Economic growth is not enough

After more than a decade of devolution, many places can point to rising GVA, new investment and city-centre regeneration. But new Health Foundation analysis showing that healthy life expectancy in the UK has fallen by more than two years over the last decade — with gaps of almost 20 years between the richest and poorest areas — should force a rethink of whether current growth models are actually improving people's lives.These trends reinforce a wider and increasingly well-established reality: health inequalities are not primarily produced inside the NHS. They are shaped by the wider determinants of health — the conditions of everyday economic life such as housing, employment and transport. The concluding essays from CLES's joint programme of work with The King's Fund and The Health Foundation therefore examine what this means in practice for strategic authorities and the next phase of devolution.For strategic authorities, the implications are significant. Economic development can no longer be treated as something separate from population health. The shape of local economies — who benefits from growth, where wealth flows and what everyday life costs — is central to whether places become healthier or sicker. One of the central findings from our programme of work is that economic growth does not automatically translate into better health outcomes. How growth is shaped and distributed matters enormously. Our latest essay on local growth plans explores this in more detail. While national guidance remains heavily focussed on high-growth sectors and productivity, some strategic authorities are beginning to take a broader approach.Places such as York and North Yorkshire, the North East and the West Midlands are increasingly combining support for higher-growth sectors with a stronger focus on the everyday economy — sectors such as care, retail, logistics and transport that shape incomes, insecurity and health outcomes for millions of people.The strongest growth plans are also asking different questions. Not simply how do we grow the economy, but who benefits from growth and how it is distributed.York and North Yorkshire is a particularly interesting example. Its local growth plan explicitly links economic development to tackling health inequalities and improving living standards, while embedding community wealth building principles around fair employment, local supply chains and broader measures of success beyond GVA alone. CLES is now working with the strategic authority to help operationalise this approach.This reflects a growing recognition that economic development is health policy.The implication is that the next phase of devolution cannot simply be about acquiring more powers. It must also be about using existing powers differently.Our second and final new essay argues that new strategic authorities in particular should focus less on trying to do everything at once and more on a smaller number of practical interventions where they can realistically make progress.Employment, housing and transport stand out because they are among the strongest determinants of health and the areas where strategic authorities hold meaningful influence.On employment, this means moving beyond "any job" approaches and linking devolved skills funding much more directly to secure work and progression routes. We argue that this funding should be used to replicate and scale up NHS-backed programmes like Birmingham's ICAN which guarantees jobs for people completing employment support training. On transport and housing, the central issue is affordability. A cheap, reliable bus network effectively raises disposable income; an expensive and fragmented one reduces it. Strategic authorities therefore need to think not just about transport connectivity or housing supply in the abstract, but about how these systems influence living standards.This is why debates around bus franchising, municipal bus companies and public and not-for-profit housing models matter so much. They are not simply governance questions. They are about whether more economic value can be retained locally and reinvested into cheaper fares, genuinely affordable homes and better everyday conditions.There is also a significant opportunity here around community wealth building. Preston's experience — including evidence published in The Lancet showing improvements in mental health and wellbeing — demonstrates how economic interventions around procurement, employment and local supply chains can support better health outcomes. Strategic authorities are well placed to convene anchor institutions around a shared approach to community wealth building — aligning economic strategies, skills, transport and housing in ways that help raise living standards and reduce health inequalities.The broader challenge for strategic authorities is therefore not simply how to generate growth, but how to shape it.In an era of rising distrust and economic anxiety, strategic authorities can continue to promise that growth will eventually improve everyday life. Or they can begin to shape local economies more deliberately around reducing insecurity, improving affordability and strengthening the conditions for healthier lives.That may ultimately become the defining test of devolution's success.Tom Lloyd Goodwin is deputy chief executive of the Centre for Local Economies (CLES)

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LOCAL ECONOMIES

Economic growth is not enough

By Tom Lloyd Goodwin | 12 May 2026

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