LEVELLING UP HEALTH INEQUALITIES

RT HON ANNE MILTON IS A FORMER PARLIAMENTARY UNDER-SECRETARY FOR PUBLIC HEALTH AND MINISTER OF STATE FOR SKILLS AND APPRENTICESHIPS WHO IS WORKING ALONGSIDE RT HON JUSTINE GREENING TO LEVEL UP BRITAIN. HERE, SHE REFLECTS ON THE PUBLICATION OF THE FIRST NATIONAL HEALTH INDEX AND THE NEED TO LEVEL UP PUBLIC HEALTH.

The first official national health index for England was revealed recently with Wokingham named the healthiest place in the country and Blackpool ranked the least healthy. Towns and cities in England were ranked by combining different health factors such as dementia, cancer, alcohol misuse and adult obesity. The index was created by the Office for National Statistics alongside financial services company Lane Clark & Peacock and it is thought to be the first composite health index in the world. The results revealed a stark north-south divide. Wokingham is at the top of the list, followed by Richmond upon Thames and Windsor and Maidenhead. In contrast, Blackpool has the lowest score, below Hull and Stoke-on-Trent. Northern towns Middlesbrough, Hartlepool, Knowsley, Doncaster, Nottingham, St Helens and Salford make up the rest of England’s ten unhealthiest areas. The numbers reveal clear and substantial differences across England and should be a wake-up call for the Government to deliver on its manifesto pledge to level up. Inequalities in the public’s health are not new and while there is no doubt there has been an overall improvement generally in the public’s health, the inequalities have persisted despite the best efforts of successive governments. The figures on where the so-called healthiest places are found will not come as a surprise to those working in the public health sector and should not be a surprise to anyone in government. The need to level up the public’s health is beyond doubt and long recognised by many governments. But it has frequently ended up in arguments about how much the state should interfere in what individuals choose to do, or whether it is anyone else’s business how people choose to live their life. The recent pandemic has given us an opportunity to relook at how we might approach the big disparities in health. It is often a surprise to me that even if most public health measures pass people by, that the disparity in life expectancy does not cause more concern - research shows that the increase in life expectancy has slowed significantly since 2011. Even in areas where the public’s health is at its best, small differences at council ward level can see life expectancy vary by as much as eight years. There are many, and sometimes compounding, factors that affect life expectancy - housing, environment and poverty are but a few. If the Treasury needs an additional impetus for coming up with funding then they should note that education is good for your health. Good health correlates closely with good educational achievement and the two must be addressed with joined-up thinking and policy-making. The case is rarely made by education providers but as Professor Sir Michael Marmot stated in his report, Health Equity in England: The Marmot Review 10 Years On, health inequalities are growing. The report cites the particularly steep decline in funding for sixth form (post-16) and further education and goes on to talk about improving access and use of quality lifelong learning. One of the report’s recommendations is to increase the number of post-school apprenticeships and support in-work training throughout the life course. At a time when the health of the public is at the forefront of everyone’s minds, the need for greater public health spending should be obvious to the Treasury. There is also a wealth of evidence out there, from City & Guilds Group among others, that re-skilling through Covid-19 and beyond should be a priority. The stats currently paint a grim picture - six million adults are not qualified to Level 2, nine million adults lack functional literacy or numeracy and over 11 million do not have the full set of basic skills. Hidden within these numbers are stark regional differences and inequalities which are well documented in the Marmot reports. For the UK Government there is a strong economic case for levelling up the public’s health. For individuals there is tangible benefit in living longer, and living longer in good health. But for us as a society there is a moral and ethical imperative. Levelling up for those who have the worst health outcomes is surely what we should want to do? It is simply not fair that your chances of living a long and healthy life are dependent on where you are born or live.

By Rt Hon Anne Milton, former Parliamentary Under-Secretary of State for Public Health