My Lords, in the brief time available, I will address health inequalities between the north of England, where I live, and the south, and their implications for levelling up and regeneration. Health inequalities are defined as avoidable, unfair and systematic differences in health between different groups of people. In 2010, Sir Michael Marmot conducted his celebrated review into such inequalities, in the hope that this might lead to some improvement. Instead, we have seen an increase, rather than a reduction, of such inequalities over the last 12 years. For instance, life expectancy in deprived areas of the north-east is at least five years lower than it is in similar areas here in London. A baby boy born in Blackpool today can expect an additional 17 years of poor health compared with a baby born in Richmond upon Thames. People in all social groups in the north of England, male and female, are consistently less healthy than those in the south, and premature death rates are about 20% higher across all age groups in the north, due not least to lower lifetime chances.
These statistics—there are many more—are a stark reminder that inequalities in health are often closely linked to people’s socioeconomic circumstances. This has been forcefully illustrated by the Covid pandemic, which, in the words of one commentator, exposed “deep fractures of inequality” running across our society. During the first year of the pandemic, the mortality rate was 17% higher in the north than in the south, unemployment was 19% higher and there were significant differences in mental well-being between the north and the south. It is now reckoned that health issues account for about 30% of the gap in productivity between the north and the south.
Reducing health inequalities is a matter of fairness and social justice, which is what the Levelling-up and Regeneration Bill is all about. It potentially provides us with a great opportunity to tackle those inequalities, not least by addressing some of their wider social determinants, two of which have already been mentioned by several noble Lords in this debate: transport and housing. Transport, especially in rural areas, has huge implications for access to hospitals and medical services. I recently had some post-operative treatment in the excellent general hospital in Hexham, and, while I was there, I took the opportunity to ask several of the staff what they would most like to see change. “Access” was their unanimous answer, and this is especially true in a huge, sparsely populated county such as Cumbria, which has neither big cities nor many large hospitals.
On housing, which was mentioned by so many speakers, we are all aware of the close connection, which the noble Baroness, Lady Warwick, reminded us of, between good-quality accommodation and good physical and mental health. The briefing from Shelter that I guess we all received comes as a timely reminder of the need for much more social housing in the north —not just, as the noble Baroness, Lady Thornhill, said, so-called “affordable housing” in expensive areas.
Alongside paying attention to transport and housing, any effective strategy for reducing these health inequalities must include a commitment to two other factors. One is community hospitals, of which we have a number in the county where I live. These not only prevent admission to acute units but enable earlier discharge from larger hospitals. They are an invaluable local resource, but many are losing beds and are starved of funds. The other is better integration between health and social care. I hope that the new structures—ICBs and so on —will make a real difference. I hope also that continuing work on levelling up and regeneration will be properly informed and influenced by two forthcoming reports on social care, from a Select Committee of your Lordships’ House and from an Archbishops’ commission.
This Bill commits His Majesty’s Government to putting forward a statement of levelling-up missions, but it does not commit the Government to implementing them. My right reverend friend the Bishop of London regrets that she cannot be here today, but, with me, she will engage with the Bill with regard to increasing life expectancy and reducing health inequalities. Can the Minister give us some assurance that these issues will be adequately addressed and that the 12 levelling-up provisions will happen?
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