The cruellest postcode lottery of all

Yesterday Public Health England published an interactive map showing the levels of variation in early death rates for local authorities across England (or as some have dubbed it, the Early Death Atlas).

Graeme Henderson is a research fellow at IPPR North

Yesterday Public Health England published an interactive map showing the levels of variation in early death rates for local authorities across England (or as some have dubbed it, the Early Death Atlas).

The health secretary has described the disparities as “shocking”, but it should not come as a shock to anyone, least of all those councils recently tasked with tackling this issue.

Rather, it simply feeds the impression that our governing class is increasingly detached from the everyday lives of many of its citizens. 103,000 early deaths a year classed as preventable shouldn’t just be one news cycle’s headline, but rather the start of urgent and sustained action to dramatically reduce this number.

Much reporting today has focused on the north-south divide apparent in the statistics. Of the 56 local authorities considered to have the ‘best’ premature mortality outcomes, only three were in the North of England – North Yorkshire, York and East Riding of Yorkshire.

These figures are hardly surprising given the greater proportion of deprived areas in the north of the country. The North also continues to be affected by the historic burden of industrial illnesses from those working in mining, shipbuilding and construction. The figures for the UK as a whole are not great – seventh out of 17 European countries for men and 15th for women.

The new feature of these statistics is the ability to compare early death rates across areas with similar levels of deprivation. While this addition layer of analysis is useful, it must not cloud the fact that these figures, like most health statistics, follow a broadly similar pattern to deprivation levels.

Risk factors in relation to premature death include being overweight, lack of exercise, excessive alcohol consumption and smoking – all of which are linked to economic deprivation. These figures also disguise within local authority variation. Those claiming benefits became more segregated and increasingly concentrated in certain neighbourhoods during the last economic boom.

The coalition’s housing benefit cap and ever increasing levels of income inequality can only help reinforce this trend.

The levels of deprivation and poor health outcomes within our largest cities were once again highlighted. All eight of the largest English cities outside London were graded as having among the worse premature mortality outcomes.

The coalition has focused much attention on these cities as drivers of economic growth. Yet it would appear that much more needs to be done in treating them as places where people live, not just engines of growth. Manchester, seen by many as the poster boy for localism, managed to place 150th out of 150 in the ranking. The council though has only received £41 million for public health of its £51 million target allocation based on the government’s own formula.

London itself had huge levels of variation with Richmond being ranked 2nd and Tower Hamlets 137th.

So what can be done to address these disparities?

Lead responsibility for improving public health passed to local councils in April with a ring-fenced budget of £5.4 billion over two years. This is a welcome development. Healthcare services are just one determinant of health, with living and working conditions playing a big role, so local authorities are better positioned to have an impact than the NHS.

However because the benefits of investing in improving the population’s health tend to be felt by the NHS, it is essential that local commissioners of public health, healthcare services, social care and housing come together to tackle these problems.

While local government is much more capable of acting in the joined up way required for improving health outcomes than Whitehall, this must not be used as a way for central government absolving itself from responsibility. Measures such as plain cigarette packaging and alcohol minimum unit pricing can only come from a national level.

The local government cuts falling disproportionately on the more deprived areas will not help councils deliver the holistic response required. Moreover, the coalition has changed the public health funding allocations for the next two years with some of the healthiest and wealthiest areas in the country having been allocated much more than some of the most deprived areas.

The Royal College of Nursing have said that a man in Kensington and Chelsea can expect to live 86 years whereas in Hendon in Sunderland, male life expectancy is just 69. Nonetheless, Sunderland will only get 57 per cent of the per head public health funding which Kensington and Chelsea will get.

This can only help entrench and increase health inequalities. Local areas must also be given the powers as well as resources. For instance, councils are often powerless to clamp down on nightclub late licenses and pay day loan shops which bring misery to their local areas, and indirectly affect mental and physical well-being.

Jeremy Hunt wants areas to use the data to identify local public health challenges like smoking, drinking and obesity and to take action to help achieve the government’s ambition for saving 30,000 lives a year by 2020.

So many things will influence this, including housing, transport, employment opportunities, school curriculums and leisure centre facilities.

This will require sustained action by national government and it providing councils (along with the NHS and Public Health England) with the right powers and resources to make a meaningful impact.

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