Annex A: Policy areas to improve health equity

Table A1 lists evidence-based policies that can be taken to increase health in populations. The list was developed from the research and consultation previously mentioned. Our future work will further explore high-impact health improving activities and also cost-effective interventions through the public health grant.

Table A1: Evidence-based policies that can improve health with estimated costings

Rationale for action

Policy proposals


Enabling all children to have the best possible start in life

  • Childcare can indirectly influence family health through improved employment outcomes for parents, such as increased hours and flexibility
  • Early years are the foundation for social, intellectual and physical development and can determine future health and wellbeing
  • Financial resource affect i) parents’ ability to provide a child with quality housing and diet, as well as learning materials and social enrichment, and ii) the amount of economic stress a parent will face, which impacts on parenting abilities and contributes to parental psychosocial and physiological problems (the financial stress model)

Lift 350,000 children out of poverty by reinstating the £20 uplift to Universal Credit and extend to those on legacy benefits (CPAG)

£7.5bn per year

Offer universal 30-hours free entitlement to childcare, and provide comprehensive wrap-around childcare through extended schools, prioritising implementation in disadvantaged local areas (Sutton Trust)

£0.26bn per year

Greater investment in preventative early years services by restoring funding to Sure Start levels

£0.9bn per year

Levelling up life chances

Education affects health in indirect and direct ways:

  • Indirectly, higher levels of educational attainment are associated with better employment outcomes, and consequently higher earnings and income. For example, the IFS estimate that the net financial value of an undergraduate degree over the life course is between £100,000 and £130,000 on average
  • Directly, education is also associated with higher levels of health knowledge and literacy. It is also associated with a greater sense of control and self-efficacy, which can help mitigate against the effects of stressors

Levelling up educational attainment by increasing the pupil premium to historic levels (around 10%)

£0.2bn (Health Foundation estimate)

Enduring financial settlement for further education and sustained investment in further education through either meeting Augar Review or reversing spending cuts (Auger Review)

  • Augar: £0.3bn–0.6bn per year;
  • Return to historic high: £3.8bn per year (Health Foundation estimate)

Great places to live and work

  • Work can affect health directly and indirectly. Indirectly, employment is a major determinant of income, which also influences health. Directly, the absence of employment can act as a stressor, encourage harmful coping behaviours, and deprive people of the health benefits offered by good employment. Poor-quality employment can pose a health threat equivalent to unemployment, if the job lacks the assets that allow demands/stresses to be met or lacks sufficient reward
  • Housing quality and security can also affect health. Cold, damp or mouldy homes can directly affect respiratory and cardiovascular health, particularly for children and older adults. Housing affordability and security can act as a stressor, whereas lacking a stable home through homelessness is associated with much worse health outcomes

Improving access to safe and quality housing and the introduction of a Healthy Homes Bill requiring: minimum space for good living, year-round thermal comfort, proximity to health assets such as green space, low carbon emissions, and be climate resilient (Town and Country Planning Association)

Minimal direct cost to government

Improving access to safe and quality housing through a one-off £20bn investment in social housing over 10 years (National Housing Federation)

£20bn over 10 years

Reduce homelessness through sufficient funding of policies to implement the Homelessness Reduction Act

£0.05bn (Health Foundation estimate)

Connecting the country, creating opportunities

Transport influences health through four main channels: active travel, air and noise pollution, road safety and social exclusion:

  • Active travel can increase physical activity and minimise time spent sitting down, helping maintain a healthy weight and reduce the risk of long-term health problems
  • Outdoor air pollution is associated with premature mortality and increased risk of hospital admissions from respiratory disease, lung cancer and cardiovascular illness
  • Road collisions are a major cause of preventable death, serious physical injury and psychological trauma
  • A transport system that is easily accessible, reliable and affordable enables access to work, friends and family, as well as health-supporting facilities

Ensure every local transport authority is in a statutory enhanced partnership suggested in the Bus Back Better strategy (Department for Transport

No direct cost to government

Devolve spatial planning powers, and control over transport, rail services and funding to local authorities and metro mayors to allow them to create more efficient and affordable transport plans (Centre for Cities)

Cost for Greater Manchester estimated at £134m for buses

Ringfence 10% of the central government transport budget to be spent on active travel, with the priority focused on more deprived areas (Walking and Cycling Alliance)

Potential reallocation increases budget by up to £1.58bn per year (Health Foundation estimate)

Local authority planning to focus on low carbon neighbourhoods, with an aim to ensure that people live within a 20-minute walk from everyday services and needs (Sustrans)

No direct cost to government

Health and the environment

  • The presence of air pollution (eg high levels of particulate matter and ozone) has been associated with increases in all-cause mortality and hospital admissions, with a direct effect on physiological health through eg tissue damage or as irritants
  • Environmental assets (such as green space) or environmental risks to health (like off-licenses) are thought to influence health by conditioning behaviours: making it easier to exercise or to buy alcohol; reducing the cost of a given behaviour; or by providing visual or normative cues for the behaviour. Green space can also mitigate the effects of air pollution and mitigate flooding, noise, and high temperatures
  • Climate change can influence health through a range of mechanisms including increased summer mortality, patterns of infection, and food and water supply disruption

Improving local green space through factoring in early to local authority funding plans and increasing social prescribing of green space activities (Public Health England)

England parks spend is 30% below the historic peak. Future Parks Accelerator suggests a £5.4bn spending programme plus £0.28bn annual maintenance

Reducing air pollution through more clean air zones and allowing local authorities to close roads when air pollution levels reach a certain threshold (Taskforce for Lung Health)

Net cost to administer, including set-up costs of around £20m and running costs annually of between £41m and £81m for London and five other areas

Achieving net zero by 2050 (based on early action scenario from OBR fiscal risk report)

Public sector spend of average £12bn a year over 29 years

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