CPP analysis shows that:

• 30 million years are lost due to education
• 18 million years are lost due to income
• 15 million years are lost due to employment
• 8 million years are lost due to crime
• 8 million years are lost due to housing
• Circa. 80 million total lost due to socioeconomic inequality

The CPP’s new report, Beyond the NHS: Addressing the root causes of poor health is the culmination of a 12-month inquiry supported by an advisory board of NHS and non-NHS health experts looking at the health of the nation in the broadest sense.

From poor-quality housing to knife crime, from skills’ deprivation to in-work poverty and homelessness, CPP argues that the greatest socioeconomic challenges of our time are also our greatest health challenges. Despite stagnating health and rising economic inequality, public policy continues to focus on cure rather than long term prevention.

Socioeconomic inequality not only effects how long we live, but also how healthy that life is. CPP estimates that 170 million years of healthy life are being lost due to these inequalities. Healthy life refers to the proportion of life spent in good health.

For the first time, the public can also see how socioeconomic inequality in their local area reduces their life expectancy and time spent in good health. For example, people living in Hull will live circa. 4.2 years less due to employment (1.1 years), income (0.6 years), education (1.7 years), crime (0.4 years) and housing (0.2 years).

Top three local authorities in England with the most life years lost

Local authority	Years lost overall	Years Lost: Employment	Years Lost: Income	Years Lost: Education	Years Lost: Crime	Years Lost: Housing
Kingston upon Hull, City of	4.2	1.1	0.6	1.7	0.4	0.2
Nottingham	3.9	1.0	0.7	1.6	0.4	0.2
Sandwell	3.8	0.9	0.6	1.7	0.3	0.3

More than half of the variation in life expectancy across local authorities is explained by these socioeconomic inequalities. To shift away from the current failing narrow model of healthcare and towards a social model of health in the broadest sense, the report makes several recommendations including:

• Strengthening the role of the Chief Medical Officer (CMO) as it pertains to social determinants and making the role accountable across government.
• Raising social and other forms of government spending relative to health spending.
• Within the NHS prevention budget, ring-fencing money for addressing the social determinants of health and measuring progress over the long term (5+ years).
• Accelerating the review and roll-out of NHS initiatives that embed good practice in terms of employment, training and procurement in deprived areas.
• Strengthening the role of Directors of public health within the current and future health system framework (including the emerging Integrated Care Systems) and providing greater resource and more discretion for how local areas deploy their public health budgets to tackle social determinants.

Ben Franklin, head of research methods at CPP, said: “With the health and prosperity of the nation stagnating, now is the time to be daring and disrupt the status quo. The tried and tested approach of continuing to set aside more money for the NHS while cutting back other services has failed. At this critical moment, it is important to think again about health policy – to shift away from the narrow definition of health simply relating to the work of the NHS and to deliver health in all policies and places.”

Top ten local authorities in England with the most life years lost

Local authority	Years lost overall	Years Lost: Employment	Years Lost: Income	Years Lost: Education	Years Lost: Crime	Years Lost: Housing
Kingston upon Hull, City of	4.2	1.1	0.6	1.7	0.4	0.2
Nottingham	3.9	1.0	0.7	1.6	0.4	0.2
Sandwell	3.8	0.9	0.6	1.7	0.3	0.3
Leicester	3.7	0.9	0.7	1.6	0.3	0.3
Birmingham	3.7	1.1	0.6	1.2	0.3	0.4
Manchester	3.5	0.8	0.6	1.3	0.4	0.3
Wolverhampton	3.5	0.9	0.6	1.4	0.3	0.3
Blackpool	3.5	0.6	0.5	1.5	0.4	0.4
Middlesbrough	3.4	1.2	0.5	1.4	0.4	0.0
Barking and Dagenham	3.4	1.0	0.3	1.4	0.5	0.3

London local authorities

Local authority	Years lost overall	Life expectancy
Barking and Dagenham	3.4	79.7
Barnet	0.8	83.6
Bexley	1.6	82.1
Brent	0.8	82.6
Bromley	0.6	83.1
Camden	1.2	84.5
Croydon	1.8	82.0
Ealing	1.5	82.5
Enfield	2.2	82.3
Greenwich	2.0	80.8
Hackney	2.3	80.9
Hammersmith and Fulham	1.1	82.0
Haringey	2.0	82.3
Harrow	0.6	84.2
Havering	2.2	82.2
Hillingdon	1.4	82.3
Hounslow	1.3	82.1
Islington	1.8	81.4
Kensington and Chelsea	1.0	85.1
Kingston upon Thames	0.5	83.3
Lambeth	1.5	80.9
Lewisham	2.0	81.2
Merton	0.7	82.5
Newham	2.9	81.2
Redbridge	1.4	82.7
Richmond upon Thames	0.4	84.1
Southwark	1.7	81.4
Sutton	0.8	82.1
Tower Hamlets	2.3	80.5
Waltham Forest	2.5	81.7
Wandsworth	0.9	81,9
Westminster	1.1	84.2

Notes to editors

Contact details

Rachel Shortte, Account Manager, ZPB Associates
07834 523 001
rachel.shortte@zpb-associates.com

About the Centre for Progressive Policy

CPP is a think tank committed to making inclusive economic growth a reality, led by Charlotte Alldritt, former Senior Policy Advisor to Nick Clegg. By working with national and local partners, our aim is to devise effective, pragmatic policy solutions to drive productivity and shared prosperity in the UK. Inclusive growth is one of the most urgent questions facing advanced economies where stagnant real wages are squeezing living standards and wealth is increasingly concentrated.

CPP believes that a new approach to growth is needed, harnessing the best of central and local government to shape the national economic environment and build on the assets and opportunities of place. CPP is independent and impartial. We are not aligned with any political party and are a not-for profit organisation. We are fully funded by Lord David Sainsbury, as part of his work on public policy.

For more information or to interview CPP, please contact Rachel Shortte at ZPB Associates: rachel.shortte@zpb-associates.com

CPP Health and Social Care Advisory Board

Charlotte Alldritt, Director, Centre for Progressive Policy

Siva Anandaciva, Chief Analyst, The King’s Fund

Professor Mike Bewick, former Deputy Medical Director, NHS England and Independent Chair Mid and South Essex STP Joint Committee

Jo Bibby, Director of Health, The Health Foundation

Sir Cyril Chantler, Honorary Fellow and Emeritus Chairman UCL Partners Academic Health Science Partnership

Maureen Dalziel, former Chair, Barking, Havering and Redbridge University Hospitals NHS Trust

Pam Garside, Fellow, Judge Business School, Cambridge University

Sir Ian Gilmore, Professor, University of Liverpool and former President, Royal College of Physicians

Paul Jakimciw, Digital Health Expert

Alex Kafetz, Managing Director, ZPB Associates and Independent Member of the National Information Board

Tim Kelsey, CEO, Australian Digital Health Agency

Stephen K. Klasko, M.D., M.B.A., President and CEO, Thomas Jefferson University and Jefferson Health

Professor Peter Kopelman, Vice-Chancellor and Emeritus Professor of Medicine, University of London and former Principal, St George’s

Dame Julie Moore, Professor of Health System at Warwick University

Professor Sir Terence Stephenson, former Chair, General Medical Council and Nuffield Professor of Child Health, Institute of Child Health, UCL

Geraldine Strathdee, former Clinical Lead for Mental Health, NHS England

Margaret Willcox, Past President, Association of Directors of Adult Social Services

Method for calculating years of life lost due to socioeconomic inequality

We estimate the total years of life lost in England due to the effects of social determinants. In line with analysis of the Marmot Review, we do this by looking at how much longer people live in areas that are least deprived. We develop the analysis first by assigning the life lost to each of five social determinants. Second, we model the impact of different social determinants in different places. Our analyses are aimed at raising awareness of the different social issues affecting health in different areas, rather than providing precise estimates.

Method – calculating total life years

We report that 80m years of life are being lost by the population of England due to socioeconomic deprivation. The premise of the calculation is that all parts of the country should be able to have the life expectancy of the least socially deprived areas. This is presented as the years of life that will be lost by everyone alive in England today.

Specifically, we define the least socially deprived areas as the 10% of local authority districts (LA) with the best adjusted Index of Multiple Deprivation (IMD) scores, taking the unweighted mean life expectancy (LE) across these 32 LAs as our baseline. The adjusted IMD score is the 2015 IMD score with the health and employment domains excluded, composed using the ONS recommended methodology. We exclude health and employment as these are at least partially measures of health outcomes. Using the standard IMD would have given the slightly higher figure of 84m.

Local authority life expectancies by age are based on ONS data for 2014-16, which report LE at birth and at 65. We interpolate between these ages, and decay above 65, using LE by age for England. For healthy life expectancy, we apply the proportion of life spent in good health, which is provided by county or unitary authority. The difference in LE between each local authority and the baseline is then applied to the population by age. All calculations are done separately for males and females and then summed.

Our methodology differs from the Marmot analysis in looking at whole local authorities, not Middle Super Output Areas, and in using a composite IMD, not simply the income domain, and using period life expectancy, not cohort. Each of these differences reduce the reported total.

Method – splitting the life years lost by social determinants

We divide the 80m years of life lost into contributions by each of five social determinants: education (30m), income (18m), employment (15m), crime (8m) and housing (8m). This is based on a regression looking at the extent to which each determinant explains variation in life expectancy between local authorities in England. We also include place-based factors of rurality and region which are powerful predictors of life expectancy. This regression analysis is similar to earlier work by the King’s Fund on older data.

Data

The social determinants data are, with exceptions, based on the 2015 indices of deprivation (2015 ID). The exact data used is described in table 1. Other indices of deprivation domains which did not have a significant relationship with either male or female life expectancy were excluded.

Table 1: Social determinant data source used

Variable	Description and data
Education	The 2015 ID domain ‘Education, Skills and Training’. As for all ID variables, the ‘average rank’ by local authority district is used. A higher rank is more deprived.
Crime	The 2015 ID domain ‘Crime’.
Housing	The 2015 ID sub-domain ‘Indoors living environment’. This has been aggregated to local authority level by CPP using ONS recommended method. Unlike other domains, a higher rank is less deprived.
Employment	The unemployment rate, April 2012-March 2013.[1] This period was used to match 2015 ID inputs. The IMD domain was not used as this includes measures of several incapacity benefits, meaning that we would be directly measuring health outcomes, rather than the social factors which might explain them. Data expressed as percentage points.
Income	Gross disposable household income per capita, 2013.[2] This period was used to match 2015 ID inputs. Average income had more explanatory power than income deprivation, which was also not used as its measurement is based partly on an incapacity benefit. Data expressed as £000s.
Rurality	Rural including hub towns population as % of total population 2011 (ONS). Data expressed as percentage points.
Region	England region in which local authority is situated. Each region is included as a dummy variable with results presented relative to London.

[1] ONS (2019b) Regional labour market statistics:M01 Model based estimates of unemployment (April 2019). Available at https://www.ons.gov.uk/employmentandlabourmarket/peoplenotinwork/unemployment/datasets/modelledunemploymentforlocalandunitaryauthoritiesm01

[2] ONS (2018c) Regional gross disposable household income by local authority (May 2018). Available at https://www.ons.gov.uk/economy/regionalaccounts/grossdisposablehouseholdincome/datasets/regionalgrossdisposablehouseholdincomegdhibylocalauthorityintheuk