SIPHER aims to help policy teams with different priorities work together to reduce health inequalities. In this blog, I argue that the selection and framing of evidence could be an important part of collaborative efforts to tackle economic inactivity and health inequality together.
What’s the problem?
Why should health inequalities be anyone’s policy problem? For those involved in public health the answer is obvious: health inequalities are a problem because avoidable ill-health and human suffering should be avoided, and policy has a major role in determining who is more or less likely to suffer.
But this argument is not obvious to everyone.
In part, it may not be obvious because many people assume individual responsibility for health. It may also be doubted because ill-health is not the only cause of human suffering. Attempts to systematise ‘Health in All Policies’ have often been underwhelming from a public health perspective; non-health policy actors don’t necessarily agree that health should be the imperative. Economic outcomes have long dominated policy goals, under the assumption that participation and earnings improve living standards in a broader sense than solely ‘health’.
SIPHER’s Understanding Policy Processes & Evidence Needs (WS1) research is finding that policy partners are highly concerned with economic inactivity, and the role of ill-health as a driver. One interviewee working in economic policy told SIPHER that health inequalities are now “a huge priority” for their team, while another said health inequalities were “a higher priority than [they] had been for quite some time”. In neither case was this to reduce the suffering caused directly by ill-health, but instead because of the impacts of ill-health on the economy via employment.
Recent publications by SIPHER’s policy partners also highlight economic inactivity. The Scottish Government’s new policy prospectus (p11) includes a new target to improve economic participation “with fewer people unable to work due to ill health or disability”. In Greater Manchester, their Independent Prosperity Review which informs the new Local Industrial Strategy states that health inequalities were harming productivity and “the evidence of that has only become more compelling” (Evidence Update: Reflections (2022, p29)). Similarly, Sheffield City Council’s work on a new City Strategy is informed by an evidence review (PDF) that highlights in its Key Messages (p76) the impact of poor health on Sheffield’s workforce and on some communities’ access to suitable employment opportunities.
Economic inactivity’s current high status as a policy problem is because levels of economic inactivity due to long-term sickness are at unprecedented highs. This is at least partly driven by Covid-related illness and by post-Covid delays in the healthcare system, though the picture is complex. With relevance to two of the most pressing electoral issues – the economy and the NHS – economic inactivity is considered by some policy actors to be a more pressing agenda than the long-term and highly complex health inequality agenda.
But as both agendas are so closely linked, economic inactivity represents an important policy opportunity for interventions that also act to reduce health inequalities. For example, economic policymakers may be keen on workplace interventions that facilitate flexible working for the mildly ill if evidence can show how it may boost earnings or limit welfare costs. That fair work may also benefit the health of low-paid groups may not be as compelling to those policy teams.
Similarly, evidence showing how a mental health intervention may improve employability may appeal strongly to economic policymakers. Evidence that it also improves WEMWBS scores for mental wellbeing in disadvantaged groups, for example, may boost health policy support but be less interesting to other policy teams.
To paraphrase the saying, “the world has problems while policy has departments”. SIPHER’s work aims to assist policy partners in aligning cross-departmental priorities so they can better tackle cross-cutting problems. But this is not a simple question of providing evidence; it is also about relationships and collaboration. By evidencing the priorities of policy teams with important social or economic levers, public health can contribute to policy which reduces health inequalities without trying to persuade those policy teams of the primacy of health. This approach – known as “win-win” or “co-framing” – appears more likely to facilitate joined-up policy.
Understanding that the policy determinants of health inequalities are largely outside of health policy control means learning to speak the same language as policymakers who are less focused on health outcomes. And that may mean helping to evidence the distributional outcomes of top policy priorities outside of health policy, and leaving coincident health benefits for another day.
The views and opinions expressed in this blog are those of the author/authors.
- Seeing Upstream: Mapping the Gaps between Expert and Public Understandings of Health in the United Kingdom, March 2018 A FrameWorks Map the Gaps Report Commissioned by the Health Foundation
- Scottish Government – Equality, opportunity, community : New leadership – A fresh start, April 2023
- Greater Manchester – Independent Prosperity Review: Evidence Update: Reflections Report 2022
- Sheffield City Council – Sheffield Economic Evidence Base: A Draft Report for the Health and Wellbeing Board, June 2022 (PDF)
- Rising ill-health and economic inactivity because of long-term sickness, UK: 2019 to 2023 Census2021, July 2023
- Is poor health driving a rise in economic inactivity? The Health Foundation, October 2022
- The Warwick-Edinburgh Mental Wellbeing Scales – WEMWBS
- The world has problems while universities have disciplines: Universities meeting the challenge of environment through interdisciplinary partnerships Journal of the World Universities Forum, 2009
- The future of public health policymaking after COVID-19: a qualitative systematic review of lessons from Health in All Policies
- Glossary for the implementation of Health in All Policies (HiAP) – BMJ Journal of Epidemiology & Community Health Vol 67 Issue 12 2013
- Obesity prevention: co-framing for intersectoral ‘buy-in’ Critical Public Health Vol 28, Issue 1 2018
- Using Win-Win Strategies to Implement Health in All Policies: A Cross-Case Analysis – PLOS ONE, 2016