Building Health Equity – The Role of Developers

A collaborative partnership has been established between Legal & General, the UCL Institute of Health Equity and the Quality of Life Foundation. It aims to support and inspire the development sector to commit to greater health equity through homes and places across the UK. 

The partnership will develop a programme of action to galvanise investors, housebuilders and developers, with two objectives: 

• To develop practical approaches to create homes and places that improve health equity. 
• To build a platform for leadership on homes, place and health.

In its initial phase the partnership will: 

• Consolidate and communicate the evidence base on the impact of homes and places on health equity.
• Interview key stakeholders to understand barriers and opportunities to promoting health equity in the development process.
• Convene a roundtable of individuals and organisations to strengthen health equity in the sector. 

The partnership will publish key findings, recommendations and a programme of action in early 2024. 

For questions and further information, please contact Jamaica Noferini at j.noferini@ucl.ac.uk

New Publications:

• Health inequalities: Improving accountability in the NHS, August 2023

Integrated Care Systems (ICS) in England bring together the NHS, local government, the third sector and other partners. At the same time as these systems have been introduced, NHS England has paid increasing attention to health inequalities in its statutory and non-statutory guidance. NHS England commissioned IHE to examine past and current mechanisms and levers that affect accountability in relation to health inequalities, focussing on the role of ICSs. Our report Health inequalities: improving accountability in the NHS provides proposals to improve accountability for health inequalities

We interviewed senior NHS managers and academics researching accountability in the NHS and reviewed grey and academic publications. We concluded accountability for health inequalities in the NHS since 2010 has been weak but in recent years, actions have improved, with the appointment of a national team on health inequalities created in 2020 as part of the COVID-19 pandemic response and then in 2021 a health inequalities programme team and national director were appointed. These appointments prompted a new strategic and policy focus on health inequalities however, accountability mechanisms remained insufficient to drive appropriate investment and action on health inequalities and their causes.

The report addresses the role of performance monitoring and funding as tools to improve accountability. We recommend actions for NHS England to provide better support and tools to enable ICSs to better address health inequalities in the NHS and in partnership. Professor David Hunter of Newcastle University provides IHE with his reflections on the findings from this report and the wide challenges of strengthening action on health inequalities in the NHS.

• Building a Fairer Gwent: improving health equity and the social determinants
  Rapid review of inequalities in health and wellbeing in Norway since 2014, March 2023

Building a Fairer Gwent: improving health equity and the social determinants is the most recent IHE Marmot place report, published in July 2023. Gwent covers five local authorities in South Wales: Blaenau Gwent, Caerphilly, Monmouthshire, Newport and Torfaen. The founder of the NHS, Aneurin Bevan, was born in Blaenau Gwent and one of our first meetings was held in Bedwellty House, where Bevan was a local councillor before he became a member of parliament.

The IHE worked with a range of partners across Gwent in 2022-2023. One of our aims was to influence Gwent’s Wellbeing Plan. This is a five-year plan and is a statutory requirement of the Wellbeing of Future Generations (Wales) Act. Much international attention has focussed on this Act yet health inequalities have not shifted. Whilst Welsh Government policy is supportive of the need to address health inequalities, the policy focus on wellbeing is not leading to reductions in inequalities. The report suggests Gwent adopt more effective practices and approaches to better address inequalities. The IHE report includes a set of local Marmot indicators and recommendations tied to a five-year strategy to drive at-scale actions.

Going forward, the report will be discussed with Gwent leaders in October 2023, focussing on the partnerships and actions required to better address economic inactivity, particularly in post-industrial places that have had high levels of long-term unemployment. In addition, Torfaen local authority are leading an application with local partners for the NIHR’s second wave of ‘health determinants research collaborations’ funding.

IHE Marmot Places Work

Ongoing implementation work 

Leeds

• We have been commissioned by Leeds’ City Council public health team to advise and input into action to address health inequalities. The new Marmot City launched in Leeds on 12 June. The initial focus is on early years and housing.  

Southwest Region 

• Michael Marmot launched a Marmot Southwest region in Taunton in April. We are working with the regional public health team over two years, analysing where actions can be scaled up to take more effective actions to reduce health inequalities. We are developing evidence on the economic case for tackling health inequalities. 

Gwent

• The IHE report Together with hope: health equity and the social determinants in Gwent was published late in June 2023. The report is based on our analysis of local/regional and national data and workshops and interviews with stakeholders in Gwent and a range of partners working in the Welsh government and national bodies. 

Luton

• The first Marmot Town continues implementation of the recommendations of the report.  An evaluation of the changes and impact from the work is being undertaken to establish how the work and report have shaped future plans in different sectors in Luton.   

Waltham Forest Borough Council continues to develop implementation plans and embed the recommendations of the Review.


Cheshire and Merseyside

• In May 2023 Michael joined the one-year on anniversary of our report for the Region, All Together Fairer, hosted by CHAMPS, the public health collaborative led by the Directors of Public Health in Cheshire and Merseyside. Leaders from councils, the Liverpool City Region Combined Authority and the NHS joined more than 200 people to discuss achievements (such as Sefton’s child poverty strategy) and challenges for the next year. Knowsley and Liverpool have integrated the recommendations into their local strategies and local social determinants leads are working across the authority to implement these recommendations. All Together Fairer leads continue to meet every 6 weeks.

 
Lancashire and Cumbria 

• Both Lancashire and South Cumbria Health and Care Partnership and North East and North Integrated Care System have/are integrating the recommendations from our report A Hopeful Future: Equity and the social determinants of health in Lancashire and Cumbria into their strategies. 

Other collaborations 

Greater Manchester 

• Commissioned by the Greater Manchester Health and Social Care Partnership this review, ‘Build Back Fairer in Greater Manchester: Health Equity and Dignified Lives’, includes bold and ambitious recommendations on how to reduce health inequities and build back fairer from the COVID-19 pandemic for future generations. A new Framework is part of the review and comes as life expectancy falls for everyone across the UK, and health inequities widen, at a cost of £39 billion every year. 

Norway

• Rapid Review of Inequalities in Health and Wellbeing in Norway since 2014 was commissioned by the Norwegian Directorate of Health to inform the development of a National Strategy to Reduce Social Inequalities in Health. The Directorate of Health is assessing the recommendations for action by the Government. 

Children and Young Peoples Health Equity Collaboration

• IHE is collaborating with Barnardos and 3 ICS – Birmingham and Solihull, Cheshire and Merseyside and South Yorkshire to co-design a Children and Young People’s Health Equity Framework and a measurement tool that brings in the key local insights around children and young people’s health equity.  pilot interventions are being designed for each ICS to make a sustainable impact on health and wellbeing outcomes.

The Greater London Authority – health equity intervention reviews

• IHE has been commissioned by the GLA to produce a series of reviews of effective interventions in key social determinants of health in London.

These include:

• The impacts of the Rising Cost of living on health inequalities in London
• Evidence Review: Housing and Health Inequalities in London

• Review of the health equity impacts of skills programmes in London
• Review of the health equity impacts of structural racism in London.

Hong Kong

• The third report in a series about health equity in Hong Kong, this report will discuss the role of neighborhoods and communities for health equity, as well as the negative effects of climate change and the health impacts of conflict and crises. The series is a joint collaboration between IHE and its partner, the Institute of Health Equity at the Chinese University of Hong Kong.