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Will the levelling up missions help reduce inequality? A view from the health sector

5 January 2023


What is levelling up?

Levelling up has been all over the news since the Governments Levelling up white paper was released in February. The launch of the Government Sector Property Strategy (2022-2030) has prompted us to reflect on the Levelling up agenda. The Levelling Up fund is set to ‘spread opportunity’ and ‘reduce spatial disparities’ supported by a £4billion of grant investment, mainly on the construction of new infrastructure such as bridges, new roads, ports, cycling lanes, town centre regeneration and more.

To drive the programme, the white paper sets out 12 key missions[1]
to ‘level up’ the UK, which the government pledged to achieve by 2030. Key themes include:

  • Boost productivity, pay, jobs and living standards by growing the private sector, especially in those places where they are lagging
  • Spread opportunities and improve public services, especially in those places where they are weakest
  • Restore a sense of community, local pride and belonging, especially in those places where they have been lost
  • Empower local leaders and communities, especially in those places lacking local agency

But with the differences in people’s health being such a big contributor to inequality in the UK[2], will the levelling up missions go far enough to help reduce inequality?


Inequalities: a healthcare perspective

From an NHS perspective, health inequalities are unfair and avoidable differences in health across the population, and between different groups within society. These include how long people are likely to live, the health conditions they may experience and the care that is available to them.[1]
The conditions in which we are born, grow, live, work and age can impact our health and wellbeing. These environmental, social and economic factors are often referred to as the social or wider determinants of health[2]. They make and keep us healthy[3]
and include employment, housing, income, our surroundings, education and skills, food, and family, friends and community.


A review of the 12 missions

Levelling Up missions

Our analysis shows that some of the levelling up missions don’t align as well as others when it comes to the NHS definition of inequalities:

  • Mission 3 – Transport Infrastructure - by 2030, local public transport connectivity across the country will be significantly closer to the standards of London, with improved services, simpler fares and integrated ticketing.
  • Mission 4 – Digital Connectivity - By 2030, the UK will have nationwide gigabit-capable broadband and 4G coverage, with 5G coverage for the majority of the population.

Therefore, if we want to reduce inequalities (and to maximise the value of the programme), perhaps it would be more beneficial to focus more on the missions that are most aligned with the NHS definition:

  • Mission 1 – Living Standards - by 2030, pay, employment and productivity will have risen in every area of the UK, with each containing a globally competitive city, with the gap between the top-performing and other areas closing.
  • Mission 7 - Health - by 2030, the gap in Healthy Life Expectancy (HLE) between local areas where it is highest and lowest will have narrowed, and by 2035 HLE will rise by 5 years.
  • Mission 8 – Wellbeing - by 2030, well-being will have improved in every area of the UK, with the gap between top-performing and other areas closing.

Or alternatively, could some of the funding be realigned to the NHS to help progress the above missions and therefore contribute to achieving the desired outcomes?

Harnessing the value of the public sector estate to fill the gaps

Being able to harness the value/power of the public sector estate is significant in this context. An estate that is strategically managed in a way which adds social value (positive social, economic and environmental impacts) can enhance the wider determinants of health and reduce health inequalities. We were recently commissioned by NHS England to produce a resource to provide practical information on the role of estates in reducing health inequalities.

Watch this space, as this is due to be published very soon!

Drees & Sommer UK is a community of multi sector specialists brought together around the needs of our clients and their communities. We have an experienced team of estates strategists, health planners and business case practitioners that can help apply the 12 missions in context in order to help reduce inequalities.