A guest briefing by Tom Stannard, Wakefield MDC’s corporate director of regeneration and economic growth
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Back in 2010, in the now seminal Fair Society, Healthy Lives, Sir Michael Marmot argued: “This link between social conditions and health is not a footnote to the ‘real’ concerns with health – health care and unhealthy behaviours – it should become the main focus.”
His report was a timely wake-up call, at the height of the recession, that regeneration practice required a step change in attitude, approach and solutions focussed on tackling “2.5 million years of life potentially lost to health inequalities.”
In the intervening period the recession and its consequences for public expenditure have been profound. The story of this has been retold many times – declining public investment in local government generally forcing a focus on statutory vs non-statutory services and interventions. There has been financial challenge across the health service combined with the opportunity, in some areas, of devolution. Clinical acute care has arguably taken centre stage - often forced by winter crises - over adult social care, and mental and public health. And public health’s much-heralded move to local government was followed regrettably by further years of financial challenge.
Undeniably austerity has taken its toll on the health economy writ large. Economic patterns have shifted in this period as well. A more health conscious, ageing society living longer, alongside population growth across many areas of the country, compounds the pressures felt in localities. The statistics remain stark. In my own area, Wakefield, our 2017 State of the District report found 70.5% of adults were overweight or obese, gradual improvements in life expectancy and physical activity levels, but also persistent levels of under-employment and in-work poverty.
LGC Future Places
Tom Stannard is a speaker at LGC’s Future Places event, to be held in Birmingham on 22-23 May.
The race is on to build 300,000 new homes a year – but how can you ensure your new communities are prosperous, healthy and vibrant? The event seeks to support councils to form the relationships that can get new developments off the ground, and offer inspiration to shape their rapidly changing places to promote fairness and opportunity.
For details see here.
Despite nine years since Marmot, there remains a huge agenda to be tackled. A 2018 report by the King’s Fund provided a clear and up-to-date argument for the role of city regeneration in improving population health. It argued that better integrated health economy governance can lead the way in getting the “system” to talk to itself – a pre-requisite in successful health economy planning and intervention.
We should not overlook the dramatic success that place based planning can have on population health outcomes. In health circles there is much focus on housing, but to enable progression for people on the housing ladder, out of poor quality stock that inhibits good health, and away from purely reactive enforcement in the private rented market, the starting point must be skills and facilitating labour market progression for residents.
The raw economics demonstrate the deficit model we will bequeath to future generations without tackling the UK skills crisis. With this will come continuing deteriorations in public health. Earlier this year, the UK Learning & Work Institute argued that as a result of cuts in public funding for adult skills, alongside falling employer investment in skills, the UK is poised to:
- Fall from 4th to 6th of the G7 countries for low skills;
- Remain 5th for intermediate qualifications; and
- Remain 4th for higher qualifications.
Their analysis demonstrated that by setting out a higher ambition for the UK, making sure more people have functional and intermediate qualifications, the economy could be boosted by £20bn per year, helping another 200,000 people into work. The costs? Extra investment of £1.9bn per year to reverse the falls in the number of adults improving their skills each year seen since 2010.
This represents a relatively small price to pay in the grand scheme of UK public expenditure, for economic mobility and population health improvement. Given this analysis, I would propose three key issues for the regeneration and health improvement worlds and their various local partners to focus on:
1. Housing condition, housing growth and community development – planning with health at the table. Our early work with Wakefield CCG seeks to plan properly for population health need in areas of substantial housing growth.
2. Community engagement – take your population with you. It is bad planning to ‘impose’ growth on established communities and it is essential to go well beyond statutory planning consultation to get this right. Other services can also assist. Our work in Wakefield in engaging local communities in health improvement via local leisure facilities is a good example.
3. Skills and employment progression – investing upstream in skills and in-work progression support, particularly for the working age adult population is essential for economic mobility, and via this for population health improvement. Doing this in partnership with local NHS colleagues only adds further value to the mix. Our in-work progression pilot in Knottingley is a good example in practice.
There is a lot further we can go to secure health improvement via regeneration interventions. For me, the labour market issues come close to the top of the list each time. Find out more at LGC’s Future Places event in Birmingham, 22-23 May this year.
Tom Stannard, corporate director of regeneration and economic growth, Wakefield MDC