Government will miss key levelling up targets on health inequalities, study warns

21 May 2024

Research from City University London suggests that the government will miss key health inequalities targets, which are a cornerstone of its levelling up agenda.

Although the study concludes that a notional immediate outright ban on tobacco sales would eventually increase healthy life expectancy by 2.5 years, it would not be enough for the government to meet the targets for reducing health inequalities set out in its levelling-up white paper. An immediate ban on smoking would, however, extend the working lives of both men and women, the paper concludes, with the greatest impact in more deprived areas.

Local government secretary Michael Gove’s 2022 levelling up white paper pledged to narrow the difference in ‘healthy life expectancy’ (HLE) between England’s most prosperous and most deprived local authorities by 2030, and to boost overall HLE by five years by 2035.

HLE measures the number of years lived in at least reasonable health. In the UK it has risen more slowly than life expectancy in recent decades – meaning people are typically spending more years in poor health, with obvious implications for NHS and social care budgets.

The researchers, drawn from Bayes Business School (formerly Cass), Heriot-Watt University and LCP, analysed the likelihood of the 2035 target being met. They published their paper, ‘The great health challenge: levelling up the UK, in The Geneva Papers on Risk and Insurance: Issues and Practice.

Les Mayhew, lead author and professor of statistics at Bayes Business School (formerly Cass), said, “It is clear that drastic smoking cessation intervention is necessary to increase healthy life expectancy across the population and to narrow pernicious health inequalities.

“The rolling ban proposed in the government’s current legislation is a good first step but further research could strengthen the case for an outright ban.

“Policymakers need to commit to politically difficult policies even if improvements in population health are gradual and long-term. With an ageing population, the pressure on policymakers to intervene in behaviours that shorten working lives will become irresistible – as seen already with the current focus on sickness and disability benefits.”

Tobacco continues to blight and shorten lives

The analysis confirmed that people who have never smoked typically enjoy an additional six years of HLE. Earlier research has shown that smoking kills around 78,000 people in England each year and leads to around 500,000 hospital admissions.

Recent research by the International Longevity Centre concluded that smoking cuts UK economic output by £19.1bn due to shorter working lives. Welfare and healthcare costs would boost that figure significantly.

The latest study also concluded:

  • The nine-year gap in average life expectancy between the richest and most deprived local authority areas almost doubles to 17-years for years lived in reasonable or good health.
  • A one-year improvement in health expectancy increases life expectancy by 4.5 months. This means the gap between lifespan and health span gets smaller so that people live both longer and in better health.
  • Lung cancer deaths in different local authority areas revealed a correlation with the number of years spent in good health. HLE was lowest in cities, including London, the north of England and the midlands – and notably low in an arch linking Liverpool, Manchester, Leeds and Hull.
  • A targeted campaign in areas with high levels of smoking would significantly reduce health inequalities, but the results would take time to work through.
  • Targeted smoking cessation policies would extend working lives, reduce the welfare bill and ease pressure on NHS and social care budgets.

Andrew Cairns, professor of actuarial mathematics at Heriot-Watt University, said, "Our paper confirms that a smoking ban on those born in 2009 or later is one of the best ways to improve the health of people living in more deprived areas of the UK. The findings vividly illustrate the transformative impact of this measure on the health landscape. It coincides with a parliamentary debate, signalling a concerted effort towards a healthier future for all."

Mei Chan, senior statistician in LCP’s Health Analytics, said, “Our study has shone a light on the importance of measuring how much time people spend in good health rather than just focusing on life expectancy. While recent political events have put the issue of smoking into the spotlight, the UK Government already had ambitious targets in place.

“It’s clear that more needs to be done to meet the ambitious target to improve healthy life expectancy by five years and narrow the gap between the richest and poorest areas.

“The study also highlighted that lifestyle-related risk factors such as smoking, nutrition, alcohol consumption and physical activity are interconnected, particularly in more deprived communities. The rolling smoking ban is a promising start, though the use of joined-up policy approaches tackling multiple lifestyle factors would strengthen the long term impact of the smoke free generation policy.”