Levelling up

Council services such as housing and public spaces are key to reducing health inequalities.

In his first speech as Prime Minister, Boris Johnson spoke of “levelling up” society. This will require a renewed focus on tackling the health inequalities that exist between and within local authority areas.

It’s a stark statistic that almost 20 extra years of healthy life are enjoyed by those in the most prosperous areas of the country, compared with those in the most deprived.

We know that those living in the most deprived communities experience poorer mental health, higher rates of smoking and greater levels of obesity than the more affluent. They spend more years in ill health and die sooner. 

Reducing health inequalities is an economic and social challenge, as well as a moral one. Since 2013, local government has been responsible for public health in England and has special responsibilities to tackle health inequalities, as well as improve the public’s health overall.

Local authorities and their public health teams have been on a journey together to understand how we can use councils’ traditional functions in conjunction with our newly acquired public health expertise to maximise our contribution to closing the unjust health inequalities gap.

Of course, central government has to play its part in reducing poverty and breaking the link between deprivation, ill health and lower life expectancy. But there is much that local government can do by reducing harm from what we know as the ‘social determinants of health’ – those factors in people’s social, economic and built environment that play the greatest part in determining how long, and with what quality of life, they will live.

“Local government services are health services

When we focus on the social determinants of health – rather than the medical cause of some particular disease, or what health and care services are available locally – we see that local government services are health services.

It is no exaggeration to say that, without local government, adults and children would die sooner, would live in worse conditions, would lead lives that made them ill more often, and would experience less emotional, mental and physical wellbeing than they do now.

Council services and support – in areas such as housing, skills, employment, transport, parks, leisure centres and public spaces – all have a part to play in deciding our wider public health.

Nonetheless, despite overall gains in life expectancy across all socio-economic groups, health inequalities persist – and may even be increasing – and there is always more that local government can do.

Addressing the widening gap in health inequalities entails lifting our gaze from the immediate concerns of pressures on the NHS and social care, or unhealthy lifestyles, and focusing on the causes of ill health. It starts with the nature of early child development, continues through school and employment, and ends with the conditions in which older people live out their lives.

Ahead of next month’s Budget, the LGA will continue to make the case that every pound invested in council-run services will help relieve pressure on other public services, such as the NHS.

If we are to achieve the stated aims and ambitions in the Government’s Prevention Green Paper, to make sure people are able to live for longer in good health, councils need adequate and sustainable long-term funding for their public health budgets.


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