• The UK’s health has flatlined since 2010. No progress has been made in overall life expectancy or healthy life expectancy, while health inequalities have worsened.
• Our new analysis reveals that failure to make realistic progress on health inequalities led to 64,000 more avoidable deaths between 2010-2019 – mostly due to failures in prevention.
• Yet the party manifestos almost exclusively look at health through the prism of the NHS – treatment of disease and waiting lists, while leaving aside those crucial policy levers that sit beyond the healthcare system.
• This briefing argues that we are not starting from scratch. If we can learn the lessons of what worked during the last Labour government’s health inequalities strategy while scaling up and out the approaches being taken in Greater Manchester, we can start to transform the nation’s health.
• In this context, our 10-point plan for better health focuses on a national strategy for health inequalities combined with better regional leadership and coordination on health. We argue this should be supported by existing and emerging institutions including strengthened Mayoral Combined Authorities and better resourced Integrated Care Systems.

Good health is the cornerstone and key determinant of inclusive growth. It is much easier to contribute to economic life if you’re well and not suffering from chronic conditions. Yet in many parts of the country, poor health starts significantly before pensionable age, while poor working conditions are actively contributing to bad health. Health inequalities and income inequalities are mutually reinforcing, deepening economic exclusion and deprivation.

Ultimately, health inequalities cost lives. New CPP analysis reveals large differences between local authorities in England in progress on avoidable mortality – these are deaths which could have been avoided through better prevention or treatment.1 During 2002-2010, England saw significant progress in reducing avoidable mortality nationwide. But after 2010, this progress has been limited to a few areas, with other, particularly poorer areas, experiencing stagnating or even rising avoidable mortality rates. We calculate that if avoidable mortality had fallen in line with the top 10%, there would have been 64,000 fewer deaths. Or to put it more bluntly, failure to make realistic progress on health inequalities cost 64,000 lives. Our analysis also shows that these excess deaths were more the result of failures in prevention than treatment – in other words, less to do with NHS activity and more about failures to address the underlying causes of poor health.

Even prior to the pandemic, the rate of growth in life expectancy was slowing across advanced economies. However, the UK’s slowdown was one of the most pronounced. CPP has calculated that life expectancy at birth rose by an average of 0.32% per annum between 1980 and 2009, before slowing to an average of 0.12% growth between 2010 and 2019. Only in the United States did life expectancy grow more slowly during the last decade across OECD countries.

Since the pandemic, the UK has also fared worse than comparable countries in terms of rising economic inactivity due to ill health. In most other developed countries, levels of health-related economic inactivity are back to where they were pre-pandemic, but in the UK, it remains elevated at around 2.8m people and there is a worrying trend of heightened inactivity due to poor mental health amongst younger people.

CPP’s prior research estimates that there are substantial economic gains to be made by reducing health inequalities – if the bottom half of local authorities could catch up with the national average on life expectancy, it could boost GDP by around £50bn (or 2% of GDP). Research from the Northern Science Health Alliance has also demonstrated the economic potential from improving regional health.

The remainder of this briefing explores what the main political parties’ manifestos say on health before outlining what we at CPP think should happen next based on our prior national policy work and practical delivery with places across the UK through our Inclusive Growth Network.

The politics of health is often seen through the prism of the NHS – and in particular which party has the best pledges for getting waiting lists down or for ensuring faster GP access. But these priorities are less about creating good population health, and more about alleviating immediate capacity constraints facing the healthcare system.

In this regard, Labour and Conservative manifestos were conventional, with little detail about how to improve health prevention or reduce health inequalities. Indeed, Labour’s manifesto had a chapter on “building an NHS fit for the future” rather than one focused on the overall health of the nation, with only two mentions of health inequality in the entire document. The Conservatives meanwhile spent much time focusing on efficiency and productivity within the health service.

There were however some interesting hints in Labour’s manifesto of a deeper approach to health – including the relatively bold commitment to halving the gap in healthy life expectancy between the richest and poorest regions in England – but little detail on how that might be done in practice. After the Levelling Up White Paper made similar bold promises, the public would be right to treat such a target with initial scepticism. More important perhaps is that regional differences in healthy life expectancy are dwarfed by gaps between local authorities. Across regions, female healthy life expectancy ranges from 58.9 in the North East to 64.7 in the South East. By comparison at local authority level, it ranges from 54 in North Ayrshire and Blackpool to over 70 in Wokingham and Windsor and Maidenhead. Focusing on inequalities within regions and not just between regions will be crucial.

Labour’s main measures on public health were broadly consistent with current Conservative policy (particularly around banning smoking for the next generation and banning the advertising of junk food to children). Labour also made welcome commitments around gambling reform and online safety. But overall, there was scant detail on how an incoming government would seek to improve the population’s health in practice.

On mental health, both main parties did make clear commitments. Labour pledged 8,500 new mental health staff including new mental health support in schools which is something CPP has called for. The Conservatives pledged early support hubs in every local community and full expansion of Mental Health and Support Teams for all schools and colleges by 2030. But legitimate questions remain about whether these pledges will really shift things in the face of a significant mental health crisis.

Perhaps the most impressive manifesto for health was the Liberal Democrats. They were the only party to explicitly talk about a cross-government approach to health through establishing a health creation unit in the Cabinet and the only party to pledge an increase in the public health grant – which has been shown to be more cost effective in producing good health than spending on the NHS. Their manifesto also had the most detailed promises on mental health services.

While there may have been scant detail from the two main parties on health beyond the NHS, there is hope that an incoming government will do more. New Labour’s transformative Sure Start children’s centres – area-based initiatives to provide wraparound family support - were not in the 1997 Labour manifesto, and instead introduced in 1998. Systems interventions, which take a targeted but holistic approach to different aspects of prevention, are perhaps not an election winner and can take time to bed in. But they are proven successes, and critical tools in effective policymaking on health.

It is easy to forget that we have managed to reduce health inequalities in the past. Evaluations of the previous Labour government’s health inequalities strategy show that it did manage to reduce the gap between the healthiest and unhealthiest places (while all places continued to see increases in life expectancy). It was driven from the heart of government and required all departments to focus on health as a key outcome of policy. Looking regionally, one beacon of hope from the last 14 years is Greater Manchester: a pioneer of health and economic integration through devolved powers it has seen larger improvements in life expectancy than comparable regions. With devolved powers for transport, adult education, employment support, and strategic planning alongside specific powers for health and social care, Greater Manchester has been able to sustain coordinated activity over both health and social care services and wider determinants across the region.

But talk is cheap – at CPP we don’t just write about interventions, we help places innovate to deliver them in practice. At the heart of CPP is our Inclusive Growth Network (IGN) of 14 local and combined authorities – including Greater Manchester – who are leading the mission to drive inclusive growth in their areas. The network is passionate about developing systems interventions that are preventative despite severe cuts to local government budgets since 2010 putting huge resource constraints on places, with many local authorities struggling to deliver life and limb services.

The IGN’s projects, ranging from designing employability programmes for disabled people in Barking and Dagenham to designing a collaborative employability strategy in the North East, to supporting good work charters in Greater Manchester and beyond recognise the close relationship between health and inclusive economies. Both during and after the pandemic, we have facilitated deep collaboration with members on addressing health inequalities through recovery plans and shared learning, tackling poverty by bringing together local economic and health levers, and the role of community power in population health strategies. Fundamental to the IGN approach is recognition of the need to bring together economic policy levers with innovative public service delivery to improve outcomes.

There is a big opportunity after the election to think more deeply about the integration of economic levers, social policy and healthcare across regions. Under the Conservatives, the Mayoral Combined Authority (MCA) model has been expanded to more areas, while trailblazer regions – Greater Manchester and the West Midlands – have been afforded more powers of spending through incoming single pot settlements. Meanwhile, on the population health side, The Conservatives have brought in Integrated Care Systems (ICS) which include Integrated Care Partnerships (ICPs) of NHS trusts, local authorities and other relevant local organisations. As ICPs, these organisations come together to plan how to improve health outcomes and reduce inequalities while also having a specific economic development remit. The introduction of ICSs represents an important opportunity to deliver a more joined-up, regional model of preventative health.

Our prior work with the Kings Fund demonstrated how ICS’ can be ambitious in tackling the root causes of poor health, enabled by smarter use of local regional data to help target proactive population health interventions.

National level:

• There must be a cross-government health inequalities strategy led from the centre of government, but which involves all departments. As part of this there should also be:

• National level targets on key Marmot indicators including food insecurity, child obesity, children’s mental health and inequality in school readiness.
• Assessments of health impacts as standard when national and local government departments develop and evaluate major new projects and programmes.

• The local authority public health grant must be restored and rise in line with inflation.
• Sure Start 2.0. Reinvesting in local family hubs based in areas of higher deprivation, applying detailed learnings from long term evaluations of the original Sure Start programme.
• Increase deprivation targeting of local government finance to ensure central government funding goes to where it is most needed.

Integration of regional economic development and population health

• Ensure more of the UK’s population is covered by a Mayoral Combined Authority, and work to ensure regions have the capacity to take on similar powers to Greater Manchester on health and economic development.
• Work towards the maturity of ICSs as key engines for coordinating activity on the determinants of health including some aspects of economic development working in partnership with local and regional government.
• Establish trailblazer ICPs from across regional and local authorities with higher deprivation populations. These trailblazers should have ring-fenced prevention budgets for joint local/regional government and health initiatives.
• ICPs should be mandated and resourced to explore all local, regional and neighbourhood level data to understand where and how interventions could be made earlier – developing “early warning” systems and action.

The greatest achievement of the post-war era among advanced economies was the rapid advance in life expectancy as better and universal healthcare combined with improvements in living standards and working conditions. But this progress has stalled over the last 14 years exacerbated by a pandemic. The UK may not be alone in seeing progress stall, but its health has fared worse over this period than other comparable countries.

The UK now finds itself at a critical juncture. Do we continue to invest increasing sums into the healthcare system and double down on the treatment of disease, with the NHS accounting for an ever increasing share of government spending, or do we seek to build something a bit different which addresses the systemic causes of health inequalities? Do we centralise and assume all health is created through the Department of Health and Social Care, or do we lean into the emerging regional and local models of health creation?

There is cause for optimism in our recent past. We can shift the dial on health inequalities nationally – we did so under the last Labour government and there are encouraging signs regionally under the Mayoral model in Greater Manchester. Learning the lessons of what worked and why in these examples of success will be key to kickstarting better health over the next parliament.

Brettion et al. The impact of devolution on local health systems: https://www.sciencedirect.com/science/article/pii/S0277953624002454

Holdroyd et al. Systematic review of the effectiveness of the health inequalities strategy in England between 1999 and 2010 https://pubmed.ncbi.nlm.nih.gov/36134765/

Carniero et al. IFS. The short- and medium-term impacts of Sure Start on educational outcomes. https://ifs.org.uk/publications/short-and-medium-term-impacts-sure-start-educational-outcomes

Crumbling foundations CPP: https://www.progressive-policy.net/publications/crumbling-foundations

CPP Replenishing our roots CPP: https://www.progressive-policy.net/publications/replenishing-our-roots