Health Inequalities: Office for Health Improvement and Disparities

Debate between Andrew Gwynne and Derek Twigg

Wednesday 26th January 2022 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I add my congratulations to my hon. Friend the Member for Bootle (Peter Dowd) on securing this debate and on the passionate way that he opened it.

Health inequalities are one of the defining issues of our time and are innately linked not only to how long we live, but to how well we live. Every person across this great country deserves to thrive and live a long, fulfilling and healthy life. That principle informed the creation of our national health service and it continues to drive the work that Opposition Members do.

As colleagues have done, I reinforce to the Minister the perilous position that we find ourselves in with regard to health inequalities. The pandemic has exacerbated the health inequalities that were already widening prior to the first lockdown. Indeed, in February 2020 the King’s Fund reported:

“Males living in the least deprived areas can, at birth, expect to live 9.4 years longer than males in the most deprived areas.”

For females, as we have heard, this gap is 7.4 years. That is not good enough.

Worse, the gap is increasing. Life expectancy has had a steady ascent for 100 years. That ascent began to plateau in 2011. Can the Minister advise what she thinks happened in 2010 that led to that abrupt stalling of life expectancy? It is very real. [Interruption.]

[Derek Twigg (in the Chair)]

Order. The sitting is suspended for 25 minutes for Divisions in the House.

--- Later in debate ---

[Andrew Gwynne]

Before I was interrupted by the Division bell, I was about to say that I have seen at first hand the injustice of health inequality. Denton, the main town in my constituency, where I grew up and have lived, is not a very large town. It has a population of 38,000 people spread over three council wards, and its area is 2.5 miles by 1.5 miles. I grew up in Denton West, which is one of the more prosperous wards in my constituency and in the borough of Tameside.

My best friend at secondary school lived in Denton South, which, conversely, is one of the poorest. We both went to the same school. We were two kids growing up in the same community, at the same school, doing the same things, hanging around together. Yet according to the average life expectancies, he will live 10 years less than I will. That cannot be acceptable, it is not acceptable, and it is one of the reasons I joined the Labour party and became politically active. Tackling those inequalities, not just in a small community such as Denton but across the country, is absolutely what we should be about, in order to improve outcomes for all.

The last decade has been a disaster in terms of inequality, and I say to the Minister that that is the direct consequence of political choices that her party has made. It is a consequence of a decline in real-terms local authority spending, a consequence of a reduction in per-person education spending—a consequence of 12 years of Conservative government. The fact is that it is impossible to corral health inequality into one box. As we have heard in this debate, it is closely tied to social determinants: where people grow up, their environment, their education and their disposable income all contribute to health inequalities. If we are to tackle the crisis, the Government must recognise that they cannot make policy decisions in a vacuum.

That leads me to the issue of the Office for Health Improvement and Disparities. I note that one of OHID’s key priorities is to

“develop strong partnerships across government, communities, industry and employers, to act on the wider factors that contribute to people’s health, such as work, housing and education”.

That is music to my ears. It is clearly a positive and welcome aspiration, but three months on from OHID’s launch, we have yet to see any clear indication that cross-Department work has actually been prioritised by the Government. This point has been made by the Inequalities in Health Alliance, an organisation with more than 200 members, including the Royal College of Physicians. The IHA has asked the Government to underpin and strengthen OHID’s work with an explicit cross-Government strategy to reduce health inequalities, involving all Departments, and led by and accountable to the Prime Minister. So far, the Government have been resistant to committing to that.

I would be grateful if the Minister, in her response, could advise us what assessment she has made of the request from the IHA and whether her Department will commit to developing a specific cross-Government strategy. In addition, can she set out how OHID will assess its own effectiveness, and what influence it will have on other Departments? Will she also outline what engagement OHID has had with other Departments since it was established back in October? We need to know that OHID is not just more warm words with very little in the way of positive action. The Government cannot point to OHID with one hand and then, with the other, undermine the work that it purports to do.

For example, last October, the very month in which OHID was formed, the Chancellor of the Exchequer ended the £20-a-week uplift to universal credit. That plunged 300,000 children into poverty pretty much overnight. That political decision obviously has a negative public health impact for people across the country, yet apparently that was not something the Chancellor either considered or seemed particularly concerned about at the time. Can the Minister advise us how OHID will prevent further such disastrous policies from being implemented? If she cannot, I simply do not see how it will solve the crisis of health inequality in this country. I would be grateful, too, if she could outline what role OHID will play with regard to the new integrated care systems. Some clarity on that would be very much appreciated, particularly in advance of the Health and Care Bill’s anticipated return to the Commons in the next few weeks.

Finally, I want to touch on the subject of levelling up and its relationship to health inequalities. It has become somewhat of a go-to phrase for the Government. It should perhaps be a cause of concern to the Minister that, more than two years into this Administration, the levelling-up White Paper still has not been published. On that note, I want to press her on what exactly the Government’s priorities are.

In 2020, Professor Sir Michael Marmot published “Build Back Fairer” in Greater Manchester, which called for several policy interventions from the Government. Professor Marmot proposed investment in jobs, housing, education and services, and made particular reference to tackling the social conditions that cause inequalities at local and community level. We saw local authority public health funding cut by 24% per capita in real terms between 2015-16 and 2020-21. That is the equivalent of a reduction of £1 billion, which cannot be right. We need to restore public health funding to local authorities, so that local teams are able to provide vital services that communities need to stay healthy.

In conclusion, we went into the pandemic with health inequalities already growing, which left Britain’s poorest areas, as well as those in black, Asian and minority ethnic communities, acutely vulnerable to covid-19. That is totally unacceptable. We are now in 2022; we should not be living in a society with such extreme levels of health inequality. It is not right, and it needs fixing. The Government must do more and can do more, and they must do better.

[Derek Twigg (in the Chair)]

The debate will finish no later than 4.25 pm. I know that the Minister is aware of the need to allow two or three minutes at the end for the hon. Member for Bootle (Peter Dowd) to wind up.