The recent weather reminded me of the wonderful properties of snow. It gets people out of their cars walking and, in non-pandemic times, brings them together for some fun and laughter. Snow also makes things appear brighter, more appealing, by providing a uniform covering that hides some of the uglier sides to our communities.
Covid-19 has had the opposite effect, highlighting the stark inequalities that exist, particularly in health and wellbeing outcomes between the most and least affluent parts of our region.
Those in poorer communities have been more likely to be hospitalised by the virus, to lose their job and to go hungry. The fragility of our health and wellbeing, and the relationship it has with a thriving economy has never been more obvious.
At a population level, how long we live is seen as the key metric for assessing health and social progress, and this has increased dramatically over the last 100 years.
The problem is, this varies hugely depending on where you grow up – as much as 15 years between the richest and poorest areas in the UK - and this gap is growing, not shrinking.
This week marks the first anniversary of the opening of Sheffield Hallam University’s Advanced Wellbeing Research Centre (AWRC) and insight from our research, particularly with disadvantaged communities, confirms what actually matters most to people is not how long they live (within reason) but the quality of life lived.
A situation that should no longer be tolerated
In Sheffield, the gap in ‘healthy life’ between the most and least affluent, is 20+ years. This is mirrored in Barnsley, Doncaster and Rotherham. A large proportion of the factors driving this gap can be avoided, things like quality of education, jobs, housing and built environment. On the basis of social justice alone, this situation should no longer be tolerated.
Economically, inequalities are hugely costly: £50-70 billion nationally. The burden of disease caused by shortfalls in these wider determinants of health leads to greater utilisation of health and social care services, higher unemployment, and lower productivity.
This has a negative impact on economic growth manifest in fewer high-quality jobs, poorer quality of housing and lower income across our region, particularly in disadvantaged communities, perpetuating inequalities.
A place-based approach to change
As the vaccine brings hope that things will ‘return to normal’, we should aim for normal to mean something different. How about a normal that eradicates inequalities in healthy life years within a generation? To achieve this, we need to tackle the root causes of poor health and wellbeing, prioritising a healthier, active and fairer society through a focus on ‘place’.
Whilst access to and the quality of health-care services in our region is important, upwards of 75% of what drives healthy life years is determined by the conditions into which people are born, live and work. Transforming these conditions can only be achieved by bringing together the different organisations, assets and investments that shape the ‘place’ where people live.
Place-based approaches speak fundamentally to the truth that some people simply do not have the same opportunities or resources to enjoy healthy life years as others purely based on their local context. Place-based change is not about relying on interventions to tackle individual behaviour but instead linking environmental and social factors together.
These could be interventions such as building affordable housing that also costs nothing to heat, providing people with access to high quality green space in which to be active, or enforcing the minimum wage whilst also providing opportunities for high quality employment.
The importance of place is recognised in the UK government Industrial Strategy as one of its five foundations of productivity, and place-based systems of health and care have emerged through the NHS long-term plan. Whilst government action is needed, it is impossible for a centralised system to truly understand the nuances of local areas. This is why devolved decision making and investment is so important, underlining the role of Sheffield City Region leadership.
Providing a voice to the marginalised
One of the research themes at the AWRC is focused on how we can create the conditions to deliver 100 years of healthy and active life for everyone living and working in our region. This is an agenda steeped in place. Transformation of our pre-Covid ‘normal’ starts by providing a voice to those that live and work in communities – especially those who are traditionally marginalised.
Authentically listening to and giving power to their agenda and ideas of what improves wellbeing where they live will help create the conditions for a new normal, one that sees Sheffield City Region transformed into the healthiest, wealthiest and most equitable place to live and work in the UK. This is the new kind of normal I would like to see.
