Revealed: Midlands and the North endure biggest public health cuts in England, shows IPPR research

• New analysis shows that since 2014 the Midlands and North have endured the biggest cuts to public health budgets in England.
• Overall, England has seen a cut of £13.20 per person, whilst the Midlands experienced a cut of £16.70 per person, and the North £15.20 per person. Within this, the North East was worst affected with cuts of £23.24 per person.
• The West Midlands, North East and North West, which saw the highest mortality rates in the first peak of Covid-19, are also among the worst affected areas by public health cuts.

New analysis published today by IPPR and IPPR North reveals how cuts to public health budgets have disproportionately hit the Midlands and North of England.

Despite overwhelming evidence that public health grants represent excellent value for money and will be vital to ‘level up’ the country – addressing health inequality between the North and the rest of England would be worth an additional £20bn GVA boost each year for the North alone -they were cut by £750 million across England between 2014/2015 and 2020/2021, with all regions affected.

The Midlands endured per-person cuts 26 per cent higher than the England average, and North 15 per cent higher. The worst affected areas were the North East which saw a cut of £23.24 per person, the West Midlands at £17.80 per person, and London at £16.23 per person.

Worryingly, IPPR and IPPR North found that those areas that saw the highest rates of mortality during the first wave of Covid-19 had also seen the biggest cuts to their public health budgets- over three and a half times as high as areas where Covid mortality was highest. The West Midlands, North East and North West saw a 0.11 per 100 mortality rate between March and July of this year - the highest in England. And according to NHSA figures, in March-July 2020 57.7 more people per 100,000 died in the North of England of all causes including Covid-19 than across the country as a whole. Those extra deaths could cost the economy £3.86 billion in lost productivity.

Today’s research shows that many different factors affect health outcomes, one of which is likely to be reductions in public health budgets. Researchers argue that investing in public health is good for people, good for resilience, good for the economy, good for places like the Midlands and the North, and ultimately good for the nation. They say that central and local government need to work effectively together to improve health resilience, including by:

• Making wellbeing a core measure for economic development and expanding the economic development remit of devolution deals to take account of wellbeing impacts.
• Introducing a new ‘health security and inequality council’, chaired by the Prime Minister and responsible for overseeing progress on health inequalities.
• Restoring the public health grant to its 2014/15 level and increasing funding in line with the NHS funding settlement, as part of an ambitious ‘invest to save’ programme, and give local leaders the powers and budgets to drive health improvement.
• And mandating health impact assessments for all public spending decisions.

Chris Thomas, Senior Health Fellow at IPPR and co-author of the report said:

“Today’s figures lay bare the deeply unjust impact of public health cuts on people across England. They were nonsensical cuts to budgets that made a considerable difference to peoples’ health, to our economy, to our resilience. A change of track is long overdue. Yet in this week’s spending review, the Chancellor missed the opportunity to raise public health grants.

“The places where we live, work, grow up and grow old all play a fundamental role in shaping our health.Our health and our economies are intimately linked, and inequalities in either of them are not inevitable.

“To succeed in recovering from Covid-19 and ‘levelling up’ the nation, central government must make ending health inequalities a priority. Only by supporting local experts to invest in the health and resilience of people in places across the country, will we create a fair and prosperous economy”.

Hannah Davies, Health Inequality Lead for the Northern Health Science Alliance said:

“The disproportionate effect of the COVID-19 pandemic on the North of has thrown into sharp focus how closely health and the economy are interlinked.

“The £20bn lost from the economy each year due to inequalities between the North and South of the country must be tackled through a levelling up strategy which takes into account this disparity and the huge potential in investing in health prevention, health R&D and the NHS.

“We support the recommendations in this important new report to view health as a new national mission and for a stronger and more local approach to health investment, taking account of the role of health in driving prosperity and economic inclusion.”

Alison Cox, Cancer Research UK’s director of prevention, said:

“More deprived communities have higher rates of smoking and obesity, and are most in need of local prevention services which help to reduce the burden of preventable diseases, including some cancers.

“IPPR’s report starkly sets out that not only has there been huge cuts to public health over the last six years, but that public health investment appears to have shifted away from the areas of the country that need it most. The spending review has done nothing to change this. The effect of inequalities has been highlighted by the disproportionate burden of COVID-19 among the most deprived communities.

“Now more than ever it’s important that local authorities are provided with increased and equitable funding so they can deliver important prevention services to those who need it.”

ENDS