Debbie Horne, Senior Policy Officer at Diabetes UK, reflects on what the Spending Review omitted and what the forthcoming White Paper on Levelling Up must do to level up health.
Imagine a society where health inequalities didn’t exist or at the very least were vastly smaller than at present. Where no matter who you are, where you are born, what skin colour you have – you fully experience your human right to the highest possible attainable standard of health.
Not only would this significantly reduce the numbers of people living with preventable conditions (like type 2 diabetes) and the devastating consequences these illnesses create. Not only would this increase the number of years people could live in good health free from illness and fundamentally live longer lives. It would also have unprecedented positive benefits for the wider economy. As the saying goes, an ounce of prevention is worth a pound of cure - or rather for these times, a penny spent on prevention is worth more than a pound spent on treatment.
Creating a healthy society is possible. The society and economy we have today was designed and it can be redesigned to work for everyone.
That’s why last week’s Spending Review was disappointing and marked a missed opportunity to level up health. Whilst we’ve all heard the rhetoric of levelling-up: many have asked what does levelling up actually mean and what should it look like?
For us at Diabetes UK, the answer is simple: levelling up must mean levelling up health.
Creating an economy and environment where everyone can afford and experience a healthy life - to live well. We know that’s not the case at present.
Take the prevalence of type 2 diabetes in our most impoverished communities that are two and half times higher than in the most affluent areas. Or the outcomes people in poverty can expect when diagnosed with diabetes, where you’re twice as likely to experience serious and devastating consequences such as amputation, strokes and heart problems.
The Covid-19 pandemic exposed the health inequalities that exist in society to a greater audience than ever before, inequalities that many working in health have been aware of for decades.
The Spending Review identified four areas of levelling up: spreading opportunity and improving public services; boosting living standards; restoring local pride and empowering local leaders and communities. However, it failed to properly address the key underpinning issues that create health inequalities.
If we are going to level-up health we need to see concrete action on the three pillars of health: our wealth, our environment including housing, and racial inequalities.
Improvements announced in the Spending Review to Universal Credit are welcome small steps in the right direction. But the changes announced to Universal Credit for people in work will affect just 40% of people who are accessing this element of social security. And comes just weeks after many people have seen a £20 a week reduction to their entitlement. It’s not acceptable that those who are out of work, are disabled and can’t work, are likely to slide further into poverty with the devastating consequences we know that poverty has on our health. Evidence shows that in order to meet Government’s own Eat Well Guidelines, a person in the lowest income bracket would have to spend 75% of their disposable income on food. These choices push a healthy diet beyond the reach of the poorest in our society.
The £9m announced for 100 new parks is also welcome – but is a small amount of what is required to enable people to live in a healthy environment. We need a leap forward in addressing access to green space, access to exercise and access to active travel opportunities.
There needs to be a step change in tackling the underpinning social determinants of health (where we are born, live, work and age). In the Spending Review it is noted ‘the government will publish the Levelling Up White Paper by the end of the year, setting out in more detail the framework and next steps towards levelling up opportunities and boosting livelihoods across the country.’
When people in areas identified as ‘left-behind’ are asked what resources they want in their community, over half identified jobs and parks as key resources and over 40% say housing and better welfare advice services. The message from this is clear, people need action to address poverty and to address living standards through better housing and the environment in which we live. These areas must be addressed in the forthcoming White Paper.
We need concrete action to address poverty; the evidence tells us this requires action to increase wages and social security rates, and to tackle the cost of living. The White Paper on Levelling Up must act ambitiously to tackle poverty, improve our living environments and address racial inequalities.
At Diabetes UK, we look forward to seeing the White Paper on Levelling Up due to be published later this year. As part of this - and alongside over 180 other organisations who are part of the Inequalities in Health Alliance – we call on the government to urgently bring forward a cross-government strategy that focuses on addressing the social determinants of health (the conditions in which we live, grow and work) in order to put the building blocks of good health under all our feet. And end the deepening health inequality currently being experienced by our poorest communities.
It’s time, once and for all, to level up health.
