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Title page

Contents

SUMMARY 5

PART 1. THE LINK BETWEEN BETTER HEALTH AND GREATER PROSPERITY 8

1. INTRODUCTION 9

A SICKER NATION? 9

A POORER NATION? 12

THE UK AT A CROSSROAD: SICKER AND POORER, OR HEALTHIER AND MORE PROSPEROUS? 13

METHODOLOGY 14

2. HEALTHY PEOPLE,PROS PEROUS LIVES 18

INSIGHT 1: POOR HEALTH CAN SUBSTANTIALLY REDUCE EARNINGS 18

INSIGHT 2: POOR HEALTH CAN UNDERMINE OUR CAPABILITY TO STAY IN WORK 20

INSIGHT 3: HEALTH SHOCKS UNDERMINE OUR CAPABILITY TO ENJOY OUR WORK AND PROGRESS IN OUR CAREER 24

SUMMARY OF KEY FINDINGS 27

3. A STRONGER, FAIRER ECONOMY 28

INSIGHT 4: HEALTH-DETERMINED LOSS OF EARNINGS HAVE A LARGE ECONOMIC COST 28

INSIGHT 6: BETTER HEALTH COULD HELP DELIVER A MORE REGIONALLY BALANCED AND MODERN UK GROWTH MODEL 31

INSIGHT 7: BETTER HEALTH COULD TACKLE ECONOMIC INEQUALITIES, AND HELP HARDWIRE THE UK ECONOMY AROUND FAIRNESS 33

SUMMARY OF KEY FINDINGS 39

4. CAN WE DO BETTER? 40

WHY DON'T WE DO BETTER? 42

THE SIX KEY THEMES OF UNWILLINGNESS 43

SO, WHAT CAN WE DO? 45

PART 2. THE HEALTH AND PROSPERITY ACT 48

5. STEP 1: SET THE MISSION 49

6. STEP 2: BUILD THE RIGHT INSTITUTIONS 52

CREATE A NEW PUBLIC HEALTH BODY WITH A LEGISLATIVE DUTY TO ADVISE ON TARGETS AND DELIVERY, AND WITH THE MEANS TO HOLD GOVERNMENT... 52

CREATE AN EVIDENCE REVOLUTION ACROSS POPULATION HEALTH, DRAWING LESSONS FROM HEALTHCARE (NICE) AND EDUCATION (EEF) 54

7. STEP 3: ESTABLISH THE RIGHT FUNDING 56

DESIGN AND DELIVER A HEALTH CREATION FUND, TO ADDRESS UNDERINVESTMENT IN PREVENTION 56

CREATE A HEALTH INVESTMENT BANK, TO BETTER WORK WITH THE PRIVATE SECTOR ON HEALTH CREATION 58

FUND NEW SPENDING IN A WAY THAT MAXIMISES HEALTH AND PROSPERITY 61

REFERENCES 65

Tables

TABLE 1.1. THERE ARE CONSIDERABLE INEQUALITIES IN HEALTHY LIFE EXPECTANCY BY UK NATION AND BETWEEN ENGLISH REGIONS 11

TABLE 1.2. DISPOSABLE HOUSEHOLD INCOME IS LOWER OUTSIDE THE SOUTH OF ENGLAND 13

TABLE 1.3. OVERVIEW OF REGRESSION STATISTICAL SIGNIFICANCE FOR FALLING ILL (BOTH STUDY PERIODS) 17

TABLE 2.1. PEOPLE WHO FELL ILL SAW A SIGNIFICANT REDUCTION IN HOURS WORKED PER WEEK 27

TABLE 5.1. A HEALTHY LIVES MISSION ADHERES TO ESTABLISHED BEST PRACTICE FOR SETTING MISSIONS 51

TABLE 6.1. HOW WOULD A COMMITTEE ON HEALTH AND PROSPERITY WORK? 53

Figures

FIGURE 1.1. PREVALENCE OF MOST MAJOR CONDITIONS IS RISING 10

FIGURE 1.2. HEALTH IS WORSE OUTSIDE THE SOUTH OF ENGLAND 11

FIGURE 1.3. THE UK HAS VAST PRODUCTIVITY INEQUALITY BY REGION/NATION 12

FIGURE 1.4. ALMOST ONE-THIRD OF THE WORKING-AGE POPULATION REPORT A LONG TERM ILLNESS 15

FIGURE 2.1. IN OUR MODELLING, BOTH PHYSICAL AND MENTAL HEALTH ARE ASSOCIATED WITH A CONCURRENT DROP IN ANNUAL EARNINGS 18

FIGURE 2.2. A VARIETY OF HEALTH CONDITIONS ARE ASSOCIATED WITH SIGNIFICANT EARNINGS LOSS 19

FIGURE 2.3. THERE IS A STRONG RELATIONSHIP BETWEEN WORSENING HEALTH AND LIKELIHOOD OF EMPLOYMENT EXIT 20

FIGURE 2.4. POOR HEALTH AND AGE BOTH INCREASE LIKELIHOOD OF LABOUR MARKET EXIT 21

FIGURE 2.5. POOR HEALTH AND INCOME BOTH PREDICT LIKELIHOOD OF LABOUR MARKET EXIT 22

FIGURE 2.6. OCCUPATIONS AND ONSET OF MENTAL AND CHRONIC ILLNESS, BEFORE AND DURING THE PANDEMIC 23

FIGURE 2.7. A LARGE PROPORTION OF RESPONDENTS SAY THAT POOR MENTAL HEALTH MEANS THEY ACCOMPLISH LESS AT WORK 24

FIGURE 2.8. ONSET OF ILLNESS IS ASSOCIATED WITH A SHARPER DECLINE IN JOB SATISFACTION 25

FIGURE 2.9. MANAGERS AND CUSTOMER-FACING JOBS EXPERIENCED THE BIGGEST DROPS IN WELLBEING DURING THE PANDEMIC 26

FIGURE 3.1. EARNINGS LOSS DUE TO NEW HEALTH CONDITIONS HAD AN ESTIMATED COST OF £43 BILLION IN 2021 29

FIGURE 3.2. BETTER HEALTH COULD HAVE PREVENTED OVER HALF OF ALL EMPLOYMENT EXITS IN 2015 TO END 2019 30

FIGURE 3.3. THE MOST COMMON ROUTE OF EXIT FOLLOWING ONSET OF CHRONIC OR MENTAL ILL HEALTH WAS EARLY RETIREMENT, BUT FOR THOSE UNDER 50... 31

FIGURE 3.4. WORKING-AGE PEOPLE LIVING IN THE NORTH, THE MIDLANDS AND WALES WERE SIGNIFICANTLY MORE LIKELY TO BE ILL THAN THOSE LIVING IN... 32

FIGURE 3.5. BY LEVELLING UP ON HEALTH GAPS ACROSS UK NATIONS, WE COULD EXPECT TO SEE REGIONAL EARNINGS IMPROVED BY AS MUCH AS... 33

FIGURE 3.6. PEOPLE WITH THE LOWEST EARNINGS FACE THE HIGHEST RATES OF CHRONIC PHYSICAL ILLNESS AND POOR MENTAL HEALTH 34

FIGURE 3.7. A 10 PERCENTAGE POINT REDUCTION IN RATES OF ILL HEALTH (BOTH LONG-TERM PHYSICAL AND MENTAL) WOULD BOOST EARNED INCOME THE... 35

FIGURE 3.8. WORKING-AGE WOMEN ARE MORE LIKELY THAN WORKING-AGE MEN TO EXPERIENCE CHRONIC ILLNESS OR MENTAL ILL HEALTH 35

FIGURE 3.9. WOMEN ARE MORE LIKELY TO NOT BE IN EMPLOYMENT THAN MEN, AND ILLNESS MAKES THIS WORSE 36

FIGURE 3.10. BETTER HEALTH COULD BENEFIT FEMALE EARNINGS TWICE AS MUCH AS MALE EARNINGS 37

FIGURE 3.11. WORKING-AGE PEOPLE WITH BLACK CARIBBEAN HERITAGE ARE MORE LIKELY TO REPORT A CHRONIC ILLNESS THAN ANY OTHER ETHNIC GROUP,... 38

FIGURE 4.1. THE UK HAS A LOWER HEALTHY LIFE EXPECTANCY AT BIRTH THAN COMPARABLE COUNTRIES 40

FIGURE 4.2. THE UK HAS HIGHER TREATABLE MORTALITY THAN MOST OTHER G7 COUNTRIES 41

FIGURE 4.3. WHAT DRIVES THE DEFICIT OF WILLINGNESS? 43

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