Health is moving up the agenda at the Ministry of Housing, Communities and Local Government with the recent publication of the English Devolution and Community Empowerment Bill. The new health duty for strategic authorities is a welcome recognition of the role local leaders can play in shaping health. They will now need to consider how they impact on health and health inequalities across ‘any of their functions'.
A wave of new powers supporting the Government's ambition to deliver economic growth includes a requirement for mayors to produce and publish local growth plans. There are inextricable links between growth and health. Being in poor health is a growing barrier to economic participation and is shortening lives prematurely. In local authority areas with the highest rates of premature deaths, people are almost twice as likely to die before they are 75 than in areas with the lowest rates. There are clear links between ill health and stalling growth. Education, occupation and deprivation levels are behind most of the variation in avoidable premature deaths.
Given how good health and growth are mutually reinforcing, it is a concerning omission that the recently released guidance for local growth plans overlooks health. Although health has emerged in the local growth shared priorities agreed between the Government and each mayoral strategic authority, this has so far been limited to greater integration of work and health services for people who are economically inactive.
Better wraparound support for people in ill health would of course be a positive step. However, if the Government meets its goal of halving the gap in healthy life expectancy between regions, greater ambition is needed across all efforts to drive growth. There is scope to go much further - local leaders are already pioneering new approaches to improve health within inclusive growth strategies, such as establishing new anchor practices and setting new standards for private sector contracts. Currently, these are one-offs, often without a long-term commitment and it won't happen everywhere without the Government setting minimum expectations.
Five stress tests are set out below to guide the Government and mayoral strategic authorities in developing local growth plans.
1. Is health recognised as essential to delivering growth?
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 and £7.6bn gross value added (GVA) is generated in the area. However, in Blackpool, life expectancy is 73 years for men, with £5.5bn GVA.
Growth plans that fail to address ill health will overlook a major barrier to prosperity. The integration of health and economic participation, as seen in the Workwell Vanguards and Trailblazer pilots, is important, however, good quality employment should be a cornerstone of the jobs newly created.
2. Is improving health an objective and is progress tracked?
New devolution powers offer flexibility and greater freedoms, particularly in the integrated finance settlement for eligible mayoral strategic authorities. Outputs, indicators and targets focused on growth that explicitly aim to improve health – across planning, regeneration, housing and skills – would ensure that strategies are aligned, opportunities aren't missed and teams aren't inadvertently working against one another.
3. Are communities involved in shaping local plans?
Health inequalities are deeply rooted in place and no one knows better than local people themselves about the challenges they face. Designing growth strategies without community input risks missing the mark entirely. Local leaders must actively engage with residents to reflect their lived experiences and priorities and to foster trust and accountability. It's also more likely to result in practical solutions that will make the local economy work better for people – like making affordable childcare available or accessible local transport.
4. Is there a commitment to evaluate what works?
To improve health through local growth efforts, robust data on the most effective interventions is needed. The Government should support local areas in evaluating their strategies, sharing best practices and scaling what works.
Evidence-led decision making is essential to avoid tokenistic approaches and instead build local analytical capacity, creating platforms for collaboration with long-term impact among public health teams, economic development officers and community leaders.
5. Is investment targeting the building blocks of health?
Local growth funding should be used to invest in the building blocks of good health – high-quality housing, skilled jobs, clean air, active transportation and strong community infrastructure. These are not just health interventions; they are core components of sustainable local economies. Investing in high-quality housing not only improves health but also stimulates the construction sector and creates jobs. Developing walkable, green neighbourhoods boosts retail footfall while improving mental and physical wellbeing.
In the Bill, the Government sets its stall out to bolster economic growth and introduces a new major shift with the health duty. Successfully delivering economic growth will depend on a coherent policy framework that prioritises health in all policies through the health duty, including local growth plans.
