The “Due North” report sets out actions that can be taken by organisations and communities in the North and by central government to ‘turn the tide’ on the unacceptable health inequalities that exist within the North and between the North and the rest of England.

The causes of these health inequalities are broadly similar across the country; differences in poverty, power and resources needed for health. But the severity of the causes is greater in the North.  What is of particular concern is that many of these trends are getting worse, the gap is widening and austerity measures are making the situation even worse, impacting more heavily on the North and disadvantaged areas.

There are, however, new opportunities. Local government has recently been granted new responsibilities to tackle the causes of poor health and health inequalities and increasingly local governments in the North are demanding greater control of resources previously controlled by Whitehall. It is against this background that the independent Inquiry on Health Equity for the North was set up. The inquiry highlights how northern agencies can make the best use of these devolved powers to do things more effectively and equitably. It also sets out actions that only central government can take to improve health equity.

What is the Inquiry?

The Inquiry was commissioned by Public Health England (PHE) and led by an independent Review Panel. The panel brought together leading policy makers, practitioners and academics from local authorities, the NHS, the voluntary sector and universities from across the North of England.  It was chaired by Professor Margaret Whitehead from the University of Liverpool. Recommendations were developed through submitted evidence papers and a series of policy sessions at which discussion papers were presented and policy, practice and public witnesses were invited to give their expert opinions.

What needs to happen?

The report sets out a series of evidenced based recommendations for agencies in the North, central government, the NHS and Public Health England.

Agencies in the North, from communities to organisations and enterprises, working together can make a difference by:

  • Linking up Northern economic development programmes and public service reform to support people into employment – actions focused on the twin aims ofpreventing poverty and promoting prosperity;
  • Deepening collaboration across the North, between Combined Authorities that involve cities, counties and districts across the North to drive a programme of devolution and investment that promotes economic growth and tackles inequalities;
  • Tackling the major causes of health inequalities: poverty, poor housing and unemployment. Working together, agencies in the North can reduce health inequalities by implementing and regulating the Living Wage; reducing child poverty; increasing the availability of high quality affordable housing through stronger regulation of the private rented sector and through new sources of investment in new homes; and by using a joint progressive approach to procurement that promotes health and supports people into work;
  • Maintaining and expanding the provision of universal good quality early years education and childcare and integrated neighbourhood support for early child development with a central role for health visitors and children’s centres;
  • Reducing the democratic divide. The most disadvantaged members of society lack influence on how public resources are used. All levels of local government have a role to play to enhance the democratic engagement of the communities they represent. Citizens should be more involved in shaping how local budgets are used and in influencing local decision-making.

Central government needs to support action to reduce health inequalities within the North and Between the North and the rest of England by:

  • Ensuring national policies reduce debt and poverty, particularly amongst families with children. This includes setting welfare benefits so they provide a minimum income for healthy living and providing incentives to private sector organisations and legislation for public sector contractors to pay a living wage and end in-work poverty;
  • Making sure austerity measures do not widen inequalities;
  • Developing a fair deal between agencies in the North and national government that allocates the total public resources for local populations so that they reduce inequalities in life chances, within the North and between the North and the rest of England;
  • Leading a national industrial strategy that reduces inequalities between regions by investing in sectors that promote sustainable and quality employment in disadvantaged areas;
  • Prioritising investment in the early years. Including increasing the proportion of overall expenditure allocated to the early years, increasing investment in expanding universal good quality early years education and child care and support to families through children’s centres;
  • Granting local government a greater role in deciding how public resources are used to improve the health and wellbeing of the communities they serve, and greater flexibility to raise funds for investment. This should include control over national budgets for training and programmes to support people into employment;
  • Assessing the impact of changes in national policies on inequalities in health between socioeconomic groups and between regions of the country – and take action on adverse impacts.

The NHS:

The NHS needs to build on its considerable achievements in mitigating some of the effects of rising social and economic inequalities.

  • To sustain and increase the impact the NHS has on health inequalities between rich and poor and the North-South Divide, it must:
  • maintain the NHS core principle of equitable access to high quality health care, free at the point of need;
  • integrate locally to develop services that prevent poor health and poverty across the life course (including using its commissioning and procurement power to maximise social value for the North);
  • reaffirm its role as a champion for action on health inequalities by all organisations.

Public Health England:

Public Health England was established to be an independent advocate for actions across all sectors on health inequalities.  Public Health England needs to be supporting and challenging local agencies and central government departments to tackle health inequalities.

“Due North” offers solutions to complex problems from a Northern perspective. We have lived with the North-South health divide for too long, and action is long overdue – the recommendations in the report provide a way forward.

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3 Comments

  1. Pat Johnson says:

    I think that basically this is a pretty good report. However I feel that I need to comment on some real issues around PH or maybe it’s more of a letting off steam
    What it doesn’t take into account, in my opinion, is the “watering down” of Public Health knowledge,expertise and experience for some of those currently employed within Local Government. I admit that some LAs have embraced Public Health but many believe that they “do” Public Health adequately enough and see the very skilled PH workforce as superfluous. PH England are generally NOT seen to be organisation of expertise, LATs seem to do very little of note and PH in general is so fragmented that I’m not convinced anyone within the current structure is happy with the fragmentation of this vital Specialism.
    Many DsPH do not report directly to the CEO within LAs clearly not complying with the recommendations that this role should directly report to CEOs. Itransferred across to LA , and at the very first meeting for the PH team was told that as an officer of the council we could not lobby elected members, question the way they allocated their funding to community projects or challenge any decisions they may make in relation to activities they undertook in their wards.

    I think this report blurs the lines between who has responsibility, between PHE and PH within LA ,for influencing and leading PH activities within LAs and their communities and CCGs and H&W Boards add to that confusion. My experience has been that evidence base and data often comes a poor second to what the leaders of H&W Boards and CCGs may think are headline grabbing projects and are merely “never mind the quality feel the width” type projects in order to grab headlines. This is where this report may fail to impact, LAs and CCGs are looking for quick wins and seldom play the long game

  2. Tony Jewell says:

    I agree that systematically tackling health inequalities is a long game and the emphasis on parenting and early years is self evident. It has been a frustration to people like me who recall the publication of the Black Report, Margaret Whiteheads work on the Health Divide and the more recent example of Marmot’s social determinants that we haven’t (despite the evidence) been able to make much impact. The 1997 landslide Labour victory should have been associated with a shift but the reform was left too late. The later commitment to abolish child poverty was good practice but needs resolute long term commitment. The highlights of this North/South report seem to reiterate modern good practice but we still need to distill what the fundamental drivers are and measures linked to them so we can achieve the change we wish to see.

  3. mike.roberts says:

    Lets cut out these myths about its all poor health in the north and good health in the south.

    As someone who represents a town with 2 wards in the top 20% of disadvantage, a Borough with 3 and with another Borough next door with one cheek by jowl with £1M houses plus then like Westminster those sleeping on the streets are a good litmus test of the reality of life around us

    In addition some of the poorest areas of health inequalities in the country are in Tower Hamlets, Peckham and places in London and the extremes are even more so.

    The argument should be about uplifting all such areas, tackling disadvantage and deprivation. The Labour Party needs to be aware that here is growing little tolerance if it doesn’t. Some can blame immigration but its deeper than that.

    Power away from Westminster and Whitehall to respond will help enormously but after failing for nearly 25 years to do it is Labours sectional self interests now ready for that new earthquake final frontier.

    Can it get use to breaking away from sectional policy to a cross cutting response?

    Time is now running out and Manchester will determine whether we sink or swim against the tide.

    As a radicalist policy evolver I know where myself and John Cruddas stand. What about the rest?

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