Mission possible? The government’s overarching goal for reducing inequalities in healthy life expectancy
There is new energy and optimism in health policy. That is much needed. And while much of the public and media framing has been about a broken NHS and the ‘NHS Plan’, for understandable reasons, arguably the biggest commitment in the new government’s health policy is its commitment to tackling health inequalities.
The statement on this in Labour’s manifesto is worth repeating in full here: ‘Labour will tackle the social determinants of health, halving the gap in healthy life expectancy between the richest and poorest regions in England.’ Those few words carry potentially huge implications if followed through. But there is room for a lot of interpretation, and the former government had a not too different version that underpinned its levelling up (remember that?!) mission. We wait to see, but so far Labour’s statement appears to be a meaningful commitment.
We wait to see, but so far Labour’s statement appears to be a meaningful commitment.
There are three elements to this statement. First is the focus on healthy life expectancy (HLE). This combines two elements, the ‘H’ and the ‘LE’. The ‘LE’ was (for those with longish memories) the focus of the previous Labour government’s health inequalities policy, alongside infant mortality, so this is a change. The ‘H’ is a measure of how well life is lived, proxied by self-reported health from survey data. So we are combining an objective and a subjective measure of health. If this statement becomes operationalised into some form of target, then what is the balance of the ‘H’ and the ‘LE’, where should the focus lie, and what is possible?
The Office for Health Improvement and Disparities has looked at the drivers of HLE as a whole. The upshot is that shifting HLE significantly really means a strong focus on the ‘H’, particularly mental health and musculoskeletal health. The Health Foundation has also looked at the long-run forecast of health inequalities in 2040, with a focus on inequalities in an index of health conditions, including mental health and chronic pain. Its view is that many of these inequalities are already ‘baked in’ to future trends, and so making a difference quickly is going to be challenging. There is clearly much for the Department of Health and Social Care to consider in unpacking HLE and in closing the gap, as well as deciding where to focus, and what is feasible, by when.
The second element of Labour’s statement is the focus on the social determinants of health, and regions. Regions is not a new geography for health, which is used to dealing with different and changing geographies, but its meaning here goes beyond the regional structure of the NHS. In my view this is truly significant, and signals the connection to wider regional economic policy and devolution, as key answers to making a difference to the social determinants of health and, through that, to health inequalities. The message to the NHS and health leaders is that it’s not all about AI and personalised prevention; you need to get with the programme and get your hands dirty in what drives population health at scale in place – and that programme is devolution, economic growth (as the Secretary of State has clearly signalled), and mayors and combined authorities (see our related project on this with the Centre for Local Economic Strategies).
Regions is not a new geography for health, which is used to dealing with different and changing geographies, but its meaning here goes beyond the regional structure of the NHS.
The NHS needs to connect much more with this regional landscape than it has previously, as we and others have argued before. Look outside the walls of your buildings and to the wider context. It appears the new government is expecting you to be a much better economic and social partner than you have been used to being. That includes integrated care systems (ICSs) – and NHS England – taking the fourth principle of their creation as seriously as the other three, and the integrated care partnership (ICP) becoming as important a focus as the integrated care board (ICB).
The third element in Labour’s statement is what is missing – and that, of course, is a timescale. Is it 5 years, 10 years, 25 years? A time trajectory is needed to set an ambition, and to sift, order and prioritise action – not just what needs to happen, but also who is responsible for making it happen. The timescale clearly interacts with and, to some extent, drives the nature of the answers to the other questions above – that is, where to focus action and intervention, and through what means. The word ‘regional’ implies that this will not just be through a traditional Whitehall approach, yet that has consequences for complexity, timing and control, pushing this to a 10-year timeframe and beyond. Commitments such as this can galvanise action and effort if they become the cohering narrative (this is something the Health Foundation’s ‘Bill of Health’ work is looking at).
Unpicking, unpacking and getting on with all this is therefore going to be critical to delivering a health mission. And there are many ideas that the government can call on, including the work The King’s Fund has supported over the last year on a Covenant for Health. While we shouldn’t expect quick answers to these questions, and my interpretation may be wrong, we look forward to finding out what the new government is thinking. Our health won’t wait.
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