Healthy Life

The ‘good health’ gap: what will it take to reduce health inequalities?

Of course, recent years are not necessarily predictive of the future. The 2000s saw healthy life expectancy improving at a rate that, if returned to and sustained to 2035, would put the government on track to more than meet their target of a 5-year boost to healthy life expectancy.

Clearly there is significant uncertainty as to what future trends in healthy life expectancy may be. But we shouldn’t overlook the sharp shift in the pattern in healthy life expectancy improvements since the turn of the decade, something that demands closer attention and examination.

Reducing inequalities in healthy life expectations

Rightly, the government’s mission is not just about absolute increases, but reducing inequalities too. That’s important because of the wide – more than 18-year-old – gap in healthy life expectations between the 10% most and least deprived areas. Reducing this gap could boost the average and help fulfill their ambition.

Improvements in healthy life expectations have also varied, and have been reversed for some groups. Within areas with similar levels of deprivation, there are wide disparities in outcomes. This suggests the right policy mix can help drive improvements (even accounting for existing conditions).

Prevention: government priorities (and parameters)

So where should the government start if they are to boost the nation’s health and make credible the long-term aim of treating our health as an asset?

The shift in the policy narrative towards recognizing health as an asset is welcome, but it needs to be backed by a shift in investment. For much of this decade, many of the other areas of spending that create good health, and sitting outside the NHS, have seen major funding cuts. Paying more attention to the long-term consequences of any fiscal settlement on health will be key.

One area to watch is the public health grant, which plays an important role in improving and maintaining the population’s health. Real term, per capita funding of the grant is set to fall by 25% between 2015/16 and 2020/21. Halting this trend is a crucial place to start, but other government areas, such as social security, are important too.

Naturally, it is the conditions in which we live that are the strongest determinants of our health – as my colleagues have explored in What makes us healthy?. Improving these conditions requires the right mix of regulation, ‘polluter pays’-style tax design, and provision of information. With such a wide range of factors influencing health, cross-government and cross-sector action is vital. Ensuring effective change and embedding a health focus in all government decision-making will require more than rhetoric.

One possibility is a legislative commitment to improving health. This approach is already in place in Wales through the Future Generations Act, and is currently being promoted by Labour. Another move could be to widen key government metrics of success to include indicators of health, wellbeing and our wider prosperity (not just GDP-based measures) – as New Zealand’s first Wellbeing Budget does. Whatever the mechanism, embedding long-term decision-making at the heart of government is key.

There are clear limits on what central government can achieve alone. With the places we live in so key to our health, recognizing the role of local governments to find the right interventions at a regional level is important. It’s also crucial to reach beyond government: involving communities in creating activity to support their health; and ensuring businesses support the health of their employees and consider the wider contribution they can make to health.

Every sector needs to treat our health as an asset that underpins our prosperity. A comprehensive shift in approach is needed to create healthier lives for people in the UK – it will need a bold approach from the new Prime Minister and his government.

David Finch (@davidfinchRF) is a Senior Fellow at the Health Foundation.


  • Definitions of healthy life expectancy changed over the period 2001–11. The analysis takes the longest most recent consistent time series available (from 2009–11) and applies the historic proportional change in HLE between 2000–02 and 2009–11 for our upper-case scenario.

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