Greater wealth doesn't always mean better health, argues professor

Emeritus Professor Neil Small has long focussed on health inequalities. He taught at Bradford from 1999 to 2021. Here, he broadly backs recommendations made by a Yorkshire-based health partnership but argues we must be much bolder if we are to make an impact on health inequality.

A new report authored by the consortium YHealth4Growth advocates for the devolution of health funding to the regions but it relies too strongly on the assumption that increasing prosperity will improve health.

YHealth4Growth is a partnership between Health Innovation Yorkshire & Humber, the NHS Confederation and Yorkshire Universities.

Its latest White Paper is called ‘Empowering local places for health and prosperity: new perspectives from Yorkshire and the Humber’, and it includes a foreword from Andy Haldane, Chief Executive of the Royal Society of Arts and Permanent Secretary for Levelling Up at the Cabinet Office.

It is the distribution of wealth and not its creation that is key to addressing health in a way that reduces inequality

This White Paper seeks to offer a “roadmap for turning the tide of health and economic outcomes from negative to positive in Yorkshire and the Humber”, the region with the third lowest life-expectancy in England. Its aspirations rest on three key routes to change, firstly empowering local leaders to identify and pursue the sorts of investment and the sorts of initiatives that best serve the circumstances of their areas, second by greater integration across services so that there is a vision for health informing the action of all and third by galvanising partnerships and empowering communities, not least by recognising the success of local initiatives and building on their example.

A further theme looks to the potential for businesses to recognise and act on their ability to positively enhance health. It’s a theme that assumes a relationship between health and (economic) growth that the White Paper says has “for the better part of 200 years… generated a positive loop of improving health outcomes and sustained economic growth”.  

This final and more contentious theme points to the context of this White Paper’s genesis – The Department for Levelling Up, Housing and Communities “Levelling Up the United Kingdom” White Paper of 2022. 

It is a dubious assumption that all sorts of economic growth benefits health. Rather, it is the distribution of wealth and not its creation that is key to addressing health in a way that reduces inequality.

We also need to be more questioning about what sorts of economic growth generates the wealth we want. If we want to sustain the air we breathe, improve the quality and affordability of our food and support the emotional well-being of all of us, we need to think again about what ‘wealth’ really means when we think about health.

Local authority actions are a crucial factor in the prevention of ill health and a reformed care system would remove major pressure from the NHS

Some sorts of economic growth, such as road building, opening coal mines, developing new oil-fields and promoting processed and fast-food, damage the wider environment and adversely impact on health. Additionally, a simple push for growth benefits those who are already well-off the most. Their salaries and dividends go up, their property increases in value and the gap between rich and poor gets ever wider. 

Governments lazily argue for the importance of the ‘trickle down’ effect, which claims wealth increases and then it ‘trickles down’ from rich to poor. It does not. A report on the growing inequality between the north and south of England from the Institute for Public Policy Research (North) called State of the North (2024) published on March 1, 2024, identifies a growth in average wealth between 2010 and 2020 but inequality in its distribution with the North falling behind the South, a trend they forecast will continue up to 2030.

There is also a wider context to bear in mind. Sustained austerity has been in place since the 2008 financial crash. It has impacted on the capacity of health, local government and the voluntary sector to sustain existing services, let alone develop new ones. 

Even if the economic context has remained stagnant, the policy context is dominated by short-term political expediency. An example of just two policy changes that would impact across the health economy are to reverse the cuts to local authority funding that followed the 2008 financial crisis and introduce meaningful social care reforms in line with recommendations on Funding of Care and Support made in the Dilnot Report, which has been gathering dust since its publication in 2011.

Why these two changes? Local authority actions are a crucial factor in the prevention of ill health and a reformed care system would remove major pressure from the NHS and address widespread anxieties in those older people fearful of their futures.

There is some great work going on right here in Yorkshire and the Humber. The YHealth4Growth White Paper includes some inspiring examples of excellence from across our region.

It is good to see the ongoing Born in Bradford (BiB) study, of which I was a founding member, being cited in the White Paper as an “internationally significant exemplar for monitoring health longitudinally”.

The impact BiB has sought since its inception in 2007 fits well with the White Paper’s  encouragement of developing a public better informed by robust research evidence to make healthy choices, by the value of a local focus, by collaboration across sectors and by spreading the lessons of successful local initiatives.