Intended for healthcare professionals


Levelling up the UK: is the government serious about reducing regional inequalities in health?

BMJ 2022; 377 doi: (Published 01 June 2022) Cite this as: BMJ 2022;377:e070589
  1. Rob Ralston, research fellow12,
  2. Katherine Smith, professor of public health policy234,
  3. Clementine Hill O’Connor, research associate24,
  4. Ally Brown, PhD researcher24
  1. 1Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
  2. 2School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
  3. 3SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), Edinburgh
  4. 4SIPHER (System-science Informed Public Health and Health Economic Research), Glasgow
  1. Correspondence to: R Ralston rob.ralston{at}

The recent white paper lacks innovation, policy levers, and, crucially, long term investment, say Rob Ralston and colleagues

The Levelling Up white paper,1 released in February 2022 after major delay, outlines the UK government’s much anticipated strategy for tackling regional inequality. The centrepiece of the government’s reform agenda, “levelling up” is presented as a solution to the UK’s longstanding and serious geographical inequalities (box 1). Although levelling up is already permeating political and media discourse,10 the white paper is the first attempt to translate this broad idea into specific policy commitments to tackle place based inequalities: white papers set out proposals for future legislation.

Box 1

UK Health inequalities—social, economic, and commercial determinants

Health inequalities (or health inequities) are systemic variations in health between groups defined by socioeconomic, ethnic, or geographical characteristics that are socially determined, modifiable, and, therefore, unfair.2 Health inequalities are caused by the unequal distribution of wider determinants of health, including housing, employment, education, and wealth, as well as by inequalities in exposure to commercial influences such as the availability of alcohol, tobacco, gambling, and unhealthy food).3 Health inequalities are pervasive in many countries, but the UK has particularly stark differences in health between socioeconomic groups and areas.4 In 2018-20, for example, men in the most deprived 10th of the population in England had healthy life expectancies 18.4 years shorter than men in the least deprived 10th,5 while in Scotland, the equivalent gap was over 23 years, and premature death in Scotland’s most deprived areas was four times higher than in the least deprived areas. A government led programme of austerity beginning in 2010 has worsened inequalities in recent years.6

Unequal impact of covid-19

Covid-19 infected, killed, and impoverished unequally by socioeconomic group, area, and ethnicity.7 The extent of differences in mortality by ethnic group drew attention to this previously under examined …

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