In a new report, ‘England’s widening health gap: Local places falling behind’, the UCL Institute of Health Equity (IHE) emphasises how the north-south health gap has increased, people’s health has deteriorated, and health inequalities have widened. Sir Michael, director of the IHE, is imploring parliamentarians to act, if they care about their local population’s health.

In the letter, he wrote: “Put simply, Britain is a poor, sick country, getting sicker, with a few rich and healthy people; the results of a dismal failure of central government policies since 2010. Not only is health the foremost concern of your local constituents, communities and businesses, health is also an indicator of how well a nation is performing. Unfortunately, Britain is performing poorly.”

Using data from the Office for National Statistics (ONS), the Office for Health Improvement and Disparities (OHID) and the National Audit Office (NAO), the report looked at every local authority in England and, for each one, plotted levels of health, inequalities in health, and cuts in their spending power. Local authorities fund many of the services – for example, housing, education, and social care – that support or ameliorate the drivers of health inequalities.

The report provides information from 17 local authorities with statistically significant increases in inequalities in life expectancy between 2010-2012 and the start of the Covid-19 pandemic. Sir Michael wrote to the 58 MPs whose constituencies lie wholly or partially in these local authorities, as well as each area’s local authority leaders. These include six former or current cabinet ministers.

Life expectancy

Overall, life expectancy improvements stalled between 2010-12 and 2020-22 (during the Covid-19 pandemic), with inequalities in life expectancy increasing nationally for both men and women between 2010-12 and 2017-19.

In six of the nine English regions, there have been statistically significant increases in inequalities in life expectancy for women (North East, North West, Yorkshire and the Humber, East of England, East Midlands, South West) and three for men (North East, Yorkshire and the Humber and East of England.

There were 14 local authority areas with significant increases in inequalities in female life expectancy, and three in which inequalities in life expectancy had increased significantly for males.

And since 2010, central government cuts to local authorities mean their spending power per head of population had fallen by an average of 34 per cent across England in 2019-20.

“It’s no surprise that local authorities are struggling to make ends meet and that people are living shorter lives than they should,” Sir Michael said. “If you slash the services that support people, then health will be harmed. Levelling up was supposed to provide badly needed funding for the most deprived areas. But it was a derisory amount and, as a result, never going to improve health.”

Since 2011, life expectancy has been increasing at a slower rate than it had during previous decades. But even the modest increase has not been uniformly enjoyed across England, the report finds. People living in the north of England and women in the most deprived neighbourhoods, for example, saw a fall in their life expectancy, even before the pandemic struck.

Based on NAO figures, the IHE calculated that funding from national government to local authorities fell by an average of 41 per cent per head in England between 2010-11 and 2015-16, and the tax raised by councils themselves fell by 8 per cent per head.

After 2015-16, extra revenue raising powers allowed councils to increase the amount raised each year, says the report, so that by 2019-20, the revenue from tax was 4 per cent more per head, in real terms, than in 2010-11. However, bemoans the report, government support per head was 58 per cent below that in 2010-11, resulting in a significant drop in overall council spending power per head.

According to the report, these funding cuts and tax rises have fallen disproportionately on the most vulnerable. The effect of this is seen in council tax arrears, which have increased by 70 per cent in the past five years in the 100 largest councils.

Marmot Principles

Alongside Sir Michael’s letter, the IHE is calling on the Government to put health equity and wellbeing at the heart of all policies by following the eight ‘Marmot Principles’. These are:

• Give every child the best start in life;
• Enable all children, young people, and adults to maximise their capabilities and have control over their lives;
• Create fair employment and good work for all;
• Ensure a healthy standard of living for all;
• Create and develop healthy and sustainable places and communities;
• Strengthen the role and impact of ill health prevention;
• Tackle racism and its outcomes; and
• Tackle climate change and health equity in unison.

“This is a dismal state of affairs,” lamented Sir Michael. “I’m saying to party leaders: make this the central plank of the next government – stop policies harming health and widening health inequalities. To MPs: if you care about the health of your constituents, you must be appalled by their deteriorating health. It’s time for action and political leadership across the board.”

He added that as important as the NHS is, more action is needed on addressing the social determinants of health – the conditions in which people are born, grow, live, work and age and which are “the main causes of health inequalities”.

The IHE proposes the appointment of an independent health equity commissioner and the establishment of a new cabinet-level health equity and wellbeing cross-departmental committee.