Ben Barr University of Liverpool How can the North lead the way on health equity?

Professor Margaret Whitehead (Chair), W.H. Duncan Chair of Public Health, Department of Public Health and Policy, University of Liverpool Professor Clare Bambra, Professor of Public Health Geography, Department of Geography, Durham University Ben Barr, Senior Lecturer, Department of Public Health and Policy, University of Liverpool Jessica Bowles, Head of Policy, Manchester City Council Richard Caulfield, Chief Executive, Voluntary Sector North West Professor Tim Doran, Professor of Health Policy, Department of Health Sciences, University of York Dominic Harrison, Director of Public Health, Blackburn with Darwen Council Anna Lynch, Director of Public Health, Durham County Council Neil McInroy, Chief Executive, Centre for Local Economic Strategies Steven Pleasant, Chief Executive, Tameside Metropolitan Borough Council Julia Weldon, Director of Public Health, Hull City Council

20 minutes on Merseyrail 10 fewer years of life Source: Barr, 2014

Causes

A distant government.

Devolution for the North

DUE NORTH: actions to tackle root causes

1. What can agencies in the North do to help reduce health inequalities within the north and between the north and the rest of England? 2. What does central government need to do to reduce these inequalities? Lessons for the whole country, not just the North Two types of recommendations

Develop better locally designed support for people moving into work. Promote living wage. Use the joint spending power to promote good employment. Improve quality and affordability of housing, through identifying new sources of investment and regulation of the private rented sector. Expand the role of Credit Unions. Rec 1: Tackle poverty and economic inequality

Monitor and increase proportion of overall expenditure allocated to giving every child a good start. Ensure access to good quality universal early years education and childcare. Maintain and protect universal integrated neighbourhood support for early child development, including Children’s Centres. Rec 2: Promote healthy development in early childhood

Expand the involvement of citizens in shaping how local budgets are used. Develop community-led systems for monitoring and accountability. Assess opportunities for setting up publicly owned mutual organisations for providing services. Rec 3: Share power over resources and increase influence of public over decisions

Give organisations in the north more control over how resources are used. Protect and prioritise national spending on children in the early years including expanding universal early years education. Allocate a greater share of resources to the places that need it most. Develop a national industrial strategy that reduces inequalities between regions. Ensure that welfare systems provide a minimum income for health living (MIHL) to those who need it. Make sure austerity measures do not widen inequalities. Actions for Central Government.

The NHS needs to build on its considerable achievements in mitigating some of the effects of rising social and economic inequalities, by: -maintaining the NHS core principle of equitable access to high quality health care, free at the point of need; - integrating locally to develop services that prevent poor health and poverty across the life course (including using the commissioning and procurement power to maximise social value for the North); -Champion action on health inequalities by all organisations. Actions for the NHS

Where next? A wide debate with local government and other agencies across the North. North East – DsPH audit and benchmark themselves against the recommendations in the report. Liverpool - Liverpool Mayoral Action Group on Poverty PHE response - discussion and debate with partners leading to response in spring 2015.

“The poorest that is in England has a life to live, as the greatest” Thomas Rainborough 1647