Can Levelling Up help us Build Back Healthier?

levelling up

With the publication of the government’s White Paper, finally we have some definition and direction to what ‘levelling up’ actually aims to achieve.

The most illuminating part of the 700-page document came in the announcement of twelve levelling up missions, most to be achieved by 2030. Looking suspiciously like a return to the Public Service Agreements of the Brown-era, mission-based policy has been back in vogue, thanks mainly to the efforts of Mariana Mazzucato, whose work had been highly influential on the UK government’s now dormant Industrial Strategy.

Certainly that strategy seems to be making a return (it is worth noting that Andy Haldane, now on secondment from the RSA to lead levelling up policy was the Chair of the Industrial Strategy Council), with some of the missions reflective of the government’s previous ‘Grand Challenges’. Public Policy Project’s Social Care Policy Network Chair, Damian Green, highlighted this in the House of Commons, welcoming the focus on maintaining a commitment to five years of extra healthy life.

Yet missions are but words on a page without a clear and deliverable strategy behind them. How these missions are to be achieved remains unknown: what is known, however, is that there is unlikely – at this point in the spending cycle at least – to be any new money to deliver them. A rejuvenation of local economies on the scale that was seen in post-reunification Germany will require a level of sustained investment that is simply in a different league to the UK’s own Levelling Up agenda.

These twelve missions are an accurate and timely depiction of why Levelling Up must succeed – but without the cash required to turn these policies into a nationally transformative reality, they risk crashing and burning. And with at least two general elections to pass before 2030, who will finally be held accountable to deliver them?

The White Paper can only have a positive impact on society if locally led initiatives are given the necessary help to scale their success. This objective is central to PPP’s 2022 Health Inequalities policy programme.

Turning an aspirational slogan into a tangible reality

The white paper correctly acknowledges central government’s role in driving these reforms, but the results of local health rejuvenation will, naturally, be delivered locally

The 12 missions are central to the government’s policy and the Levelling Up agenda is designed to “give people control over their lives” and perhaps nowhere is this principle more important than with regards to health.

Recent data shows that, even before the Covid-19 pandemic, life expectancy was stalling and declining for poorer people in most regions. Successive governments have failed to address the crisis of health inequality – Covid-19 has now laid bare and worsened this growing ‘syndemic’.

In this context, perhaps a more fitting mantra would be ‘Build Back Healthier’.

It has been long established that healthcare alone cannot close the health inequality gap. It is the social determinants of health, such as employment, education and housing that make the real difference to people’s health outcomes.

The white paper correctly acknowledges central government’s role in driving these reforms, but the results of local health rejuvenation will, naturally, be delivered locally. As such, the government’s focus on devolution is welcome news for health providers, as there is a growing body of evidence to suggest that the most effective health interventions are undertaken at a local level.

Building on Sir Michael Marmot’s ground-breaking work on health inequality, PPP has highlighted a series of compelling case studies as to how collaboration between local government, the health service, voluntary sector, business sector and the wider community can create tangible improvements to health inequality. The report can be found here.

The road ahead

The results of the Level Up agenda will be demonstrated through localised endeavour and led by a new generation of system leaders and innovators

It is clear that much more work needs to be done. This year, PPP is launching two major health inequality policy projects, Build Back Healthier: The role of business in tackling health inequalities and The Digital Divide: reducing inequalities for better health.

Sir Michael has long made the case that health is a good indicator of how ‘well’ society is doing as a whole. It is therefore reasonable to argue that health inequality statistics can be used as a clear metric of how equal a society is across a broad spectrum of indicators. In the same way that we use GDP to measure economic growth, it is not unreasonable to argue we can consider population health metrics and their relationship to ‘social growth’ in a similar way (of course this in no mean neglects or fails to acknowledge the inextricable link between economic and social growth).

Gathering together a commission of businesses, Build Back Healthier will seek to take evidence on and lead the policy debate on what businesses can do to reduce health inequalities in 2022.

Covid-19 has revealed huge inequalities when it comes to digital health. The pandemic accelerated what has always been an inevitable move towards digital over the past decade.

The debate is often pitched as binary: either we move towards digital and leave underserved populations behind, or we don’t move technological advancements along to accommodate for those people. The Digital Divide will focus on what digital health can do for underserved populations. Digital transformation is the future of healthcare and as such, good policy is in urgent demand when it comes to addressing those at risk of being left behind. We aim to meet that demand with this exciting piece of policy work in 2022.

The results of the Level Up agenda will be demonstrated through localised endeavour and led by a new generation of system leaders and innovators. Public Policy Projects is pursuing a programme of works throughout 2022 and beyond to not only showcase this work, but scale the success across a marginalised society.

To find out more about PPP’s Health Inequality series, please write to