One of the few positions that Liz Truss and Rishi Sunak had in common during their battle to succeed Boris Johnson was a sworn commitment to levelling up. Ironic then that one unfortunate casualty of the Tories’ summer implosion is the health inequalities White Paper, intended to kickstart levelling up in that most critical area – public health.
With the incoming Truss government’s immediate priority focus on energy bills and the cost of living crisis, there’s a real risk that the White Paper is not only delayed, but that this national priority remains on ice far beyond this autumn.
Yes, the NHS is under incredible strain, but we need a much wider longer-term strategy than solely focusing on impending winter pressures. That requires a leader who recognises the importance, and benefits, of addressing socio-economically driven health disparities; who understands that concerted, co-ordinated prevention campaigns are as vital to the national health as they are to the future viability of the NHS itself.
It’s understandable that current health service discussion is dominated by a sense of crisis. The picture is stark: record waiting lists lengthened by Covid-backlogs, growing ambulance wait times, stacking outside A&E, lack of GP appointments, and threats of strikes over pay.
But the new PM and her chosen Health Secretary will have a crucial opportunity – and responsibility – to reset and create a long term vision that transcends electoral timescales.
Disparities to be addressed by the delayed White Paper will only become more entrenched if we don’t tackle them now, whilst putting in place long term interventions targeting complex root causes.
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The statistics are damning. People living in the most deprived areas die nearly a decade earlier than those in more affluent areas – for example, life expectancy is 78 in parts of Manchester compared with 86 in Westminster. People in the poorest areas can expect to live 18 fewer healthy years than those in wealthy neighbourhoods.
Many of the causes of inequalities are well known, complex and inter-connected. Solutions aren’t straightforward and must be coordinated across agencies, charities and Government. We should not try to imagine a single grand scheme that addresses all of the issues. But we need less handwringing about how difficult this is to deal with and more action.
That means more coordinated short-term interventions that tackle acute problems immediately, and more action to underpin this approach with long-term education, health, employment and regional investment strategies to address the deep-rooted causes of inequality that cost our society and individuals so much.
Many such initiatives are already being delivered by charities. These must be identified, coordinated and properly supported for maximum impact. Rapid progress can come from renewed focus on healthy eating for example, demystifying healthy food and destroying the illusion that it isn’t enjoyable, is difficult to prepare and expensive.
There’s ample scope for roping in celebrity chefs and sports personalities to maximise engagement, and a role for businesses, from food producers to supermarkets who carry huge public responsibility.
Poor mental health caused by a lack of meaning in people’s lives can push some towards alcohol, tobacco or substance abuse. Long term lack of opportunity has to be addressed as part of the wider regional levelling up agenda to create many more high quality, sustainable jobs and careers – meaningful livelihoods.
In my view we should work to re-kindle pride in our communities and invest in community projects which deliver local benefit and promote socialisation and friendship, tackling loneliness and creating purpose and optimism for everyone involved.
Such short-term measures can treat the symptoms of embedded health inequality, but long-term, prophylactic strategies for changing behaviours and creating economic opportunities are essential or we will constantly be applying sticking plasters.
To begin with, health education – from infancy to adulthood – needs much greater support. It should be treated as an equally important part of education as mathematics or English. We need a well-educated workforce in every sense to perform in the jobs of the future, to be creative and compete with the world, and to be healthy and motivated to increase productivity – a major issue for the United Kingdom.
Routine screening for early diagnosis of a range of illnesses is a no-brainer. It improves patient outcomes and slashes the overall cost of healthcare. Many of these diagnostics exist and can be delivered through home-testing and home-sampling – something we’re all familiar with from our Covid experience – or in community diagnostic centres envisaged in the levelling up White Paper.
However, such widespread monitoring of key indicators would create a significant burden on the already stretched-to-breaking-point NHS. But that means we need to think about phasing the roll-out of screening and triaging results – not kick the opportunity into the long grass.
If I had to break my own rule and identify “a grand scheme” that can have far reaching positive impact, it would be the creation of focused, regional economic hubs or superclusters that mirror the concentration of biotechs around London, Cambridge and Oxford.
This idea isn’t new. Such superclusters are hinted at in the Innovation Accelerators proposed in the levelling up White Paper. What’s special about this approach is that once regional ecosystems are formed, with supporting transport and digital infrastructure, they create a pool of talent that will attract businesses and more talent in the same sector, creating long term, high quality employment without the need to move “down south”.
Rewarding careers obviously provide an improved standard of living, but also foster pride in community and self, and an optimism for the future that has an incalculable positive impact on mental health.
The incoming PM has an unenviably full plate but tackling health inequality is a top priority and must be part of a powerful vision for our country. When it comes to health, our new government has to do much more than deal with the immediate crisis in the NHS.
Dr Alastair Smith is founder and CEO of Avacta Group plc
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