It is well-evidenced that Great Britain is experiencing severe and growing health inequalities. Life expectancy is stalling and for some, reversing. At the same time the difference between the health of the wealthiest and poorest people is increasing. These are unjust and avoidable differences in the length of people’s lives and the quality of health across the population. These are determined by the social, economic, political and environmental circumstances in which people live and are largely beyond an individual’s control. Such inequalities disadvantage people, limiting their chances to live longer, healthier lives and affect the health of both individuals and groups.
People’s Health Trust wishes to see a commitment from all parties to invest in the reduction of health inequalities by focusing on social determinants of health and engaging with the foundational elements which make change possible. A joined-up, place-based approach focussing on systemic change is necessary to tackle health inequalities, with a clear vision for how to achieve this.
We call on the new government:
To develop a robust health inequalities policy which sets out clear legal targets for closing the health inequalities gap.
- This policy should place an emphasis on action addressing preventative social determinants of health and narrowing the gap in terms of both life expectancy and healthy life expectancy within a decade.
- The policy should ensure that there is robust funding for Local Authorities in England to implement preventative public health work.
To embed a fully functioning ‘Health Equity in All Policies’ approach across all government departments.
- This approach should place emphasis on upstream and preventative methods of supporting improved health by focussing on the social determinants of health across all departments of the UK Government.
- This must include a method for supporting the implementation of the Heath Equality in all Policies position and a system to audit this and to report on the progress this is driving.
To create mechanisms for long-term investment in neighbourhoods and communities where residents experience the highest levels of disadvantage across England, Scotland and Wales
- This should include the development of a Community Wealth Fund and should be achieved by using the next wave of dormant assets money.
- The investment should build on the foundational elements including supporting stronger connections within and between communities and communities being in control of decisions which affect them: two factors we know to be critical in addressing health inequalities.
- Relaxation of the laws around society lotteries, including permitting higher prizes, regardless of sales to support the growth of good causes money for grass roots causes.
Towards a robust health inequalities policy
While the NHS Long Term Plan and the green paper on prevention in the 2020s acknowledge health inequalities and indicate that some of the solutions may derive from community-led change, they do not go nearly far enough. All of the major political parties’ manifestos continue to focus on the treatment of health via increasing NHS spend, when it would be far more cost-effective to allocate funding to long-term preventative approaches achieving the conditions of real health. By taking an inclusive and joined-up approach the Government will be able to drive the systemic change needed for an enduring effect on the social determinants of health and health inequalities.
People’s Health Trust works to support the foundational elements of real health to develop, including working with some of the 30% most disadvantaged neighbourhoods according to Indices of Multiple Deprivation across Great Britain. Our funding supports progress on relevant social determinants of health, based on the things that people identify as important to them. All of our programmes place a strong emphasis on building social connections as the foundation for confidence, skills, voice and aspiration to develop growing individual and collective control that can influence local systems.
Health equity in all policies
To ensure the conditions of real health will be achieved and support health equity, a cross-departmental, health equity in all policies (HEiAP) approach is required. This should be based on a clear vision for how improved population health is going to be achieved across a diversity of policy areas, with clear health equity targets committed across departments. It’s vitally important that the HEiAP approach is championed from the top and there is clear leadership on health inequalities.
The future government could look at some of the examples emerging from New Zealand to embed a HEiAP approach, prioritising key areas and developing metrics and setting appropriate targets for each department to achieve. This should be rooted in legislation, as has been achieved in the National Assembly for Wales through the Well-being of Future Generations (Wales) Act 2015. It must also consider a method for supporting the implementation of the HEiAP position and a system to audit and report on the progress this is driving.
Creating a Community Wealth Fund
The Trust recommends that the future government should put community-based investment centre-stage in their approach to reducing health inequalities, as a cost-effective means of building the protective features of good health that come with increased connection, reduced isolation, confidence and aspiration. Findings from the Trust’s Active Communities programme suggest that just two hours of community based activity a week can have a significant impact on reducing feelings of isolation for just £122 per year, per person – or £2.35 per week.
Evidence from the Trust’s long-term Local Conversations programme demonstrates how a community-led approach is effective in strengthening social networks. Residents involved are significantly more likely to report talking to their neighbours on most days than the average for England (47% compared with 21%, 1,093 responses), based on comparison to the Community Life Survey (2017).
The Shared Prosperity report produced by the Community Wealth Fund Alliance identifies how social connection, trust and basic community infrastructure are key foundational elements for building a stronger local economy. The growth of social connections and control in neighbourhoods experiencing disadvantage play a critical role in providing the foundation for longer-term sustainable economic change.
Creating a Community Wealth Fund could be achieved by using the next wave of dormant assets money in line with the proposal of the Community Wealth Fund Alliance. This approach should place great emphasis on the foundational elements including supporting stronger connections within and between communities and communities being in control of decisions which affect them.
Increased levels of social connection lead to stronger networks and feelings of control that come from a positive local identity and regular connection to others. 81% of Local Conversations residents reported feelings of being able to make changes to their community by getting involved, compared to an England-wide average of 53%. Individual and collective agency are vital features of neighbourhood change and the future government should recognise the value of community-level economic development as a critical complement to strategic-level economic interventions.
Without due investment to the social fabric of these ‘left behind’ neighbourhoods, their economic potential will remain unrealised. The creation of, and continued investment in a Community Wealth Fund is critical to the vision of achieving real health. This funding could provide support for the on-going leadership and capacity building of neighbourhoods and achieve improvement in health equity cost-effectively and at scale.
Published on 2 December 2019, updated on 20 December 2019.
 Marmot et al. (2010). Fair Society, Healthy Lives (The Marmot Review)