Levelling up has got to work, says outgoing public health boss

One of the North West's leading health experts has urged the government to get on with levelling up the region to improve people's health.

Professor Kate Ardern, who is retiring as Wigan's Director of Public Health after 14 years in the role, is warning the cost-of-living crisis is the latest in a series of events that have the potential to drive up health inequalities.

She said: "You've had the impacts of the pandemic, Brexit, cost of living, all coalescing on a population that, by and large, has had decades of inequality.

"Going forwards I'll be doing more work with the British Academy. Earlier this year, they produced a report looking at historical and geographical inequalities.

"It's really clear that things like the cost of living, anything that depresses or makes people's financial position more insecure, reduces their ability to heat, eat and have a decent home is absolutely fundamental."

Last year, a report into health inequality in Greater Manchester showed large parts of the region were behind on factors such as life expectancy.

Professor Michael Marmot's 'Build Back Fairer in Greater Manchester' report showed life expectancy for both men and women sat well below the national average for most of the 10 boroughs.

The report also concluded that Greater Manchester was hit harder by the pandemic than other areas of the country

COVID-19 mortality rates for men across our region were nearly a third (31%) higher than the average across England and 37% higher for women.

The History of Public Health

Now, as the region attempts to recover from the ongoing pandemic, Professor Ardern says the cost-of-living crisis could widen existing inequalities:

"It's, perhaps, reminding people of the very roots and history of public health.

"In the 1850s one of my great heroes, William Henry Duncan, was appointed the first very first medical officer of health - I'm the modern-day descendant of folks like that."

"He was appointed by the then Liverpool City Council, to tackle cholera epidemics. That was all about decent home standards, sanitation, and sewage."

Professor Ardern added: "All of that poverty agenda is very topical and back in the news. It's not gone away but it has perhaps changed its face.

"So housing, education, decent employment, a decent environment, and good social network are all part of this.

"I guess for those of us who live in the north of England, this is very much at the heart of the levelling up agenda.  

"Levelling up has got to deliver, it can't be just a few nice hanging baskets somewhere, it's got to deliver on the things that actually make people healthy."

The NHS Backlog

The latest figures, released last week, show over 6.5 million people are now waiting for treatment on NHS waiting lists in England

Whilst the pandemic has had a significant impact on waiting times, with 2.5 million more people now on waitings lists, the 18-week target for treatment has not been met since 2016.

Professor Ardern argues that dealing with issues around social mobility and inequalities will, in the long run, reduce pressure on the NHS:

"The greater the burden of ill health, the more you then get demand on health and care services as well.

"In other words, premature avoidable death rates go up, or people are sick or for longer.

"It's one of the reasons we've always focused on healthy life expectancy. The longer you can live in good health, the better for you as an individual but also the pressure on systems. It does relieve some of that pressure.

"So we either overwhelm the health and care system with just more and more preventable ill health, or we actually do the important thing, which is what people like Michael Marmot and many others say - you need to invest in the very building blocks of good health and well-being.

"Plus, very importantly, if you're healthier, you're going to be contributing to the economy, whether it's through paid work or unpaid work or volunteering in society.

"It's actually in all of our interests to invest in that strong public health agenda.

"I think local leaders understand that but it's whether that influences national policy.

"Part of my work going forward will be to try and implement some of that in the national agenda as well."

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