We have long known that the health of people living in deprived areas is worse than the national average. But this raises important questions, such as how big is the gap? Is it narrowing or growing over time? Are some deprived places worse off than others? And how do health inequalities affect economic performance? In this article, from our Power in Place publication, Dr Luke Munford looks at those disparities in greater detail.

• Men and women living in left behind neighbourhoods live, respectively, 3.7 years and 3 years fewer than average. This gap in life expectancy has been widening.
• Tackling these health disparities will not only improve the lives of millions of citizens, it will also bring significant savings to the taxpayer.
• The Levelling Up strategy must include a strand on reducing spatial health disparities through targeting multiple neighbourhood, community and healthcare factors.

Investigating outcomes in left behind neighbourhoods

To answer these questions, we were commissioned by the All-Party Parliamentary Group for Left Behind Neighbourhoods to investigate health and economic outcomes in ‘left behind’ neighbourhoods.

We examined health outcomes and inequalities in the 225 left behind neighbourhoods and the rest of England, and the long-term effects of health inequalities on individual and the economy.

What is a left behind neighbourhood?

We defined left behind neighbourhoods (LBNs) as areas that were in the most deprived 10% of areas according to the 2019 Index of Multiple Deprivation and in the 10% of areas of greatest need in the Community Needs Index. The Index of Multiple Deprivation (IMD) is a composite measure, developed by the ONS, of the relative deprivation of areas in terms of seven key domains. The Community Needs Index (CNI) was developed by Oxford Consultants for Social Inclusion to measure how an area performs in terms of social infrastructure.

We identified 225 neighbourhoods as being left behind, and they were typically found in post-industrial areas in the Midlands and North of England, as well as coastal areas in the South East.

Of the 225 LBNs nationally, 138 are in the North of England (61%), 54 are in the North West (24%), and 17 are in Greater Manchester (8%).

We also looked at what we called ‘other deprived areas’ – areas that rank in the most deprived 10% in the 2019 IMD but are not in the 10% of areas of highest need according to the CNI. We compared a range of health and economic outcomes in LBNs and other deprived areas to the English average.

Health inequalities in England

In LBNs, men live 3.7 years fewer than average and women 3 years fewer. Both men and women in these LBNs 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. Health inequalities have been widening not narrowing.

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 (such as COPD). In additional, people in LBNs 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 living in LBNs were 46% more likely to die from COVID-19 than those in the rest of England.

Impact on the economy

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

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 LBNs were brought up to the same level as in 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. The Office for Health Improvement and Disparities is an opportunity to catalyse action for population health.

Long-term ring-fenced funding is needed to ensure more effective delivery of resources on the ground, and for targeted health inequalities programmes (drawing on initiatives such as Healthy New Towns) with a hyper-local focus that prioritises those left behind areas with the worst 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. This is key to improving local outcomes, and it could be achieved through mechanisms such as the Community Wealth Fund, which would give local residents the means to develop those services and facilities that best meet their needs.

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.

Government and local authorities should prioritise left behind neighbourhoods for investment in new Family Hubs to help improve wellbeing and local life chances. Existing services should be redesigned to respond to the specific challenges within a local area. 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 structure forms of community governance and decision-making.

This article was originally published in Power in Place, a collection of thought leadership pieces and expert analysis providing evidence-led solutions for thriving and sustainable communities. 

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