Richard Brown: Whitehall’s ‘levelling up’ mindset doesn’t detect Kensington & Chelsea’s health inequalities

Richard Brown: Whitehall’s ‘levelling up’ mindset doesn’t detect Kensington & Chelsea’s health inequalities

While we wait for the forever-delayed Levelling Up White Paper, a “levelling up mindset” is starting to take hold across Whitehall. Just before Christmas newspaper reports suggested that the latest Department for Work and Pensions review would explore whether pensions could be paid earlier in areas with lower life expectancy.

It is an intriguing idea. There are big differences in life expectancy across England. Between 2017 and 2019, a man born in Richmond-upon-Thames could expect to live in good health for nearly 72 years – almost 20 years longer than a man born in Blackburn. A woman born in Wokingham would have a similar advantage over one born in Nottingham.

But it’s a bit odd too. Faced with these yawning inequalities and the worrying fall in healthy life expectancy since 2014-16, you might think that addressing the causes of ill health and early mortality would be the focus of policy, not making sure everyone gets a comparable return on their national insurance contributions.

Allowing people to take their pension earlier in some parts of the country could also have strange consequences. Is a workforce that has been shrunk through early retirement really what economically disadvantaged places need? Would a wave of pension-seekers moving to northern seaside towns really act as a catalyst for revival?

But there is a bigger problem too. Health inequalities can be just as sharp within as between regions or even local authorities: data at “middle super output area” (MSOA) level show that in Kensington & Chelsea there is a 25-year gap in healthy male life expectancy between North Kensington and the area around Sloane Square. If we really want to target earlier retirement dates at those areas where people are likely to have least time to enjoy their pensions, should we not be looking at individual wards and MSOAs rather than large geographical areas?

Of course we won’t be doing that: such a system would be fiendishly complicated and deeply unfair to poorer people living in wealthier neighbourhoods. But it does highlight one problem with the levelling up debate. Health and other aspects of inequality are often presented in terms of geographies because we have good data collected on a geographic basis. But geography is not necessarily the primary issue, as anyone who has seen the wealth of the Vale of York or the poverty in north Westminster will attest.

This is not to say geography is irrelevant: the 2020 Marmot Review of health equity argued that, while life expectancy in richer places was pretty similar across the country, poorer places in London had better life expectancy than poorer places in the north. The review suggested that a mixture of economic and policy factors (particularly the impact of austerity) had hit northern areas particularly hard and had therefore widened the gap since 2010.

But the Marmot analysis is still comparing places – which in London contain a diverse mix of people, and may have become more mixed in recent years – rather than classes of people. Londoners on the poverty line may be only a block away from an artisanal coffee shop, but that may not help their health or other life chances.

There is research indicating links between income and health (for example, people in the poorest 10 per cent of households are ten times more likely to report poor health than people in the richest households), but it is more scanty. Most research on health inequality (and other forms) continues to use place as a proxy for a whole suite of characteristics that may offer or deprive particular people of opportunity.

My hope for 2022 is that we develop a more nuanced discussion of “levelling up”. I think this means southerners acknowledging that there are regional imbalances that do need addressing. I’d suggest that two of these are the need for investment in strategic transport schemes (rather than the apologetic bodge-job of the Integrated Rail Plan) and in research and development. But it also means that we shouldn’t make the mistake of assuming that every inequality is primarily regional in character when that may simply be a result of the basis on which we collect and publish statistics.

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Categories: Comment

2 Comments

  1. Mark Bole says:

    Certainly hope I never see perverse rewards for poor life choices, as in getting my pension early if I smoke because health models predict I will die earlier.

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