Levelling-up and Regeneration Bill

Baroness D'Souza Excerpts

Report stage
Tuesday 11th July 2023 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

I declare an interest in that I am vice-president of Marie Curie and co-chair of the Bevan Commission on health in Wales. I shall speak principally to Amendment 7 in this group, which is based on the previous amendment in Committee from the right reverend Prelate the Bishop of London, who is also a signatory to this amendment.

The levelling up White Paper, the precursor to the Bill, published in February 2022, identified that:

“One of the gravest inequalities faced by our most disadvantaged communities is poor health”.


Yet health disparities are not explicitly specified in the Bill and the health disparities White Paper has been scrapped, hence this amendment. In Committee the Minister stated that the Government are committed to working with the devolved Governments to reduce geographical disparities across the whole UK and to share evidence and lessons from across the country, learning what works and what does not. Today we have already heard the Minister re-emphasise this in summing up on previous amendments.

Levelling-up missions must address inequalities right across the life course, from cradle to grave. Tackling health inequalities is essential to improving the nation’s economic health as well as people’s well-being. Inequalities in life expectancy are the result of poor health literacy and those broad social determinants of chronic illness and poor health. The Bill purports to reduce geographic disparities using a range of mechanisms. There are marked regional differences in health outcomes across the nation; within and between regions, disparities are increasing.

The largest decreases in healthy life expectancy were seen in the most deprived 10% of neighbourhoods in the north-east. Between 2017 and 2019, healthy life expectancy at birth for women in the north-east of England was 59 years, 6.9 years less than for women in the south-east; for men, life expectancy was 5.9 years shorter. Alarmingly, ONS data showed that healthy life expectancy was around 19 years shorter in the most deprived compared with the least deprived areas of the nation. In these deprived areas, people had a more than threefold risk of dying from an avoidable cause. Before the pandemic, health inequalities were estimated to cost the UK £31 billion to £33 billion each year in lost productivity, £20 billion to £32 billion in lost tax revenue and higher benefit payments, and almost a fifth—£4.8 billion—of the total NHS budget.

The pandemic sharply exposed the real impact of health inequalities through excess mortality in some population groups, and exposed a number of related socioeconomic factors and regional conditions that exist across the life course. Poor housing, inadequate diet, including maternal malnutrition, and adverse childhood experiences have long-term consequences, including crises in adult life, greater need for NHS and social care support and poorer employment prospects. Living on a low income is a source of stress, and emerging neurological evidence suggests that this affects the way people make health-affecting choices, ranging from food to activity.

Poor-quality and overcrowded housing is associated with increased risk of cardiovascular and respiratory diseases, depression and anxiety. Access to good-quality green space improves physical and mental health and lessens obesity. Deprived inner-city areas have far less good-quality green space and higher atmospheric pollution. Unemployment is associated with lower healthy life expectancy and poorer physical and mental health, for unemployed individuals and their households. In 2019-20, employment rates in the least deprived decile were 81.5%, compared with 68.4% in the most deprived decile. Such unemployment damages the nation’s economy.

These health inequalities, starting in childhood, persist right through to the end of life, when social disadvantage is often exacerbated by regional disparities, leaving palliative care needs unmet, particularly for those 90,000 people who die in poverty and deprivation, and those in rural areas where a quarter of the population are aged over 65, unlike younger urban populations. In the UK, those living in poverty, particularly in the most deprived areas, are more likely to die in hospital than in the community and have more emergency hospital admissions in the final months of life. When they leave bereaved children, these young people have worse long-term outcomes in mental health, employability and so on.

The Bill could break the cycle for many if it truly focuses on the population rather than being diverted by commercial short-termism. This is not about taking away from some to give to others: levelling up must address overall well-being and health inequalities across the life course for us to be an economically stronger nation. Without this as a common thread and a foundation for all missions, attempts to level up will fail. I hope that I will get overwhelming reassurance from the Minister today, because otherwise I will be really tempted to test the opinion of the House on this important issue.

[Baroness D’Souza (CB)]

My Lords, I thank the noble Baroness, Lady Lister, for tabling this amendment, to which my name is attached. The stated intention of the Bill, reiterated many times by the Government in both Houses, is the moral duty to reduce economic, social and environmental disparities between and within different parts of the UK. I will make two points.