Improving health requires action to be taken by the whole of government

The NHS is often cited as the great leveller of health, founded on the principle of providing treatment based on need rather than the ability to pay. The NHS Long Term Plan sets out its role, including that of integrated care systems, in making funding decisions that meet the needs of the whole local population and prevent ill health. But this is only part of the story. A greater influence on people’s health are the factors that shape their opportunity to stay well in the first place: the social, economic, commercial and environmental conditions in which people live. Addressing these requires action to be taken by a broad range of organisations, of which the NHS is just one.

Despite this, action to improve health continues to be seen in public discourse, and in Whitehall, as the job of the Department of Health and Social Care and the NHS. Yet evidence shows that improving people’s healthy life expectancy, and with it their ability to live a full and active life, will require continued action from across the whole of government and beyond.

Concerted cross-government action has the potential to make a bigger difference. Between 2000 and 2010 a wide-ranging and multi-faceted health inequalities reduction strategy was implemented in England. The policies led to reductions in social inequalities in the key determinants of health, including unemployment, child poverty, housing quality, access to health care, and educational attainment and an overall reduction in health inequalities. When this strategy ended, inequalities started to increase again, underlining the importance of activities continuing beyond political cycles as successive governments need to pick up where others left off. Changing these determinants and seeing the impact on healthy life and life expectancy takes many years and requires long-term planning and change. Building cross-party consensus would help to advance the work.

The current government has created an opportunity to drive the necessary cross- government action, through the levelling up agenda (including the new Department for Levelling Up, Housing and Communities) and the reorganisation of the public health system. However, maximising the potential of these initiatives will require an explicit and concerted focus on the opportunities to improve the conditions that create and maintain good health. The new Office for Health Inequalities and Disparities will play a key role in driving progress but will need the right mechanisms and strong political backing to ensure a whole-government approach.

To date, the government’s levelling up plans have a narrow focus on separate, short-term, infrastructure funds that local areas can bid for. As well as being narrow in scope, our analysis of the fund showed that some areas with either high levels of deprivation or low levels of healthy life expectancy did not receive the most funding through the fund; 35 local authority areas with very low healthy life expectancy were found not to be a priority for investment via the Levelling Up Fund. The forthcoming white paper and levelling up activity supported through the Spending Review, can redress this balance and secure the coordinated and long-term action needed.

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