INNOVATE 19 – Levelling up health: tackling inequalities across society

Levelling up health: tackling inequalities across society

14 September 2021

As the nation moves further away from the 2020 peak of the pandemic, and seeks to learn from the unequal impact of COVID on marginalised groups, Tina Woods, Founder and CEO of Collider Health, tells us about ‘levelling up’ and the ambition to create the conditions for a nation with less disparity in health and life expectancy between different communities.

In July 2021, the Health Foundation published “Unequal pandemic, fairer recovery”, which, in the words of its Expert Advisory Panel Chair Dame Clare Moriarty, sought to “draw together thinking across a variety of disciplines, to situate COVID-19 in the wider picture of health inequalities and to understand how this extreme experience may influence the journey towards greater equality”.

The urgency of understanding and addressing the wider picture of health inequalities has been re-surfaced by a pandemic that has foregrounded the impact of poor health on “excluded” communities, and called out the need for social recovery and resilience running alongside economic growth and regeneration.

Dame Moriarty describes the “imperative to aim for a recovery that builds economic and social resilience, with ‘levelling up’ not limited to geographical areas of disadvantage but also addressing the needs of groups who have experienced the most damaging impacts of the pandemic”.

The ambition of ‘levelling up’ links back to government policy that was being articulated before the pandemic began and set the context for the “Levelling Up Health” report that was published in April this year by the All Party Parliamentary Group for Longevity.

“COVID-19 has had a devastating impact on our country, exposing our nation’s poor health and our health inequalities – 90% of those who died with COVID had significant prior poor health.”

APPG Longevity, 2021

What’s the story behind “Levelling Up Health” and what does it mean to a society recovering from the pandemic?

In order to understand the direct origins of the “Levelling up Health” report, we have to go back to March 2019 when The All Party Parliamentary Group (APPG) for Longevity was set up to address the scientific, technological and socio-economic issues relating to our ageing demographic and promote living healthier and longer lives.

In February 2020, just before COVID hit, the APPG published the Health of the Nation Strategy which set out key recommendations to meet the government goal of five more years of healthy life expectancy by 2035, while minimising health inequalities (or ‘HLE+5’).

Tina Woods, who is the director of the APPG and co-author of the report, takes up the story:

“We had been busy at work for nine months involving well over 100 experts in multiple organisations, including the Academic Health Science Network, in the development of the strategy to deliver five extra years of healthy life expectancy, while minimising health inequalities.

“COVID quickly hit us right after the launch of the Health of the Nation strategy, just as “levelling up” was starting to enter the lexicon. The NHS was hands on dealing with the crisis and so we focused on two of the core recommendations: Business for Health venture and the Open Life Data Framework.

“We could see, as the data was coming out from COVID, that the pandemic was obviously hitting our most vulnerable populations hardest. And a lot of that was due to their pre-existing poor health. This reinforced to us that we were on the right track with all of our recommendations, and indeed showed them to be more urgent and more compelling.

“So we decided to focus on the Open Life Data Framework and look at how we could harness data sets across the life course, with a focus on the wider determinants of health, as opposed to just the data that exists in our NHS and healthcare systems, and looking at how we could develop an open innovation platform and products and services to deliver our goal of the extra five years of healthy life expectancy, while minimising health inequalities.

“At the same time, Business for Health was set up looking at the role of business in public and population health.

“Towards the end of last year we started to formulate a plan to make levelling up health real and develop the policy ideas to take to government and key stakeholders. This plan culminated in the “Levelling Up Health” report that we launched in April

“It focuses on five key priorities that would help us level up the inequalities that we’re seeing around the nation: smoking, obesity, clean food, healthy children, and clean air. The priorities may not be a surprise to anyone, but actually, they’re the ones that will really drive the impact in the short to medium term, because we wanted to focus on practical solutions and things that we could actually start implementing now.

“I think this is an excellent report… a very strong emphasis on place… we must really be looking in the places where problems are greatest.”

Professor Chris Whitty, Chief Medical Officer for England and Chief Medical Adviser to the UK Government

“The work ties in really neatly with some of the thinking with integrated care and place based approaches. We are looking in granular detail about where people are healthy, and where people are less healthy and what we can do to support them.

Clean food

“Food and nutrition is already in the spotlight, linked to obesity, but by clean food we mean sustainable food and food with less additives. We know that junk food, with all its additives and all sorts of saturated fats, is a huge problem in terms of contributing to our ill health and, of course, the obesity problem. There’s a growing recognition that we’re literally getting addicted to bad foods – salt, sugar – and this links really strongly not only with the obesity crisis, but of course, to the mission to have healthy children.

“This links in with the whole health inequalities piece. We know that in a poor area there are many more fried chicken shops than in a rich area. Getting access to healthy food is often a problem and healthy food tends to be – not always, but tends to be – more expensive. And junk food tends to be cheap with high margins for supermarkets and the food industry, so there’s a massive structural problem there that we need to address.

A wider approach built at place level

“This is part of a wider systemic approach that we need to take to improve our nation’s health, which involves so much more than just the NHS and care system. There’s a massive cultural piece and it’s very important to have the NHS workforce engaged with this wider debate about what is it that keeps us healthy. We actually have a chronic disease epidemic, and that’s to a huge extent driven by our lifestyle, social circumstances and the wider determinants of health.

“I think what’s interesting is that Chris Whitty now has a far broader remit across government, which I think is a really, really interesting signal that health absolutely has to infuse the whole government thinking. I think everything is interestingly coming full circle in terms of understanding that humans sit in a wider ecosystem where all the agencies that look after us in our civic life have to come together. The relationship between health and the ability to work and provide for your children and climb out of socio-economic limitations on your life is very important, but often misunderstood or not acknowledged.

“There’s a lot of good work out there and we need to learn from it. The APPG is keen to support the next generation and the clusters of innovation that are getting things right at the local level.

“It’s about leadership, it’s about mobilisation, it’s about really, really getting your hands dirty in terms of getting embedded into communities. The role of social enterprise is vital, they know their communities best, and social capital and social investment are also important elements.

“It’s about working with local partners to come up with the right solutions at a local level.”

Get involved

The Open Life Data Framework

The Open Life Data Framework consultation is now live – the deadline for responses is 17 September. Contributions are being collected via this form.

The purpose of this initiative is to make it easier to connect data across our lives to help understand how we can keep healthier for longer and reduce health inequalities. It will look specifically at standardised integration of health-relevant data, particularly at the Integrated Care System level. The rationale for the framework was published in the Lancet, Open Life Data to Support Healthy Longevity for All.

Business Framework for Health

Business for Health (B4H) has just announced its collaboration with the Confederation of Business Industry (CBI), supported by Chris Whitty Chief Medical Officer, in the development of the initiative, Business for Health Framework: supporting businesses and employers in their role to enhance and level up health of the nation.

B4H is inviting all interested stakeholders to contribute to the next phase of the consultation of the Framework by completing this form by 24 September. All contributors will be invited to the launch on 18th October 9:30-11:00 at the CBI in a hybrid physical/virtual event.

About the author

Tina Woods is a social entrepreneur who brings diverse stakeholders together to address the system changes needed to improve health for all.

She is director of the All Party Parliamentary Group for Longevity and Co-Founder and CEO of Business for Health, a business-led coalition of socially responsible employers, purchasers, investors and innovators supporting long-term sustainable innovation and investment in preventative health and care.

Tina is also Founder and CEO of Collider Health and works with private sector and public sector, including the AHSN Network, NHSX AI Lab and UK Research & Innovation on the Healthy Ageing Industrial Strategy Challenge Fund.

Tina’s book, ‘Live Longer with AI: How artificial intelligence is helping us extend our healthspans and live better too’ is available here and free for anyone in the NHS who has an OpenAthens login to the Kortext platform.

Find out more

Information about the APPG Longevity and the “Levelling Up Health” report are available here: All Party Parliamentary Group for Longevity (appg-longevity.org)

The Health Foundation’s “Unequal pandemic, fairer recovery” report is available here: Unequal pandemic, fairer recovery | The Health Foundation

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