The RSA’s Inclusive Growth Commission, reporting in 2018, recognised the role that poor health can play in contributing to the key challenges of unequal economic growth and poor productivity. Data analysis and visual mapping conducted by the Commission highlighted the association between poor health, economic inactivity and exclusion from labour markets; illness amongst the working age population, for example, costs the UK economy £100 billion every year and around 330,000 people become unemployed due to health-related issues. Work by the RSA examined the impact of economic insecurity (volatility in people’s economic circumstances), including its relationship to poor physical and mental health in particular.
One of the Commission’s core proposals was to put “social infrastructure” on par with physical infrastructure when determining investment priorities. Social infrastructure refers to the social resources that enable people to participate meaningfully in society and the economy. This can range from social and human capital through to preventative public services and health-promoting assets. The full potential of economic investment strategies cannot be fully realised without a complementary investment in social infrastructure. For inclusive economies to become a reality, we need to bring social and economic policy together so that, for example, services and policies for promoting health are connected to policies for promoting skills development, good work and productivity.
Health inequalities are growing in the UK. Since 2010, life expectancy improvements have slowed and people can expect to spend more of their lives in poor health. How healthy a population is depends on more than the health care services available to them – it is shaped by the social, economic and environmental conditions in which people live. Creating a society where everyone has an opportunity to live a healthy life requires action across government. While social protection measures – such as income replacement benefits, pensions, free school meals, social housing – are widely recognised as a core mechanism for reducing inequalities, the impact of structural inequalities in the economy itself has generally received less attention.
The RSA’s work is clear that promoting inclusive growth requires us to take a place-based view. Social, health and economic challenges are influenced by the characteristics and histories of different neighbourhoods, towns, cities and regions. The impact of major historical events – such as de-industrialisation or automation-driven economic restructuring - often becomes concentrated in particular places. We now see a deeper impact of Covid-19 in places that were already experiencing acute challenges around health, employment and wellbeing.
Places, however, are also where hidden resources and assets can be unlocked; where social action can be activated; and where decisions can be made and public services delivered most effectively. As we turn our minds to how we might start to recover from the pandemic, it is clear that the future of health and the future of work and the economy are intimately connected. We know that de-industrialisation placed a significant, long-term social and health burden on the communities that were the most impacted. It is reasonable to assume that under current trends and in the absence of necessary reforms, automation and the changing nature of work may compound social and health inequalities.
Future-proofing the nation’s health means being explicit about the interconnections between economic change and health outcomes. The evidence base in this field is at an early stage, but it already points towards people’s health and wellbeing being promoted by inclusive economies. This means economies that support social cohesion, equity and participation; ensure environmental sustainability; and promote access to goods and services which support health, while restricting access to those that do not.
In a report published with the Health Foundation last autumn we offered a framework for practitioners to consider the interventions available and implement strategies most appropriate to their local situation. Based on the existing evidence base and a range of case studies, we identified six areas that are important in facilitating local and regional approaches to developing inclusive economies:
- Building a thorough understanding of local issues – using robust analysis of both routine and innovative data sources, as in the case study on Scotland’s inclusive growth diagnostic tool.
- Leadership providing long-term visions for local economies – and designing these economies to be good for people’s health, as in the case study on Plymouth City Council’s long-term plans.
- Engaging with citizens – and using their insights to inform priorities and build momentum for action, as in the case study on the Clyde Gateway regeneration programme in Glasgow.
- Capitalising on local assets and using local powers more actively – as in the case study on economic planners’ efforts to capitalise on Leeds’ medical technology assets.
- Cultivating engagement between public health and economic development – building alliances across sectors, as in the case study on economic development and health in various levels of government in Scotland.
- Providing services that meet people’s health and economic needs together – as in the case study on Finland’s one-stop guidance centres for young people.
Local, regional and central government therefore all have roles to play in shaping economies in ways that are beneficial for people’s health. To experiment with what this might look like in practice, the Health Foundation’s Economies for Healthier Lives programme is supporting four ambitious provider organisations across the UK to work towards a shared aim: to create the conditions within their organisations that evidence shows lead to more effective implementation of innovations. In establishing these conditions, teams can deliver the best possible care for patients.
The RSA are excited to be working with the Health Foundation, Renaisi (who are the evaluation partner) and these hubs as a learning partner. Our role is to collaborate with each hub to understand their challenges and develop a support model with a focus on economies for healthier lives and sharing emerging practice. This programme is a unique opportunity for local health economies to accelerate their effective uptake of new ideas that meet the challenges of delivering care to all who need it during and beyond the pandemic.
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I agree with most of the aims set out in this paper. However, as always, there is a difference between analysing the problems and providing a solution. How to persuade a reluctant government or an underfunded local authority to commit to realistic financial support for these proposals? The experience of 'levelling up' has not so far been a very promising indication.