The government’s strategy to level up is still under construction, with the key dimensions and the main objectives yet to be clarified. So far, announced policies and initiatives focus mainly on infrastructure, skills and innovation. While the government has acknowledged the need to ‘level up health’ and recognised its link to economic prosperity, this is not yet reflected in the targeting and allocation of wider levelling up investment – nor in a significant step change in how government collaborates across central departments or with local authorities. There is a huge opportunity now to develop a coherent strategy with a wider concept of prosperity at its core, and to include measures directly designed to improve health and reduce health inequalities as a key component.

The levelling up strategy should include a cross-government plan to act much more effectively on wider factors known to be injuring health and holding back opportunity. These include poor housing, low-quality work, support for children in their early years, and education. Such a strategy needs to be developed with local government, which will be responsible for taking action locally. Any strategy should also include much stronger central action on some of the biggest specific risk factors to health relating to diet, smoking, drug misuse and alcohol consumption – action that could include working with key businesses and major investors.

The strategy and investment should also include support to develop the role of the NHS as an anchor institution. This could cover, for example, measures to make sure the NHS can train and employ the staff needed for the future, to improve the terms and conditions of those in low-quality work, and to consider explicit subsidy to keep open NHS facilities that are a critical supplier of jobs and opportunity to local communities. Such actions should be taken over and above existing investment to boost enterprise and local regeneration through life sciences and technology.

Given the extent of government borrowing resulting from the pandemic (£303bn or 14.5% of GDP in 2020/21), there will be huge pressure to maximise every pound of investment in levelling up. Building back better must mean building up health. To do this, government carrying on as normal will not work. Without a very serious attempt to improve the health of the nation, damaged not just by the pandemic but also by pre-existing effects of austerity and structural economic change, levelling up will remain little more than a slogan. The forthcoming white paper on levelling up, and related expenditure in the Spending Review, will be a key test of the government’s commitment and strategic competence in delivering on its promises.

Previous Next