Challenges and opportunities presented by Covid-19 for health inequalities:
- Covid-19 has exacerbated existing health inequalities particularly for Black, Asian and minority ethnic communities. It has also impacted on local resources to tackle them. Planned local initiatives to tackle health inequalities and the wider determinants of health have stalled due to the demands of the pandemic response. Coordinated and concerted action across partners will be critical to helping address this resourcing deficit.
- Employment support is key to tackling health inequalities even in context of largescale job losses and a fall in recruitment. Sectors with existing challenges around providing good work and economic security are among those under greatest pressure. Targeted sectoral approaches are a focus for emerging inclusive recovery plans.
- The crisis has strengthened relationships across the public sector and the voluntary and community sector dialogue has improved between local agencies through the creation of new, responsive models of collaboration. The question is how to translate these into longer term ways of working to tackle health inequalities through the continuing response to Covid-19 and recovery.
- The role of evidence and data in tackling local health inequalities: Renewing approaches to measurement and monitoring is a key focus for member areas as they develop recovery plans. Members are incorporating wider measures of economic, environmental and social outcomes, with some places linking this to the UN Sustainable Development Goals and the Doughnut Economics tool.
- Measuring the interim impact of interventions is a challenge faced by several members: Long term indicators will be embedded within local strategies but there are challenges in monitoring progress towards achieving these, particularly at ward level. Measures need to incorporate operational data and qualitative feedback e.g. healthy life expectancy is a long term goal but could air pollution, access to green spaces and obesity rates be examples of shorter-term success measures? Leeds are proposing to adopt the Social Progress Index, as well as measuring success through lived experience.
- Collaboration across health and local authorities presents an opportunity to embed health indicators into economic planning, and vice versa, through the development of joint / shared metrics. Several members reported a need for greater capacity to analyse and interpret data that can be used to inform local agencies, businesses and communities.
- Availability of analytical resource is mixed across member areas several members reported a need for greater capacity to analyse and interpret data that can be used to inform local agencies, businesses and communities. Members may consider accessing IGN implementation advice to help address this issue.
How to build practical action on health inequalities into recovery plans:
Inclusive recovery plans are starting to build on established inclusive economy priorities to address the wider determinants of health e.g. housing quality, good work. Measuring the impact of economic interventions on health inequalities will be key to an inclusive recovery. Places can use the Health Equity Assessment Tool to support systematic action, as trialled in the West Midlands.
Joint governance models have developed from an intense period of collaboration and can now help to shape renewed and long-term ways of working across local agencies. These are now guiding local strategic approaches to recovery. Emerging examples of new governance models include:
- A cross-sector working group focused on tackling health inequalities
- Public service boards developing joint responses to cross-cutting issues
- An independent commission to respond to long-term, systemic inequalities
Shared roles and teams across the NHS and local government have been highly effective in breaking down organisational siloes and providing ‘critical friend’ perspectives across health and economic development. This approach has also facilitated more effective sharing and use of data across local agencies.
Communities are being empowered and consulted in supporting wellbeing through recovery. Recovery interventions must build on existing social infrastructure, including recently established community hubs, and be coordinated with the voluntary and community sector. Places are exploring how recovery interventions can be designed and delivered with communities, including through ‘living lab’ approaches.
Formalising health anchor roles will be key to recovery and maximising the economic and social impact of local health partners. It is important to create an agreed, shared definition of an anchor institution between local partners.
Examples of actions to advance the anchor role of health from the network include:
- Embedding health and care within regeneration planning e.g. maximising the wider impact of NHS capital investments on the local economy
- Developing an anchor network incorporating health and care bodies within the local footprint o Developing an ‘anchor charter’ with commitments around procurement, good work and climate action.
- Recruitment into local health (especially from sectors that are particularly struggling at the moment e.g. aviation).
- Advancing collaboration through existing local and national programmes, such as the One Public Estate programme.
Maximising the local impact of health employment and spend is a key focus for anchor collaboration. Members are looking to embed this activity within the core business of health partners and examples of this include:
- Establishing clear roles for health as part of recovery governance models and into formal local representation e.g. NHS representation on recovery boards
- Social value in local NHS supply chains and working locally to respond to emerging needs e.g. PPE
Engaging health partners from other areas who can demonstrate benefits of enhancing anchor role e.g. signing up as a living wage employer
Working with hyper-local health partners will be key to tackling health inequalities – including mental health – through recovery. Many areas have taken action to strengthen the role of GP surgeries as community-based anchors, e.g. through co-located welfare services. Places should explore the legacy of community hubs and the joint health and local authority role in supporting these to drive recovery.
- Presentation from Emma Spencelayh, Senior Policy Fellow at the Health Foundation. Emma highlighted findings from Using economic development to improve health and reduce health inequalities and Economies for Healthier Lives, a new funding programme to strengthen relationships between economic development and health [link]
- Presentation from Michael Wood, Head of Health Economic Partnerships at the NHS Confederation. Michael drew on Health as the new wealth: the NHS’s role in economic and social recovery [link]
- The Good Life: Measuring inclusive growth across communities, CPP
- Beyond the NHS: Addressing the root causes of poor health, CPP
- The business case for investment in public health and obesity, CPP
- Creating the workforce of the future: a new collaborative approach for the NHS and colleges in England, NHS Confederation
- Nobody left behind: Maximising the health benefits of an inclusive local economy, LGA
- Health Equity in England: The Marmot Review 10 Years On
- The NHS as an anchor institution, the Health Foundation
- 2020 Social Progress Index, Social Progress Imperative
- Supporting action on reducing health inequalities, Public Health England
- A healthy economy?, The RSA
- Building back better by focusing on health, Health Foundation
- Coventry Marmot City Evaluation, Institute of Health Equity
- At the Deep End: integrating money advice into workers into GP practices, Glasgow CPH
- North Ayrshire Inclusive Growth Diagnostic
- Covid-19: breaking the cycle of deprivation and ill health, The Strategy Unit
- Health inequalities are not inevitable, Le Monde Diplomatique