Is the government’s levelling up approach likely to support better health?

While there are encouraging signs, the approach laid out so far is partial, not yet comprehensive and coherent, and measures to improve health do not feature strongly. The ways in which new investment to boost infrastructure, innovation and technical skills might act to improve health in areas of the country that are most in need of levelling up has not been made explicit. Nor does there yet appear to have been consideration of how any new spending might link to existing government programmes with similar objectives.

Lack of focus on health

The plan for growth acknowledges a link between health and how prosperous a place is, and observes that differences in levels of human capital between places and regions (including health) are an ‘important explainer of differences in regional outcomes’. It also recognises that good health and education determine life chances, wellbeing and social connection, promising to ‘strengthen vital public services’ to address disparities. The NHS is mentioned mainly as a recipient of future investment, with its potential to contribute to inclusive local economic development unexplored, and its role in addressing wider determinants of health beyond care undeveloped.

Initiatives are firmly tilted towards boosting financial/physical infrastructure capital. As noted by the Commission on Civil Society, the top five programmes announced by value (worth £150bn) are all investments in physical infrastructure such as transportation, housebuilding and broadband, compared with just £8.7bn of levelling up funding allocated to programmes linked more directly to social objectives.

Investment criteria excluding health

In the prospectuses for the three main investment funds noted in Box 3, good health is hardly mentioned as an asset to be developed. Measures of health are not yet influencing the initial allocation criteria for these levelling up funds, even as a secondary objective.

For the Levelling Up Fund, all local authority areas in England have been grouped by priority according to the criteria set out on Box 3. Those that have been selected into the highest priority group (priority group 1) do not have the greatest health needs: lower tier local authorities (LTLAs) in priority group 1 are in the least deprived half of the country and have above average male healthy life expectancy. Only three LTLAs in priority group 2 are in the country’s most deprived fifth and have below average male healthy life expectancy. 11 of the lower tier local authorities in the government’s lowest priority group 3 are also located in the most deprived half of the country and have below average male healthy life expectancy – see Figure 1.

Source: ONS, local authority healthy life expectancy, 2009–2013; MHCLG, English indices of deprivation, 2019, DfT, HMT, MHCLG, Levelling up Fund list of local authorities by priority category, March 2021.

Figure 2 compares the priority grouping used for local authorities in England to receive the Levelling Up Fund, against male healthy life expectancy for those areas. The 30% of local authority areas in England with the highest score were in priority group 1. Of the 93 local areas with male healthy life expectancy in the lowest 30% for England, only 58 are included in priority group 1. In other words, there are 35 local authority areas with very low healthy life expectancy that are not a priority for investment via the Levelling Up Fund. Prioritising funding based on criteria that also takes into account population health would lead to a significantly different allocation of funding.

Source: ONS, local authority healthy life expectancy, 2009–2013; DfT, HMT, MHCLG, Levelling up Fund list of local authorities by priority category, March 2021.

Centralised focus and an underplayed role for local government

Much of the agency to regenerate local areas and to improve health (for example through better housing, education and early years support) rests with local government. But rather than receiving long-term investment to level up based on a broad assessment of local need and assets, local authorities are required to compete for various pots of central funding for infrastructure, with funding distributed based on centrally-decided criteria.

The pitfalls of relying on a centralised competitive process have been recognised by the Industrial Strategy Council (ISC) and the Business, Energy and Industrial Strategy Committee in its recent report Post-pandemic economic growth: Industrial policy in the UK. As well as noting that too many of the plan for growth’s initiatives are unconnected and spread thinly, the ISC has raised concerns that a competitive approach could ‘limit the scope for co-creation between national and local actors’ and generate an uneven playing field by ‘disadvantaging those areas with least capacity and capability to mount a successful bid’. The Local Government Association and Institute for Fiscal Studies have also warned that a complex array of funding pots could duplicate efforts to write bids and lead to a disjointed result.

A centralised approach also appears to run counter to the direction of policy taken in previous years of devolving powers to local government, for example through greater autonomy for metro mayors and city regions. A ‘Devolution and Recovery’ Bill addressing the powers of local government in England was promised in the 2019 Conservative manifesto, blown off course by the pandemic, and is now set to be included in a forthcoming levelling up strategy.

In the absence of progress on this, local authorities and combined authorities/city regions with metro mayors have to varying degrees developed their own plans for improving prosperity – in part based on the government’s previous industrial strategy. The plan for growth also does not mention a role for Local Enterprise Partnerships (LEPs), and the status of Local Industrial Strategies (a central plank of the 2017 Industrial Strategy) is currently unclear. This is despite the potential for local industrial strategies to be an effective vehicle for government investment, and to provide a platform for more inclusive economic development geared towards improving health and reducing inequalities.,

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