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  • Writer's pictureJohn Copps

Is devolution the missing link between health improvement and ‘levelling up’?

John Copps argues that new Health Foundation-commissioned research highlighting the relationship between devolution and life expectancy provides the missing link between levelling up the economy and better population health.

Healthcare has always felt like the omission in the government’s promise to ‘level up’ the UK. The much-heralded levelling up agenda has always appeared preoccupied with economic performance, achieving growth in left-behind areas, and targeting investment on infrastructure, high streets and regeneration projects.

Part of the strategy to deliver levelling up is a promise to ‘empower local leaders and communities’ by moving power away from Whitehall. The Government says it wants to ‘extend, deepen and simplify’ devolution across England so that, by 2030, every part of England that wants one will have a devolution deal. The existing model of Mayoral Combined Authorities is the blueprint for this change.

What is largely overlooked in the government's plans is the fact that good health is crucial for prosperous and successful communities. The inextricable link between health and economic performance is little more than a footnote. And on the flipside of the coin, levelling up just isn’t part of the language used in healthcare, which instead talks about ‘health inequalities’. Joined up this is not.

So it is exciting to read the Health Foundation-commissioned work highlighting the link between devolution in Greater Manchester and improvements in life expectancy. If feels like even asking this question is a step forward in connecting up thinking on the economy and healthcare.

What does the research show?

After crunching the numbers, researchers found that Greater Manchester had better life expectancy than expected after devolution, 0.196 years higher on average between 2014/16 and 2017/19 compared to a control group. This is equivalent to a 0.25% increase compared with the period before devolution. The improvements were most apparent in the areas with the highest income deprivation and lowest life expectancy, suggesting a narrowing of inequalities.

These finding suggest reason to be hopeful that the government’s levelling up policies will help improve health after all. The researchers conclude that improvements in life expectancy were ‘likely to be due to a coordinated devolution across sectors, affecting wider determinants of health and the organisation of care services’.

More devolution, more control over what money is spent on, and so a better response to health needs is what it seems to be saying.

A step forward

This research forges a link between the government’s plans to level up the UK and the urgent need to improve population health – one that has been largely absent so far.

Underpinning the impact of devolution on health are the twin pillars of local decision-making and system working. Local decision-making gives leaders the power to quickly move resources to where they are most needed. System working means partners can act together to influence the wider determinants of health such as public health, employment opportunities, transport and planning at the regional and local level.

The conclusions of the research give us hope that 'levelling up' can be about both the economy and health - as it needs to be if it is going to have real impact. If the findings in Greater Manchester are replicated in other regions then devolution could be the key to unlocking better health across the UK.

To read more about MV's work in integrated care click here or contact


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