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New research highlights and addresses public health gaps in the ‘levelling up’ agenda

Press release issued: 13 July 2023

The UK government's levelling up agenda is set to fail in its mission to address inequalities unless it tackles the root causes of poor health, according to a new study.

The research, led by the University of Bristol and University of Bath, presents policy recommendations to tackle the root causes of poor health which hold the key to overcome inequalities.

The study, published in the journal Contemporary Social Science, used data from interviews with 132 key government and industry professionals to assess if the 12 'missions' published in the Levelling Up White Paper will achieve better quality of urban living to improve public health.

The study is part of TRUUD, a transdisciplinary research project led by the University of Bristol, which aims to reduce non-communicable disease (such as cancers, diabetes, obesity, mental ill-health and respiratory illness) and health inequalities linked to the quality of urban planning and development.

Using seven principles that could underpin a successful ‘levelling up’ strategy for healthy urban developments, researchers recommend how the Government might address the wider determinants of health in the implementation of its ambitions.

These include establishing a cross-government commitment for health, led by the Prime Minister's office, further local devolution of powers, simplified means of funding, and increased use of evidence from local communities and health sources for decision-making.

Sarah Ayres, Professor of Public Policy and Governance at the University of Bristol, said: "Preventing poor health through tackling the wider determinants is critical to ‘level up’ the country but this requires a change in current funding, increased local powers and greater attention to local voices alongside health evidence.

"We know, from our large-scale, qualitative and transdisciplinary dataset alongside a review of the literature on health and the urban environment, that ambitions to reduce inequalities and improve life-expectancy are unlikely to be met. Our recommendations give seven clear actions to help achieve better health outcomes through better quality of urban developments."

The seven recommendations are:

  • Articulate a clear commitment to health prevention and tackling the wider determinants of health  
  • Health prevention must be designed as a cross-cutting agenda in Whitehall with clear accountability for delivery  
  • Engaging with local actors, including members of the public, is critical to understanding local health needs 
  • Local government needs policy autonomy to adopt a systems approach to addressing health inequalities 
  • Greater flexibility in local government funding is required to enable the integration of health with other policy areas 
  • Place sensitive approaches are essential for places that suffer the worst health outcomes  
  • Local health data needs to be used more effectively in urban development to highlight local health priorities. 

Daniel Black, Programme Director for TRUUD, added: "TRUUD is testing interventions across multiple parts of the urban development system. Though change takes place in fast growing cities, national level engagement is critical given how centralised we are in the UK and the central role of the private sector.

"Evidence supporting these fundamental messages – such as health prevention being a pan-Governmental issue – are vital if we are to tackle these root cause issues upstream."

TRUUD is funded by the UK Prevention Research Partnership (UKPRP).


'What needs to happen to 'level up' public health?' by Sarah Ayres, Andrew Barnfield et al. in Contemporary Social Science [open access]


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