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
|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|
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|
|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|
|Hammersmith and Fulham||1.1||82.0|
|Kensington and Chelsea||1.0||85.1|
|Kingston upon Thames||0.5||83.3|
|Richmond upon Thames||0.4||84.1|
Notes to editors
Rachel Shortte, Account Manager, ZPB Associates
07834 523 001
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: firstname.lastname@example.org
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.
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
Description and data
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.
The 2015 ID domain ‘Crime’.
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.
The unemployment rate, April 2012-March 2013. 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.
Gross disposable household income per capita, 2013. 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.
Rural including hub towns population as % of total population 2011 (ONS). Data expressed as percentage points.
England region in which local authority is situated. Each region is included as a dummy variable with results presented relative to London.
 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
 ONS (2018c) Regional gross disposable household income by local authority (May 2018). Available at https://www.ons.gov.uk/economy/regionalaccounts/grossdisposablehouseholdincome/datasets/regionalgrossdisposablehouseholdincomegdhibylocalauthorityintheuk