A report came out last week from the Kings Fund and the Joseph Rowntree Foundation giving new evidence to the link between areas of deprivation and decreased life expectancy. The Kings Fund CEO commented
“recent life expectancy figures – a fundamental measure of a nation’s health –show a depressingly stark gap between the most and least deprived areas of the UK. While the NHS can be a force in addressing poverty, as we head towards a general election, widening health inequalities and deepening deprivation must be tackled head on by government and policy-makers”
Only 2 months ago the UCL Institute of Health Equity published research showing that one million people in England live shorter lives than they should because of health inequalities across the country, and this variation in life expectancy was caused not by NHS failure but by significant variation in the social determinants of health. Professor Sir Michael Marmot commented
“Important as is the NHS – publicly funded and free at the point of use – action is needed on the social determinants of health: the conditions in which people are born, grow, live, work and age. These social conditions are the main causes of health inequalities.”
Can these conditions be addressed at the local level so as to improve the life expectancy of residents?
What interventions are effective? Responses will vary – and not in the way you might expect. It all depends on the frame of reference for what determines life expectancy.
The Institute for Public Policy Research in their recent report Healthy places, Prosperous Lives evaluated place -level interventions that are making a difference to people’s health and life expectancy, and proposed a local intervention which they called a HAPI zone – the designation of places to deliver Health and Prosperity Improvement. The authors described how these might work:
“Local leaders would work with citizens and other stakeholders to designate a new HAPI, at sub-LA level, based on need. They would work together to create aspirational, long-term Healthand Prosperity Improvement Mission Delivery Plans, designed around the seven foundations of good health outlined in this report.”
These seven foundations are: a safe home; healthy bodies; clean air to breathe; a good job; strong relationships and community; freedom from addiction; and a great start to life.
The HAPI idea is inspired by the role of Clean Air Zones in providing place- led answers to another big and complicated challenge – climate change.
“through a multi-agency approach, with local places and people in the lead, Clean Air Zones have been shown to support cleaner air, more innovation in green industries and active travel where implemented – to the benefit of the planet, public health and the wider economy. As with Clean Air Zones, the ability to designate HAPIs would be a new local authority power. An offer of ringfenced strategic investment, support and capacity from the centre will help incentivise local leaders to enact this power consistently.”
Others have looked to improve life expectancy through the lens of an ageing society, focusing on ways to support older people to maintain good health by designing age-friendly neighbourhoods that support the changing needs of people as they age. Housing and neighbourhoods that foster exercise, social connection and intergenerational support coupled with interventions that make journeys outside the home easier e.g. public toilets, seating, lighting, signage and traffic control will have an impact on life expectancy. Evidence on this from both a preventative health perspective and a neighbourhood planning perspective are continually building, and the WHO has developed its age-friendly cities framework to guide city leaders in efforts to support an ageing population.
Some have gone a step further and, rather than focus on improving places for older people, they focus on actively promoting “longevity”, actively developing and sustaining a population that live long lives in good health. The recent popularity of Blue Zones exemplifies this – and provides both a laboratory for understanding how longevity has been sustained for generations in some places and a demonstration of how interventions can create new Blue Zones and, by extension, increase life expectancy.
Taking the longevity approach a step further are initiatives that support “longevity-ready” places, distinct from age-friendly places in their focus on early-life social determinants of healthy and successful ageing. Citing examples of interventions in US cities that have gone beyond the “older-person-focused, age-friendly model”, a recent report in Natures summarised why they have been effective:
“the success of longevity-ready cities heavily relies on the concerted collaboration of multiple sectors, along with the engagement of policy makers, planners, designers, researchers, and beneficiaries of all ages. Integrating policies and research in longevity-oriented action plans will raise awareness of the determinants of healthy longevity among stakeholders (especially the private sector) while creating opportunities for partnerships. Moreover, the bottom-up participation of multiple generations in planning is critical, and this can stimulate their connections to one another and help reconcile potential conflicts by crafting actions that will fulfill different needs of different groups. Involving younger generations in the discussion to, for example, learn how they picture the cities they would like to live in when they grow old, could also benefit dynamic and adaptive policy making.”
Whether the focus is on eradicating health disparities, supporting an ageing population, promoting healthy longevity or undertaking regular local needs assessments, all of these approaches start with a comprehensive understanding of life expectancy and health need at the local level. Health Assessments derived from the ground up, combining self-reported and discussion-generated information with population level knowledge and tools delivers value for local communities because they
1. Bring people together to discuss their health – doing a health assessment, understanding needs of older people, determining drivers of health inequality. Offering people an opportunity to extend their life expectancy seems to do that. Everyone cares about living their life in good health.
2. Connect local communities with non-local resources – eg population health tools and support -- broadening and deepening local knowledge, and providing a platform to build trust moving forward.
So can local interventions improve life expectancy? If they start with insight and knowledge gained through local conversations and social connection, which in turn fosters trust and a belief in the future, then absolutely yes. Investors in local regeneration projects might find that focusing their engagement with residents around health and life expectancy delivers the support they often find so elusive.
Clare Delmar
Listen to Locals
26 March 2024
