Public health experts urge government to put health at centre of levelling up

Researchers have published practical guidance on how to reduce health inequalities to put health needs at the heart of the Government’s levelling up agenda.

Based on decades of research around tackling health inequalities at local and regional level, the guidance is aimed at central and local government as well as other agencies with a stake in improving health.

The report produced by researchers from the University of Cambridge and Newcastle University, including Fuse Associates Professor Clare Bambra, Dr Vic McGowan and Dr Sarah Sowden, sets out five principles and eight policy recommendations that are designed to be used together long-term across national, regional and local systems.

The principles are:

  • Allocating resources proportionate to need
  • Working in partnership with local communities
  • Developing long-term, multisector and cross-government programmes 
  • Offering bespoke services to disadvantaged groups
  • Ensuring initiatives are healthy-by-default and easy to use.

Each principle is supported by case studies, including 'Healthy New Towns' and 'Fit for the Future', which were both evaluated, either in part or as a whole, by Fuse researchers.

Fit for the Future

Supporting: Working in partnership with local communities

Gateshead Council shifted public health from being focused on interventions to a more grassroots approach working with communities on the issues that matter to them. Fit for the Future was originally developed as a place-based, community-led approach to address childhood obesity and wellbeing and implemented in Felling where life expectancy is lower than both Gateshead and England averages. At the time the programme was developed, 50% of children in Felling were living in poverty and 47% of year 6 children were classified as obese. Although there was a focus initially on childhood obesity, the community-led approach meant residents were able to drive the work to address issues that were important to them. The programme used a community-based participatory approach and worked with a community anchor organisation in the area whose staff are known and trusted within the community. The anchor organisation, Pattinson House, engaged with a group of local women to identify key determinants of obesity and actions needed to address them. Residents described major structural, environmental, social, and financial barriers that impacted their children’s ability to engage in activities which may be health promoting. Both parents and children described concerns over community safety which prevented children from playing outside. Reports of bullying, crime, traffic, drug paraphernalia, broken glass, fly tipping, anti-social behaviour, violence, threats, and intimidation coalesced to create an environment which resulted in high levels of stress and anxiety among residents. Pattinson House provided a safe and welcoming space for the community which offered children’s activities and opportunities for adults to develop social relationships with other members of the diverse community. For example, activities were held to encourage integration and challenge race or ethnic stereotypes among the wider community.

How the project was evaluated by researchers in Fuse

An independent evaluation of the programme led by Fuse researcher Dr Mandy Cheetham at Teesside University found that residents who engaged with the activities in Pattinson House were able to influence decisions about issues that were affecting where they lived and reported improvements to community connectedness, mental wellbeing, and reductions in social isolation.

Find more about the project in this handy Fuse Research Brief: Fit for the Future: how community-led approaches can address childhood obesity

Healthy New Towns

Supporting: developing long-term, multisector and cross-government programmes

Healthy New Towns Healthy New Towns (HNT) was a three-year (2016-19) NHS England initiative which provided resources (through a process of competitive bidding) to ten housing development sites across England to shape the health of communities and to rethink how health and care services could be planned more effectively from a whole-systems, integrated approach. Within a national context of housing shortages, there was recognition that the rapid development of new places and communities provided an opportunity to design and shape new towns so that they promote health and wellbeing, prevent illness, and keep people independent for longer. Darlington, a large market town in the North East of England, was selected as one of the ten Healthy New Towns demonstrator sites in 2016. The Darlington HNT programme was delivered by a collaboration between Darlington Borough Council (lead agency), Darlington Clinical Commissioning Group, County Durham and Darlington NHS Foundation Trust, the housing developer Keepmoat, and InHealthcare a digital health and telehealth technology provider.

How the project was evaluated by researchers in Fuse

Although to date there has been no evaluation across all ten demonstrator sites, an implementation and process evaluation was conducted independently by Fuse researcher Vic McGowan at Newcastle University and found that the programme in Darlington acted as a catalyst to accelerate the ideas and innovations that were percolating before the NHS England HNT programme was announced. It provided resources and spaces for working collaboratively across the health and social care sector and allowed stakeholders to be innovative and work through a process of testing, learning, and adapting. These spaces, for example, enabled the inclusion of HNT design principles in the local plan for Darlington which cements health within local policy in perpetuity. The case study above highlights the potential to shape healthy new places through collaborative multi-sector partnerships.

Find more about the project in this Fuse Research Brief: Darlington Healthy New Towns: evaluating the building of a healthy community

The policy recommendations include:

  • health being a core part of levelling up
  • development of a cross-government health inequalities strategy
  • establishing a consensus around what levelling up health means
  • A focus on the social and structural factors that determine health.

A move away from an emphasis on the individual 

Importantly, the report recommends a move away from initiatives that require individuals to invest time and effort to benefit from, such as promoting gym membership, because they tend to increase inequalities. Rather, the researchers recommend initiatives that make healthy choices the default and require minimal effort from the individuals, such as fluoridation of water and opportunistic screening for health problems during vaccine appointments.

Funding based on need

Furthermore, the report calls for an end to competitive bidding of local areas to allocate public funds. Instead, it recommends allocating funding based on population need.

Fuse Senior Investigator Clare Bambra, Professor of Public Health at the University of Newcastle, said: "Levelling up needs to urgently focus on health inequalities by addressing the unequal conditions in which we live, work and age.

"For too long, a lack of investment in key services has meant that more deprived, 'Left Behind Areas' – particularly in the north – have suffered disproportionately.

"The COVID-19 pandemic has worsened these inequalities and it will cast a long shadow across our future heath and economic prosperity as a country unless we act now.

"That’s why levelling up health is so central to the government’s overall approach to levelling up the country.”

COVID-19 has exacerbated health inequalities

Health inequalities in England mean that men and women in deprived areas live an average of ten and eight years less respectively than men and women in more affluent places. Area-level health inequalities like these are driven by the conditions in which we live. Education and employment opportunities, housing, opportunities for exercise and a good diet are just some of the factors that directly affect our health.

Left-behind neighbourhoods, which have not prospered as much as other areas, experience greater health inequalities and the health of disadvantaged areas in the Northern regions has been falling further behind. For example, a baby boy born today in Blackpool can expect an additional 17 years of poor health compared to a baby boy born in Richmond upon Thames.

The pandemic has exacerbated inequalities, and deaths related to COVID-19 in the most deprived areas of the country are double those in the least deprived. The long-term repercussions of the pandemic for some people – food and housing insecurity, debt and poverty – are expected to disproportionally affect those living in areas of higher deprivation, causing further damage to wellbeing and health.

The researchers say that work to address area-level health inequalities is critically important for the UK Government’s levelling up agenda.

The team reviewed data from over 650 research studies and 19 published reports. The 12 case studies were selected from 143 potentially relevant examples from across England showing what works.

The new guidance was commissioned by Public Health England.

Read the report: Levelling Up Health: A practical, evidence-based framework. December 2021

Last modified: Fri, 10 Dec 2021 16:52:44 GMT