Growing divide in regional health inequalities exposed

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A new report has found a worrying pattern of lower life expectancy, higher infant mortality, and worse health and wellbeing in the North of England.

Health Equity North: 2023 provides a snapshot of the health issues facing the North and adds to a growing body of evidence highlighting the urgent need to address regional health inequalities and improve productivity in the North.

Published on the 19th April 2023, the report marks the launch of Health Equity North (HEN), a new virtual institute focused on place-based solutions to public health problems and health inequalities across the North of England.

The institute’s academic directors analysed the latest available data on life expectancy, infant mortality rates, and self-assessed health, disability, and unpaid care, and the findings have exposed the worsening health divide between the North and the rest of England.

The North does significantly worse in all these areas, which also impacts productivity with above-average rates of economic inactivity due to ill health or disability.

The key findings include:

* People born in the North can expect to live at least one year less than the English average.

* The North East of England has the lowest life expectancy – around three years less than the best-performing regions

* Across the North there is an average of 4 deaths per 1,000 live births compared to 3 deaths per 1,000 live births in London and the South East – this equated to an extra 144 infant deaths in the North in 2021

* Of the 72 local authorities in the North of England, 52 (72%) have lower levels of very good or good health than the national average

* The North has higher rates of bad/very bad health with 6.9% of people in the North East, 6.4% in the North West, and 5.9% in Yorkshire and the Humber reporting bad/very bad health – compared to the English average of 5.3%

* The North has the highest rates of people who report that their day-to-day activities are limited a lot by a disability: North East (9.8%), North West (9.1%), Yorkshire and the Humber (8.2%) – compared to the English average of 7.5%

* The five local authorities with the highest levels of people who report a disability limits their day-to-day actives a lot are located in the North: Knowsley (North West; 13%), Liverpool (North West; 12.7%), Blackpool (North West; 12%), Manchester (North West; 11.4%), and Hartlepool (North East; 11.3%)

* The North has higher rates of economic inactivity due to ill health or disability: 5.7% in the North East, 5.3% in the North West, 4.7% in Yorkshire and the Humber – compared to the English average of 4.1%

* The top five local authorities with the highest levels of economic inactivity due to long-term sickness or disability are in the North

* More people in the North state that they provide unpaid care – in the North East 10.1%, the North West 9.7%, and in Yorkshire and the Humber is 9.3%, compared to the English average of 8.9%

HEN brings together leading academics who have a unique understanding of their regional communities enabling the creation of research and policy solutions of local benefit. The institute will produce annual updates on health in the North to help and challenge local and national policy makers in their efforts to reduce regional inequalities.

The institute directors were joined by leading health and policy experts from across the North of England at the HEN launch event in Leeds today [April 19, 2023], where they discussed the findings of the new report and HEN’s mission to tackle inequalities in the northern regions.

Dr. Luke Munford, HEN Academic Director, Health Economist from the University of Manchester, and co-author of the report, said: “Health Equity North’s first health status report adds further weight to the growing list of evidence laying bare the ingrained health divide across the country. The northern regions have faced worse health outcomes for many years and with the added challenges posed in the wake of the pandemic and the current cost of living crisis, things look set to continue on a downward spiral. However, a joined up approach to tackle these inequalities at local and national level would help to rebalance regional health inequity.”

Professor Clare Bambra, HEN Academic Director, Professor of Public Health at Newcastle University, and co-author of the report, said: “Health Equity North is committed to fighting health inequity through research, policy impact, and public health improvement.  Our first report clearly shows that health inequalities in the North of England aren’t going away. They are getting worse and they will continue to do so without urgent action to ensure people living in the North have the same life chances as those in the rest of England.”

Professor David Taylor-Robinson, HEN Academic Director, Professor of Public Health and Policy at the University of Liverpool, and co-author of the report, said: “It is not acceptable that children born in the North face the prospect of shorter lives. Everyone deserves to have the same chances, but we know that many families in the North face a daily struggle to meet basic needs. While our report is a sobering read it also provides clear recommendations on a range of short and long-term measures that could help improve health outcomes for people across the North.”

The report authors have made a series of recommendations to help improve health and productivity in the North:

1 – Local government, Integrated Care Systems and combined mayoral authorities should work with researchers to identify areas of greatest health need within their authorities where they can most effectively implement evidence-based policies to tackle the social determinants of health.

2 – Central government should commit to policies and interventions to improve health across the North and take a cross-governmental approach, across the Department for Levelling Up Housing and Communities, the Department of Health and Social Care, the Department for Work and Pensions and the Department for Science Innovation and Technology.

3 – Long-term increases in public health funding to local authorities and the Integrated Care Systems in the North need to be made and ring-fenced and achievements reported to Parliament.

4 – Prioritise the development of an integrated, national health inequalities strategy with an explicit focus on addressing the social determinants of health:
* reducing poverty
* improving housing
* increasing energy security
* creating better jobs
* improving early child development and education
* creating healthy and sustainable places in which to live and work
* improving efforts at prevention

5 – Research funders should give increased priority to research that helps to address health inequalities including a place-based focus on prevention.

6 – Provide universal access to occupational health for the country’s workforce with a specific focus on increasing access and supporting employers in areas with the worst health outcomes.

7 – Increase NHS and local authority resources and service provision for mental health in the North. Increase the existing NHS health inequalities weighting within the NHS funding formula.

8 – Embed Equality Impact Assessments in all policy processes relating to socioeconomic deprivation at national, regional, and local levels.

9 – Integrated Care Systems should commission more health promotion, condition management, and prevention services that promote the health and wellbeing of the workforce in the North.

10 – Local public health and health inequalities budgets in the NHS should be safeguarded so that action to relieve acute NHS backlogs does not undermine efforts to tackle the root causes of ill-health and boost health resilience.

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