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Levelling up health: A practical, evidence-based framework for reducing health inequalities

The Covid-19 pandemic has exposed and exacerbated health inequalities. As we begin to recover and rebuild from the pandemic, it’s important that action is taken to reduce those health inequalities – closing the gap between those who experience good and poor health, and improving health for all.

• This research provides a framework of guiding principles based on a high-level rapid review of evidence to inform levelling up health.
• The framework is aimed at local and national decision makers who are responsible for shaping and guiding efforts to recover and rebuild communities after the pandemic.
• It provides practical guidance on how to reduce health inequalities at a local and regional level.
• The work has been carried out by researchers at the University of Cambridge/NIHR ARC East of England and Newcastle University/NIHR ARC North East and North Cumbria.
• The team have produced a report and framework for local and national policy makers, alongside an academic research paper.

Looking back over decades of policy impact

The work has reviewed research from 2007 onwards around tackling health inequalities at local and regional level.

It particularly highlights how previous cross-government health inequalities programmes reduced the socio-economic gap in life expectancy by six months and improved overall life expectancy. This was achieved through sustained, multi-component, and cross-government action over more than 10 years.

The authors set out five principles and eight policy recommendations that are designed to be used together long-term across national, regional and local systems.

The principles are:

• Healthy-by-default and easy to use initiatives
• Long-term, multi-sector action
• Locally-designed focus
• Targeting disadvantaged communities
• Matching of resources to need.

Each principle is supported in the report by impactful case studies, such as Healthy New Towns, the Big Local initiative, and New Deal for Communities.

Policy recommendations include:

• Health being a core part of levelling up
• Development of a cross-government health inequalities strategy
• Establishing a consensus around what levelling up health means
• A focus on the social and structural factors that determine health.

‘Healthy by default’ – make it easy

The report recommends a move away from initiatives that require individuals to invest time and effort to benefit from, such as promoting gym membership, because they tend to increase inequalities. Rather, the researchers recommend initiatives that make healthy choices the default and require minimal effort from the individuals, such as fluoridation of water and opportunistic screening for health problems during vaccine appointments.

Funding based on need

The report also calls for an end to competitive bidding of local areas to allocate public funds. Instead, it recommends allocating funding based on population need.

Report co-author Professor Clare Bambra, Newcastle University and Inequalities Lead for the NIHR ARC North East and North Cumbria, said:

“Levelling up needs to urgently focus on health inequalities by addressing the unequal conditions in which we live, work and age. For too long, a lack of investment in key services has meant that more deprived, ‘left behind areas’ – particularly in the north – have suffered disproportionately. The Covid-19 pandemic has worsened these inequalities and it will cast a long shadow across our future heath and economic prosperity as a country unless we act now. That’s why levelling up health is so central to the government’s overall approach to levelling up the country.”

Dr John Ford, lead author and Clinical Lecturer in Public Health at the Primary Care Unit, University of Cambridge and NIHR ARC East of England, said:

“The new guidance has been produced to show how to level up health. We already know that progress on closing the gap is possible. The previous cross-government health inequalities programme reduced the socio-economic gap in life expectancy by six months and improved overall life expectancy. This was achieved through sustained, multi-component, and cross-government action over more than 10 years.”

Background to the report

Health inequalities in England mean that men and women in deprived areas live an average of ten and eight years less respectively than men and women in more affluent places. Area-level health inequalities like these are driven by the conditions in which we live. Education and employment opportunities, housing, opportunities for exercise and a good diet are just some of the factors that directly affect our health.

Left-behind neighbourhoods, which have not prospered as much as other areas, experience greater health inequalities and the health of disadvantaged areas in the Northern regions has been falling further behind. For example, a baby boy born today in Blackpool can expect an additional 17 years of poor health compared to a baby boy born in Richmond upon Thames.

The pandemic has exacerbated inequalities, and deaths related to Covid-19 in the most deprived areas of the country are double those in the least deprived. The long-term repercussions of the pandemic for some people – food and housing insecurity, debt and poverty – are expected to disproportionally affect those living in areas of higher deprivation, causing further damage to wellbeing and health.

The researchers say that work to address area-level health inequalities is critically important for the UK Government’s levelling up agenda.

The team reviewed data from over 650 research studies and 19 published reports. The 12 case studies were selected from 143 potentially relevant examples from across England showing what works.

The research was commissioned by the Office for Health Inequalities and Disparities (OHID).

You can download the report for local and national decision makers (published September 2021) by following the link below:

Levelling Up Health: A practical, evidence-based framework

You can download the academic research paper (published in Science Direct in September 2022) by following the link below:

Levelling up health: A practical, evidence-based framework for reducing health inequalities – ScienceDirect