England’s Widening Health Gap: Local Places Falling Behind Institute of Health Equity

Calls for MPs to prioritise health equity and wellbeing

 The leading global expert on health inequalities and Director of the UCL Institute of Health Equity (IHE), Professor Sir Michael Marmot, has written a damning letter to party leaders and MPs across the country after a new UCL IHE report confirmed that UK government policies are cutting people’s lives short.

In a new report, England’s Widening Health Gap: Local Places Falling Behind, the IHE emphasises how the north-south health gap has increased, people’s health has deteriorated, and health inequalities have widened. Sir Michael is imploring parliamentarians to act, if they care about their local population’s health.


In the letter, he wrote: “Put simply, Britain is a poor, sick country, getting sicker, with a few rich and healthy people; the results of a dismal failure of central government policies since 2010. Not only is health the foremost concern of your local constituents, communities and businesses, health is also an indicator of how well a nation is performing. Unfortunately, Britain is performing poorly.”


Using data from the Office for National Statistics (ONS), the Office for Health Improvement and Disparities (OHID) and the National Audit Office (NAO), the IHE has looked at every local authority in England and, for each one, plotted levels of health, inequalities in health and cuts in their spending power. Local authorities fund many of the services e.g., housing, education and social care, which support or ameliorate the drivers of health inequalities.


In its new report, the IHE has provided information from 17 local authorities (see notes to editors) with statistically significant increases in inequalities in life expectancy between 2010-12 and the start of the COVID-19 pandemic*.


Sir Michael has written to the 58 MPs (see notes to editors for list) whose constituencies lie wholly or partially in these local authorities as well as each area’s local authority leaders. These include six former or current cabinet ministers, including the former Prime Minister Liz Truss, the Levelling Up, Housing and Communities, Secretary, Michael Gove and former Housing, Communities & Local Government Secretary, Robert Jenrick.


New report key findings:

Ø Overall, life expectancy stalled between 2010-12 and 2020-22 (during the COVID-19 pandemic).

Ø Inequalities in life expectancy increased nationally for both sexes between 2010-12 & 2017-19.

Ø In six of the nine English regions there have been statistically significant increases in inequalities in life expectancy for women (North East, North West, Yorkshire and the Humber, East of England, East Midlands, South West) and three for men (North East, Yorkshire and the Humber and East of England.

Ø There were 14 local authority areas with significant increases in inequalities in female life expectancy, and three in which inequalities in life expectancy had increased significantly for males (see table 1, report); there were no statistically significant decreases in inequalities in life expectancy for men or women in any of the English local authorities.

Ø Since 2010 central government cuts to local authorities mean their spending power per head of population had fallen by an average of 34% across England in 2019/20.


Sir Michael said: “It is no surprise that local authorities are struggling to make ends meet and that people are living shorter lives than they should. If you slash the services that support people then health will be harmed. Levelling up was supposed to provide badly needed funding for the most deprived areas. But it was a derisory amount and, as a result, never going to improve health.”


Since 2011 life expectancy has been increasing at a slower rate than it had during previous decades. But even the modest increase has not been uniformly enjoyed across England. People living in the north of England and women in the most deprived neighbourhoods saw a fall in their life expectancy, even before the pandemic struck.


Funding cuts and tax rises hit the most vulnerable

Based on National Audit Office (NAO) figures, the IHE has calculated that funding from national government to local authorities (e.g., through the revenue support grant) fell by an average of 41% per head of population in England between 2010/11 and 2015/16, and the tax raised by councils themselves fell by 8% per head of population.


After 2015/16, extra revenue raising powers, including increasing Council Tax, allowed councils to increase the amount raised each year, so that by 2019/20 this amount, per head of population, was 4% more than in 2010/11 in real terms. However, government support per head of population was 58% below that in 2010/11, resulting in overall council spending power per head of population down by 34% in 2010.


These funding cuts and the increases in revenue raising from local authorities have fallen disproportionately on the most vulnerable, who, alongside the cost-of-living crisis, have felt the impact of Council Tax because it is mostly a flat tax and not related to income. The effect of this is seen in council tax arrears, which have increased by 70% in the past five years in the 100 largest councils.


Health equity should be central to all UK government policies

Now the IHE is calling on the government to put health equity and well-being at the heart of all policies by following the eight ‘Marmot Principles’ (see Editor’s Notes).


“This is a dismal state of affairs,” continued Sir Michael. “I’m saying to party leaders: make this the central plank of the next government - stop policies harming health and widening health inequalities. To MPs: if you care about the health of your constituents, you must be appalled by their deteriorating health. It’s time for action and political leadership across the board.


“Important as is the NHS – publicly funded and free at the point of use – action is needed on the social determinants of health: the conditions in which people are born, grow, live, work and age. These social conditions are the main causes of health inequalities.”


The IHE proposes the appointment of an independent Health Equity Commissioner and establishment of a new cabinet-level health equity and well-being cross-departmental committee.


Deputy Director of the IHE, Dr Jessica Allen, who oversees the Institute’s work with local places, explained: “In the UK the IHE is working with more than 40 local areas, and businesses and other sectors who are prioritising health and reducing health inequalities by taking action on the social determinants of health, where they can. They are doing their best to protect lives and promote health equity with their dwindling and inadequate funds. We know what to do. We are seeing a cultural shift and more action on health inequalities in those areas, where local leaders from different sectors are working together to promote health equity, which is magnificent.”


Study Limitations

*The pandemic led to increases in deaths than otherwise would have been expected, which, as a result, artificially skews the data. As a result, the IHE has not included local authority data that included the pandemic. Since the pandemic health has resumed pre-pandemic trends, putting the UK back on course for deteriorating health, increasing inequalities and stalling life expectancy. The IHE has not included any local authorities where changes are not statically significant because the change might be by chance and therefore provide an inaccurate interpretation of the data.


Editor’s Notes All Media Requests: Felicity Porritt E: f.porritt@ucl.ac.uk T: 07739419219

OR Poppy Tombs, UCL Media Relations, E: p.tombs@ucl.ac.uk T: 07733307596


The UCL IHE, England’s Widening Health Gap: Local Places Falling Behind, report and accompanying documents are published here.


List of Local Authorities and MPs to whom Sir Michael has written:

Amber Valley Local Authority: Nigel Mills (Amber Valley), Pauline Latham (Mid Derbyshire), Sarah Dines (Derbyshire Dales)

Bexley Local Authority: Louie French (Old Bexley & Sidcup), Sir David Evennett (Bexleyheath & Crayford), Abena Oppong-Asare (Erith and Thamesmead)

Cambridgeshire Local Authority: Daniel Zeichner (Cambridge), Lucy Frazer (South East Cambridgeshire), Anthony Browne (South Cambridgeshire), Jonathan Djanogly (Huntington), Steve Barclary (North East Cambridgeshire), Shailesh Vara (North West Cambridgeshire)

Charnwood Local Authority: Jane Hunt (Loughborough), Edward Argar (Charnwood)

Cornwall Local Authority: Derek Thomas, St Ives, George Eustice, Camborne & Redruth, Cherilyn Mackrory, Truro & Calmouth, Steve Double, St Austell & Newquay, Sheryll Murray, South East Cornwall, Scott Mann, North Cornwall

County Durham Local Authority: Kevan Jones, North Durham, Richard Holden, North West Durham, Dehenna Davison, Bishop Auckland, Mary Kelly-Foy, City of Durham, Graham Morris, Easington, Paul Howell, Sedgefield

Erewash Local Authority: Maggie Throup, Erewash, Conservative, Pauline Latham, Mid Derbyshire

Guildford Local Authority: Rt Hon Michael Gove, Surrey Heath, Jonathan Lord, Woking, Angela Richardson, Guildford, Sir Paul Beresford, Mole Valley

Kensington and Chelsea Local Authority: Felicity Buchan, Kensington, Greg Hands, Chelsea & Fulham

Newark & Sherwood Local Authority: Robert Jenrick, Newark, Mark Spencer, Sherwood

Norfolk Local Authority: Liz Truss, South West Norfolk, James Wild, North West Norfolk, Duncan Baker, North Norfolk, Jerome Mayhew, Broadland, George Freeman, Mid Norfolk, Chloe Smith, Norwich North, Clive Lewis, Norwich South, Richard Bacon, South Norfolk, Sir Brandon Lewis, Great Yarmouth

Norwich Local Authority: Clive Lewis, Norwich South, Chloe Smith, Norwich North

North Somerset Local Authority: Rt Hon Liam Fox, North Somerset, John Penrose, Weston-Super-Mare

Northumberland Local Authority: Anne-Marie Trevelyan, Berwick-upon-Tweed, Guy Opperman, Hexham, Ian Lavery, Wansbeck, Ian Levy, Blyth Valley

Rotherham Local Authority: Alexander Stafford, Rother Valley, Sarah Champion, Rotherham, John Healey, Wentworth & Dearne

Stoke-on-Trent Local Authority: Jack Brereton, Stoke-on-Trent, South, Jo Gideon, Stoke-on-Trent Central, Jonathan Gullis, Stoke-on-Trent North

Telford and Wrekin Local Authority: Lucy Allan, Telford, Mark Pritchard, The Wrekin

About the UCL Institute of Health Equity

The IHE was established in 2011 and is led by Professor Sir Michael Marmot. The aim at the outset was to develop and support approaches to health equity and build on work that has assessed, measured and implemented approaches to tackle inequalities in health - works such as the ‘WHO Commission on Social Determinants of Health’ and ‘Fair Society Healthy Lives’ (The Marmot Review).


Since 2011, the Institute has led and collaborated on works to address the Social Determinants of Health (SDH) and improve health equity. In 2020 UCL IHE published The Marmot Review 10 Years on, #Marmot2020, which confirmed an increase in the north/south health gap in England. The largest decreases in health and life expectancy were seen in the most deprived 10% of neighbourhoods in the North-East, and the largest increases in the least deprived 10% of neighbourhoods in London.


Both reviews laid out what would happen if the SDH weren’t addressed to promote health equity. The 2020 report laid bare the health damaging impacts of austerity policies and associated cuts, which led to widening health inequalities across England.


The IHE works globally (with the UN and its institutions, and directly with countries) and nationally across the UK, including local authorities, the NHS, non-governmental organisations (NGOs), businesses and local community & voluntary groups. The aim is to reduce health inequalities by putting health equity at the heart of everything they do.

The IHE has set up a UK-wide Health Equity Network to help organisations and localities share best practice on implementing the evidence on reducing health inequalities.


At local government level, the IHE is working directly with 12 areas covering more than 40 local authorities. In these areas reducing health inequalities is a priority and they are taking action to support better health and health equity for their populations, despite health harming national policies, enormous financial cuts and the continuing impacts of austerity policies and the COVID-19 pandemic. All but one was created during or after the COVID-19 pandemic, and more are joining:


1. Coventry, 2013 (1 local authority)

2. Greater Manchester, 2019-21 (10 local authorities)

3. Cheshire and Merseyside, 2021-24 (9 local authorities)

4. Lancashire and Cumbria, 2021-22 (4 local authorities)

5. Luton, 2022 (1 local authority)

6. Waltham Forest, 2022 (1 local authority)

7. Gwent, 2022-23 (5 local authorities)

8. Southwest region, 2023-2025 (counties of Bath, Wiltshire, West Bristol, Somerset, Gloucestershire, Cornwall and Isles of Scilly, Devon and Dorset)

9. Leeds, 2023-2025 (1 local authority)

10. Wokingham (1 local authority)

11. Medway (1 local authority)

12. West Norfolk/Kings Lynn (1 local authority)

Further reading