Distribution of wealth and not its creation is key to addressing health inequality - Neil Small

Its aspirations rest on three key routes to change, firstly empowering local leaders to identify and pursue the sorts of investment and the sorts of initiatives that best serve the circumstances of their areas, second by greater integration across services so that there is a vision for health informing the action of all and third by galvanising partnerships and empowering communities, not least by recognising the success of local initiatives and building on their example.

A further theme looks to the potential for businesses to recognise and act on their ability to positively enhance health. It’s a theme that assumes a relationship between health and (economic) growth that the White Paper says has “for the better part of 200 years… generated a positive loop of improving health outcomes and sustained economic growth”.

This final and more contentious theme points to the context of this White Paper’s genesis – The Department for Levelling Up, Housing and Communities ‘Levelling Up the United Kingdom’ White Paper of 2022.

It is a dubious assumption that all sorts of economic growth benefits health. Rather, it is the distribution of wealth and not its creation that is key to addressing health in a way that reduces inequality.

We also need to be more questioning about what sorts of economic growth generates the wealth we want. If we want to sustain the air we breathe, improve the quality and affordability of our food and support the emotional well-being of all of us, we need to think again about what ‘wealth’ really means when we think about health.

Some sorts of economic growth, such as road building, opening coal mines, developing new oilfields and promoting processed and fast-food, damage the wider environment and adversely impact health. Additionally, a simple push for growth benefits those who are already well-off the most. Their salaries and dividends go up, their property increases in value and the gap between rich and poor gets ever wider.

Governments lazily argue for the importance of the ‘trickle down’ effect, which claims wealth increases and then it ‘trickles down’ from rich to poor. It does not. A report on the growing inequality between the north and south of England from the Institute for Public Policy Research (North) called State of the North (2024) published on March 1, 2024, identifies a growth in average wealth between 2010 and 2020 but inequality in its distribution with the North falling behind the South.

Neil Small is an Emeritus Professor who has focused on health inequalities. He taught at the University of Bradford from 1999 to 2021.