Two weeks before the launch of the new NHS Plan South Yorkshire unveiled its own bold plan to become the healthiest region in the country. Health is Wealth in South Yorkshire is the result of 18 months deliberation by a 20-person expert panel established by the South Yorkshire Mayor, Oliver Coppard. The full report runs to 115 pages, with 110 recommendations, but there is a summary in the link at the foot of this article. Its core aim is to transform health and wellbeing, especially among those suffering the greatest burden of ill-health.
Why does South Yorkshire need a health plan?
First, because the region is undergoing a health crisis: its citizens are experiencing poor health at an earlier age, living longer in poor health and dying younger than the average for England. Compared to one of the most affluent parts of the country, Kensington and Chelsea, a girl born in South Yorkshire can expect to die five years earlier and experience poor health 10 years earlier. Unlike many other countries, average life expectancy has fallen across the country the, but it has fallen faster than average in this region.
The health crisis falls unevenly on the population of South Yorkshire. Those living in poor neighbourhoods are the most likely to live 10 years less and experience ill-health nearly 20 years earlier, and to have multiple health conditions, than those in the more affluent ones. Low socio-economic status intersects with other characteristics to worsen health outcomes, especially for minoritised ethnic groups, disabled people, those with serious mental ill-health, and those who are homeless. For example, the risk of maternal death is four times higher among Black than White women.
Hopes that the NHS Plan would tackle these health inequalities were misplaced. As the name suggest the new plan is focused on the NHS, which means treatment, whereas the primary causes of ill-health and health inequalities lie largely outside its purview. These are the so-called social and commercial determinants of health, the things we encounter in our everyday lives, education, work, housing, the food we eat and the air we breathe.
Inequality thrives in South Yorkshire
Second, the health crisis is a substantial contributor to an economic one. The annual GDP loss of 2% due to poor health equates to a £630mn pa reduction in South Yorkshire’s economy. Productivity losses reflect social inequalities: half of those living in the region’s most deprived 10% of neighbourhoods report being in poor health by ages 55–59, but this occurs 20–25 years later for those in the more affluent ones. Thus, rising numbers of people are either working below capacity (presenteeism) due to ill-health, or are being forced to exit prematurely from the workforce.
Thirdly, the Mayoral Combined Authority (MCA) has been forced to act because of the failure of national government to deliver on repeated health improvement targets. For example, there was a 2018 plan to halve childhood obesity by 2030, but, in fact, it is on track to double by 2030.
A bold new vison and framework
Making South Yorkshire the healthiest region in practical terms, means extending the number of years that the average person lives in reasonably good health. This is their healthy life expectancy (HLE). For men this would mean a gain of 15 years of good health, from the present 60 to 75, and for women 11 years. To achieve this requires a seismic shift in approach throughout the region. In tackling the determinants of ill-health, the main political levers are held by the four unitary authorities – Barnsley, Doncaster, Rotherham and Sheffield – and the MCA, as well as by central government.
The new four-pronged strategic approach comprises radical prevention, to tackle the causes of ill-health at source; health equity in all policies, from education to housing; proportionality, to ensure that the needs of the most deprived and seldom heard are prioritised; and an inclusive economy, that is, work that contributes to health and wellbeing and offers equal access.
Asserting the right to good health
The radical heart of the plan consists of 10 aspirational rights, which South Yorkshire believes all its citizens should expect. These are framed to reflect the life course, from birth to death, the social and commercial determinants of health, and the fact that the chronic conditions that reduce HLE and lead to early death – cancer, stroke, heart disease, dementia, diabetes – are all wholly or partly preventable. The plan states that, everyone in South Yorkshire should have a right to:
- To be born safely and in good health.
- To grow up loved, safe and respected, and supported to realise their full potential.
- To education which maximises their knowledge, skills and potential, and enables them to contribute to society as well as their own development.
- To live in decent quality housing that is affordable, and in a pleasant neighbourhood that supports wellbeing.
- To live in communities that are inclusive, empowered, resilient, and safe.
- To work for fair forward-thinking employers that value and promote health and wellbeing.
- To receive an income that provides protection from poverty and deprivation and is sufficient for a healthy life.
- To have opportunities and supports to be healthy and active throughout their lives, including in old age.
- To be protected from health-harming commercial activities.
- To respect, and to live free from discrimination, while also contributing to the protection and fulfilment of human rights.
Most of these fundamental rights can only be achieved by collaboration between the four local authorities and the MCA, while one (an income providing protection from poverty) requires action by central government. So, the plan makes targeted recommendations for the MCA, the four authorities working in collaboration with the MCA, and the government.
It is obvious that this bold new approach cannot be simply superimposed upon the existing policies and practices that too often focus on responding to health issues on an individual basis, rather than preventing them. Therefore, the plan also pinpoints seven essential changes in policy and practice that are requirements for its achievement. These include creating a new narrative emphasising the social and economic conditions for good health and wellbeing, rather than the present one focused mainly on individual responsibility.
Is it affordable and achievable?
The bulk of the recommendations for local action are frugal and cost-efficient, and aligned with measures already in place via the local health and wellbeing boards. The plan is organised into a series of small steps that, over a 10-year period, lead to large scale change. But the main question is, considering the current health crises in the region, and their negative personal, community and economic impacts, can South Yorkshire afford to avoid taking radical steps to improve health and wellbeing?
