, policymakers and practitioners, including the chief executive of the Centre for Local Economic Strategies Neil McInroy.

The panel consisted of representatives from local government, economic development, public health, and the voluntary and community sector, highlighting an appreciation that reducing health inequalities involves influencing a mix of social, health, economic and place-based factors.  This is important, as health inequalities need to be addressed through more collaboration across different sectors and interests than we have seen before. It is not the just a problem for public health bodies or the NHS.

In particular we need to see health and local government working together more closely. Public health functions within local government is a good starting point but we need to go much further, with much greater collaboration between economic development and health functions.

The causes of health inequalities are complex and require detailed attention. This is what Due North has done, in particular outlining the economic and social determinants within its extensive evidence base. The consequences are severe. The more ill health there is in a place, the greater the demand for public services.

There is real potential for devolution to herald a new approach to health inequalities

based on shifting power from Whitehall to regions, local government and communities.

Public services are already under severe strain through cuts to budgets, and those places which have higher levels of need are those which are being impacted the most through public spending cuts. This ‘double whammy’ only serves to increase health inequalities. Added to this is the impact on the local economy through lower levels of productivity. Poor health is therefore a drag on the economy. Combined, all of these factors – economic weakness, strains on public services and disproportionate cuts – put struggling places at a major disadvantage, meaning they have less ability to break out of a cycle of poor health and, more widely, leading to greater levels of inequality between places.

So what do we need to do to address the issues? The report outlines a wide range of actions for different sectors, agencies and national government, both in the north and across the country. But in addition to strengthening the connection between health and the economy, one thing that particularly stands out is that it seems clear that greater devolution of powers to make the difference at the right scale, is critical.

We must use the clout of combined authorities in the north, working together and collaborating to drive a programme of devolution and investment that reduces inequalities. There is real potential for devolution (if the current rhetoric is matched by real action) to herald a new approach to health inequalities that is based on fundamentally shifting power from Whitehall to regions, local government and communities.

At the local level this needs to matched by changes in the way we approach economic development. It means combined authorities and/or local enterprise partnerships making reduced economic and health inequalities a key objective, and that this is reflected in strategy and delivery. At the moment this is not a big enough focus, with an emphasis mainly on economic growth and the assumption of the ‘trickle down’ benefits across all communities, something that, in reality, is not happening in all places.

The challenges around health inequalities are daunting, but for the sake of the economy and society we need to have a fundamentally new discussion on how we address this. Hopefully ‘Due North’ can be a starting point for this.