The Role of Targets in Reducing Health Inequalities

Policy Briefing, December 2023
By Rachele Salvatelli and Clare Bambra

Actionable Insights

• Policymakers should use targets in their health inequalities reduction strategies.

• Policymakers should base their targets on regional, local and neighbourhood health data, which is the best measure of health inequalities at present and it is already available to them.

• Policymakers should monitor the success of their policy implementation by measuring a range of metrics: Life Expectancy (LE); Healthy Life Expectancy (HLE); Infant Mortality Rate (IMR); overweight and obesity; anxiety and depression; suicide rates.

• Policymakers should use short-term tracking of policy progress by using interim indicators, such as household relative poverty rates; employment rates; relative child poverty rates; educational attainment rates; meeting recommended physical activity rates; consuming five or more fruit and vegetables per day.

• Policymakers should create health inequalities targets that are both aspirational and achievable.

• Policymakers should be provided with adequate national support and devolved influence to deliver their policy interventions.

CHALLENGE

Health inequalities in England have been increasing over the last decade. There is currently up to a ten-year gap in life expectancy between people living in the least deprived and most deprived areas. The North East has the lowest life expectancy of any English region. Health inequalities have an economic cost to individuals, families, the NHS and to the wider economy. Poorer health in the North of England costs the UK economy over £13 billion per year in lost productivity.

IMPLICATIONS FOR THE NORTH EAST

The North East has the lowest life expectancy of any English region. The North East Mayoral Combined Authority (NEMCA) has a remit for improving health in the region. To coalesce change, NEMCA should have a health inequalities strategy which includes setting regional health inequalities targets and using policy levers across the social determinants of health to improve health in the region.

BACKGROUND

Health inequalities are largely driven by the social determinants of health including poverty, education, employment, housing, access to health services and social inclusion.
In 2022, the Department for Levelling Up, Housing and Communities introduced a new health target. This strategy included a commitment to reducing the Healthy Life Expectancy gap by 2023, and raising the Healthy Life Expectancy by 5 years by 2035.

WHAT ARE HEALTH TARGETS?

Health targets are specific, measurable objectives or goals set within healthcare and wider systems to improve health outcomes or patient care, typically aiming to address key health challenges and assess the effectiveness of long-term and short-term policy interventions.

WHO/WHERE TO TARGET?

A multi-faceted life course approach is needed in order to tackle health inequalities. This involves having multiple concurrent targets that address the social determinants of health (e.g. targets for child health will take place alongside targets for adult health, targets for specific population groups etc.) Geographical data is the most effective way to monitor health improvements. For this reason, health targets should be set at the lowest geographical level possible.

WHAT TO TARGET?

Targets should be set against six indicators:
– Life Expectancy (LE)
– Healthy Life Expectancy (HLE)
– Infant Mortality Rate (IMR)- Overweight and obesity
– Anxiety and depression
– Suicide rates.

These indicators have been chosen because they provide comparable data across the UK; are updated annually; cover mental and physical health; include measures for adults and children; collectively measure mortality and morbidity; can be analysed by some indicator of social inequality.

INTERIM INDICATORS

Measuring reductions in health inequalities requires an extensive period of time. For this reason, interim indicators are needed in order to track progress on a more frequent basis. Interim indicators should include:

– Household relative poverty rates;
– Employment rates;
– Relative child poverty rates;
– Educational attainment rates (5+ GCSE grades A*-C);
– Meeting recommended physical activity rates;
– Consuming five or more fruits and vegetables per day.

These metrics are comparable across the UK; are updated regularly; are available by Indices of Multiple Deprivation (IMD) and are strongly associated with key health outcomes.

“Targets can coalesce policy action and are a way of getting buy-in from across different parts of government.”

THE BENEFITS OF TARGETS

Health inequalities targets were used in the successful 2000-2010 national health inequalities strategy. In this period, the health gap between the most and least deprived areas decreased. Since 2010, inequalities have increased. Targets can coalesce policy action and are a way of getting buy-in from across different parts of government.

Targeting health inequalities: realising the potential of targets in reducing health inequalities