How much longer and further are health inequalities set to rise? The Office for Health Improvement and Disparities faces unprecedented challenges

The Office for Health Improvement and Disparities’ launch is accompanied by some of the most stark evidence of inequalities that exist in England. These include north-south divides, as well as rich-poor and male-female divisions.

While analyses tend to focus on recent years, it is important to look at the longer term. Between 2001-3 and 2018, life expectancy increased in England by 3.2 and 2.4 years for males. But only 0.3 of these improvements occurred after 2010-12, as life expectancy increases stalled following decades of progress. There are many reasons why this has happened, including widening socioeconomic inequality, a slowdown of improvements in cardiovascular mortality, and some extremely severe flu seasons.

The north-south divide has increased over the past two decades. This can be seen when comparing the areas that have the highest and the lowest life expectancies in the country. By 2018-20, the difference in male life span between Hart (South East) and Manchester (North West) was 10.7 years. For female life span, the difference between Kensington, Chelsea, and Blackburn, Darwen (North West), was 6.6 in 2001-3
In 2018-20, 47 out of 50 local authorities that had the lowest male life expectancy ranked in the deciles with the highest levels of poverty. The same was true for the female life expectancy.

Simon Stevens, NHS England’s Health New Towns Programme was announced by Simon Stevens last month. Public Health England will support the program, which will work with ten housing developments in order to rethink health and care delivery.

Stevens made it clear that the NHS is a pioneer in involving itself from the beginning of planning, deciding the development of these new sites, and experimenting with creative solutions to the challenges society faces, such as obesity and dementia. He was right; the NHS usually comes late to the party, and health and care issues are often an afterthought when it comes to new housing developments.

Healthy New Towns is a sensible program, but it’s also a long-term one, and we might not be able to measure the benefits of this approach for a number of years. Healthy New Towns may be a good program, but it is also long-term. We might not measure the benefits for several years. How can we improve our health and care in the meantime by enhancing one of the fundamental aspects of our lives, our homes?

The housing we live in, as well as the stability of the home we are living in, can have a significant impact on our health and the financial needs of the NHS. According to recent estimates, investing PS1.6 billion in housing-related services annually generated savings for the public purse of PS3.41 million, including PS315.2 million in healthcare costs.

A project in the North East between a housing group and a clinical commissioning group enabled people with respiratory illnesses living in cold and damp homes to ‘prescribe’ double glazing and insulation. The ‘Boilers On Prescription’ project showed a 60% reduction in the number of GP appointments required by participants.

Around a year ago, The King’s Fund and the National Housing Federation set up a Learning Network to explore approaches to integrated health care, housing, and housing. The King’s Fund brought together housing providers and housing associations to share information about innovations and developments, offer peer support, and gain a better understanding of how NHS and Social Care commissioning works. We have created a series of infographics that show the important role housing associations play in improving and maintaining health. I had always thought that housing organizations were primarily there to fill the gap in housing markets – to supply bricks and mortar – but was I wrong?

In the last 12 months, I have heard of innovative housing associations that are working with local health commissioners and healthcare providers to create new care packages for those who need healthcare in settings other than hospitals.

Housing associations work with local acute care providers to create new care pathways that are tailored for homeless people who have complex needs and may also be struggling with mental health issues or addictions. After a period of inpatient treatment, the individual is discharged to the care of a housing association. The housing association then provides “step down” care. This package of interventions and supports ranges from sheltered housing units to independent housing with the goal of helping the person to remain stable and healthy.

A housing association in another area works with the local NHS to provide community-based mental health support to over 9,500 people through an initiative known as Brighton and Hove Recovery College. The college offers a variety of courses to help people manage their mental health. Systems are produced and delivered by those with experience in mental health and others who have acquired knowledge through work or training. This model offers a range of opportunities, from one-day courses to eight-week long periods, on topics such as “managing depression” and “work and wellbeing.” It turns the idea of recovery upside down by treating everyone like a student instead.

These initiatives pave the way for continued development in this field. I heard about some excellent integrated work between the health and housing sectors. I was impressed by the enthusiasm with which colleagues from both sectors came together to achieve the best results for individuals.

We have learned a great deal at The King’s Fund from our partnership with the National Housing Federation, as well as other activities, such as our event about housing and health with Public Health England. We are now continuing to work on maximizing the contribution housing makes to health and care.


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