The English Devolution and Community Empowerment Bill has now had its second reading in parliament. With this progression through parliament comes significant potential to build healthier, more prosperous places across the country, which couldn't be more timely. The country's health is fraying and is falling behind our international peers. Some regions fare much worse than others, particularly the North East and North West, where mortality rates are 20% higher than in the South West. These stark differences are not just statistics; they reflect deep rooted inequalities in health and opportunity across the country.
Poor health is not only a personal challenge, but also a national economic liability. 8.2 million working-age people live with a long-term health condition that limits their ability to work. Meanwhile, poor workforce health is estimated to cost UK employers up to £150bn a year through lost productivity, sickness absence and recruitment costs.
As it currently stands, there are huge differences in levels of maturity across Strategic Authorities, as well as in the extent to which action to improve health is prioritised and evaluated. There is also a lack of public health expertise in many Strategic Authorities, and risks of duplication of existing activities led by local partners.
And the challenge is growing. The Health Foundation project that by 2040, an additional 2.5 million people will be living with major illnesses, most of them in the country's most deprived areas. The need to rebuild the UK's health has never been more urgent.
The government has committed to halving the gap in healthy life expectancy between the richest and poorest regions of England. But so far, it has offered little clarity about how this important goal will be achieved. And in any case, central government alone cannot deliver the change that is needed. Improving health must be a shared endeavour — and Strategic Authorities, previously known as Combined Authorities, are central to this mission. The English Devolution Bill presents a rare and timely opportunity to turn ambition into action.
Strategic Authorities are uniquely placed to shape the social and economic conditions that influence health. With powers over transport, housing, skills and economic development, they have the potential to create healthier places and fairer opportunities. There are encouraging signs that some regions are already taking action, for example the West Midlands Combined Authority are embedding inclusive economic growth approaches, Greater Manchester are driving quality standards in the private rented sector, and the Greater London Authority has used its powers over advertising to limit the promotion of unhealthy products. The Health in all Policies Toolkit, produced by the Mayoral Regions Programme, showcases many more case studies of Strategic Authority action.
However, as it currently stands, there are huge differences in levels of maturity across Strategic Authorities, as well as in the extent to which action to improve health is prioritised and evaluated. There is also a lack of public health expertise in many Strategic Authorities, and risks of duplication of existing activities led by local partners.
The Bill must tackle these challenges by setting clear minimum standards for action to reduce health inequalities and introducing stronger accountability, ensuring that all Strategic Authorities, regardless of their starting point, prioritise and evaluate action to improve health. This means requiring each Strategic Authority to publish a strategy for reducing health inequalities, to embed health in their growth plans, and to work hand in hand with the NHS, local councils and communities. Without this, the opportunity to meaningfully reduce health inequalities could slip away.
Opportunities presented by the Bill
Clause 43 of the Bill sets out a new duty under which all Strategic Authorities must "have regard to the need to improve health and reduce health inequalities" when exercising their functions. This marks a significant step forward. But to turn ambition into action, stronger guidance and accountability are needed. Strategic Authorities should be required to publish a health inequalities strategy (already a requirement of the Greater London Authority), report on progress, and work closely with partners such as Integrated Care Boards, local authorities, and the voluntary sector.
Elsewhere in the Bill, Clause 38 and Schedule 19 require Strategic Authorities to develop local growth plans, a key mechanism for driving regional economic growth. Health must be integral to these plans: rather than being simply an outcome of economic growth, good health is a precondition for stronger local economies. Without it, people can't participate fully in the labour market and contribute to local economies. In Oxford, life expectancy for men is 79.5 years, generating £7.6bn gross value added (GVA) in the area. However, in Blackpool, life expectancy is 73 years for men, with £5.5bn GVA. Statutory guidance should make clear how to identify and address health-related barriers, integrate health with shared priorities and use indicators and outcomes frameworks to track progress.
Through the English Devolution Bill, the government must set the framework required for Strategic Authorities to fulfil their role in improving the nation's health. This will require a combination of guidance, resources, and support, so that all regions can improve the health of their populations.
Katherine Merrifield is an assistant director And Mariah Kelly is a policy officer at the Health Foundation
