‘Levelling up… is about improving living standards and growing the private sector, particularly where it is weak. It is about increasing and spreading opportunity, because while talent is evenly distributed, opportunity is not. It is about improving health, education and policing, particularly where they are not good enough. It is also about strengthening community and local leadership, restoring pride in place, and improving quality of life in ways that are not just about the economy.’
– Government briefing on the Queen’s Speech (May 2021)


‘Levelling up’ has become an earworm. What it means for government policy is still being worked out. Clues have come in the 2019 Conservative manifesto, the Treasury’s Plan for Growth published in March, and more recently in the Queen’s Speech – which featured levelling up as the main theme. The basic objective appears to be improving prosperity for people living outside of London and the South East. For decades economic performance and productivity across the UK has been severely lopsided, with the UK economy the most regionally unequal out of 26 developed countries.

The policies outlined so far focus largely on boosting prosperity and widening opportunity through improving infrastructure, skills and innovation. Yet as well as developing financial and physical infrastructure – for example through new hospitals and technology – investment in other ‘capitals’ is critical to our future prosperity (see Box 1). To the public, prosperity means the overall quality of their lives and local communities, not just their economic livelihood and local GDP or productivity growth.

We also know that health is a key part of prosperity. Good health is not just personal, but a collective national asset that improves wellbeing, productivity and the ability of individuals to contribute to their families, communities and wider society. In the areas of England with the lowest healthy life expectancy, more than a third of 25 to 64 year olds are economically inactive due to long-term sickness or disability. Aside from the human toll, much of this is very costly and avoidable.

Since 2010, improvements in life expectancy in England have slowed more than in any other European country. The gap in the number of years people can expect to live in good health (healthy life expectancy) has also widened between rich and poor. In Hartlepool boys born today can expect to live 57 years in good health; in Richmond-upon-Thames, 71 years. A person’s life expectancy and healthy life expectancy are closely correlated with their income and wealth, with poorer health limiting the opportunity for good-quality, stable employment, and poverty in turn associated with worse health outcomes. Improving the nation’s health and narrowing the health gap across different areas of the country, and between different groups, are a logical focus of government efforts to level up.

The government’s levelling up strategy is still under construction. A white paper is promised later this year, overseen by a new dedicated team of civil servants working across Number 10 and the Cabinet Office, and its delivery will be a focus of a resurrected Prime Minister’s Delivery Unit. There are signs the government recognises that improving health is key to increasing prosperity, as referenced in the Queen’s Speech. Matt Hancock, former Secretary of State for Health and Social Care, also stated that ‘improving the disparities in healthy life expectancy is absolutely at the core of our levelling up agenda.’

But will the government’s plan really include health at its core? And what might be the most impactful approach to level up health? In this briefing we explore what a strategy to level up should contain, examine the approach taken by the government so far, and assess whether better health is likely to be supported. We conclude by outlining some key elements that should feature in the forthcoming white paper.

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