How can we address health inequalities in ‘left behind’ neighbourhoods?

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By Dr Luke Munford, Senior Lecturer in Health Economics at the University of Manchester

England, and the UK more broadly, is a deeply unequal country. Health, wealth, and opportunities to thrive differ greatly depending on where we live, work, and play.

MPs and local elected officials set-up an All-Party Parliamentary Group (APPG) to examine ‘Left Behind Neighbourhoods’. Whilst not a great term, this reflects that these communities have high levels of need and have traditionally been forgotten about by national policy. ‘Left behind’ neighbourhoods are communities that are in the most deprived 10% of areas according to the 2019 Index of Multiple Deprivation (IMD) and in the 10% of areas of greatest need in the Community Needs Index (CNI).

There are 225 neighbourhoods identified as being left behind, and were typically found in post-industrial areas in the North of England and the Midlands, as well as coastal areas in the South East. Of the 225 Left Behind Neighbourhoods, 138 are in the North of England, 54 are in the North West, and 17 are in Greater Manchester.

Investigating outcomes in left behind neighbourhoods

We were commissioned by APPG for Left Behind Neighbourhoods to produce a report on health and economic outcomes in these neighbourhoods. We examined health outcomes and inequalities in the 225 neighbourhoods and the rest of England, and the long-term effects of health inequalities on individuals and the economy.

Health inequalities in England

In left behind neighbourhoods, men live 3.7 years fewer than average and women 3 years fewer. People in these left behind neighbourhoods can expect to live 7.5 fewer years in good health than their counterparts in the rest of England. Worryingly, there is evidence that this gap in life expectancy has been growing since 2010.

There is a higher prevalence of 15 of the most common 21 health conditions compared to other deprived areas and England as a whole. These health conditions include high blood pressure, obesity and chronic lung conditions. People in left behind neighbourhoods also claim almost double the amount of incapacity benefits due to mental health related conditions compared to England as a whole. During the earlier parts of the COVID-19 pandemic, people in left behind neighbourhoods were 46% more likely to die from COVID-19 than in the rest of England.

Impact on the economy

People in left behind neighbourhoods had it worse before the pandemic, were more affected by the pandemic, and will be harder hit by the cost-of-living crisis. In the current economic climate, more and more people are facing unexpected financial hardships or being pushed further into poverty, particularly in left behind neighbourhoods.

Tackling these health disparities will not only improve the lives of millions of citizens, it will also bring significant savings to the taxpayer. If the health outcomes in local authorities that contain left behind neighbourhoods were brought up to the same level as the rest of the country, an extra £29.8bn could be put into the country’s economy.

Tackling health disparities

To address health inequalities, the government’s national ‘levelling up’ strategy must include a strand on reducing spatial health disparities through targeting multiple neighbourhood, community and healthcare factors.

Long-term ring-fenced funding is needed to ensure more effective delivery of resources, and for targeted health inequalities programmes with a hyper-local focus that prioritises those left behind areas with the worse health outcomes that have been most affected by COVID-19. Consistent and long-term (10-15 years) financial support is needed to build local social infrastructure in left behind communities that lack the community capacity, civic assets and social capital needed to support and benefit from preventative and neighbourhood-based health initiatives.

Community public health budgets 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 in deprived and left behind communities. Local health initiatives that increase the level of control local people have over their life circumstances should be prioritised, from community piggy bank and community health champions initiatives, to more structured forms of community governance and decision-making.

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i3oz9sHow can we address health inequalities in ‘left behind’ neighbourhoods?