How can the North lead the way on health equity?
Professor Margaret Whitehead
University of Liverpool
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Professor Margaret Whitehead (Chair),
W.H. Duncan Chair of Public Health,
Department of Public Health and Policy,
University of Liverpool
Professor Clare Bambra, Professor of
Public Health Geography, Department of
Geography, Durham University
Ben Barr, Senior Lecturer, Department of
Public Health and Policy, University of
Liverpool
Jessica Bowles, Head of Policy,
Manchester City Council
Richard Caulfield, Chief Executive,
Voluntary Sector North West
Professor Tim Doran, Professor of Health
Policy, Department of Health Sciences,
University of York
Dominic Harrison, Director of Public
Health, Blackburn with Darwen Council
Anna Lynch, Director of Public Health,
Durham County Council
Neil McInroy, Chief Executive, Centre for
Local Economic Strategies
Steven Pleasant, Chief Executive,
Tameside Metropolitan Borough Council
Julia Weldon, Director of Public Health,
Hull City Council
Life Expectancy: the North-South Health Divide
Source: HSCIC, 2014
Kensington and Chelsea, London
Kensington and Fairfield, Liverpool
20 minutes on Merseyrail
10 fewer years of life expectancy
Source: Barr for Due North, 2014
The Health Divide in Darlington
Life
expectancy
(years)
2007-09
Building Blocks for Good Health
MEN:
Highest
Pierremont
75
Northgate
83
72
78
82
Lingfield
Central
70
WOMEN:
Highest
75
69
79
87
Town centre
College
77
81
Park
West
82
87
Bank
Top
Life expectancy
better than
Darlington average
Park
East
Life expectancy
worse than
Darlington average
69
78
Lascelles
76
79
Station
73
75
East meets west – the scale of inequality in life expectancy in Darlington
Source: Davidson, M. DPH Annual Report 2013
Causes
Differences in poverty, power and
resources needed for health
Differences in exposure to health-damaging
factors
Differences in opportunities to enjoy
positive health factors and protective
conditions that help maintain health,
especially conditions that give children the
best possible start in life
Why now? Threats and opportunities
Austerity measures and poverty-generating welfare
reforms hit disadvantaged areas and the North the
hardest
Demands for greater devolution to do things more
effectively and equitably
Transfer of public health to local authorities
DUE NORTH: LA cuts increase with increasing
deprivation of area (IMD score)
Source: Taylor-Robinson et al, 2012
Trend in child poverty and inequalities in infant
mortality
Source: Taylor-Robinson et al for Due North, 2014
Taylor-Robinson et al BMJ 2013;347:f7157
Two types of recommendations
1. What can agencies in the North do to help
reduce health inequalities within the north and
between the north and the rest of England?
2. What does central government need to do to
reduce these inequalities?
Lessons for the whole country, not just the North
DUE NORTH: actions to tackle root causes
Rec 1: Tackle poverty and economic inequality
Northern agencies, working together:
- Linking economic growth with public service reform to prevent
poverty and promote prosperity
- Promoting living wage
- Joint spending power to promote good employment
- Improving quality and affordability of housing
Rec 1: Tackle poverty and economic inequality
Central government:
Ensure national policies reduce debt and poverty:
– Ensure welfare systems provide minimum income for
health living (MIHL)
- End in-work poverty through Living Wage
-Develop a national industrial strategy that reduces
inequalities between the regions
- Develop policy to enable Las to tackle poor condition
of housing stock at bottom end of private rental market
Rec 2: Promote healthy development in early
childhood
Northern agencies:
Monitor and Increase proportion of overall expenditure
allocated to giving every child a good start
Ensure access to good quality universal early years
education and childcare
Maintain and protect universal integrated
neighbourhood support for early child development,
including Children’s Centres
Rec 2: Promote healthy development in early
childhood
Central government:
Reduce child poverty through investment in: paid parental leave;
flexible work schedules; Living Wages; promising educational
futures for young women; affordable high quality childcare
Reverse recent falls in living standards of less advantaged families
Cumulative impact assessment of future welfare changes to
mitigate negative impacts
Increase proportion of overall expenditure allocated to early years
Make provision for universal, good quality early years edication
across the country
Rec 3: Share power over resources and
increase influence of public over decisions
Northern agencies:
Deep collaboration across Northern agencies for a new
approach to economic development and health
inequalities
Use greater devolved powers and resources to
develop, at scale, locally integrated programmes to
support people into employment
Reduce the democratic divide: develop community-led
systems for health equity monitoring, accountability,
involvement in how local budgets are used
Rec 3: Share power over resources and increase
influence of public over decisions
Central government:
Grant local government greater role in deciding how
public resources are used to improve health of
communities and greater flexibility to raise funds for
investment on social determinants of health
Allocate a greater share of resources to the places that
need it most and to improve the lufe chances of the
poorest fastest
Invite LG to co-design and co-invest in national
programmes, to tailor them more effectively to local
populations
Rec 4: Strengthen the role of the health
sector in promoting health equity
CCGs and other NHS agencies:
Ensure procurement and commissioning maximises opportunities
for high quality local employment and high quality care
Work more effectively with Directors of Public Health and Public
Health England to address risk conditions that drive health and
social care system demand
Support Health and Wellbeing Boards to integrate budgets and
jointly direct health and wellbeing spending plans for NHS and Las
Provide leadership to support health services and clinical teams to
reduce children’s exposure to poverty and its consequences, and
to reduce poverty among people with chronic illness