Guidance

Inclusive and sustainable economies: leaving no one behind (executive summary)

Published 25 March 2021

Purpose

This document supports place-based action on inclusive and sustainable economies as a mechanism to reduce health inequalities through improving the health of people and communities, ensuring that economic activity is sustainable and achieving shared prosperity for all, with no one left behind.

This document aims to:

• define and make the case for an inclusive and sustainable economy
• suggest opportunities for local areas to build back better from the impacts of coronavirus (COVID-19) and address the underlying inequalities which existed before the pandemic
• propose an inclusive and sustainable economies framework and data catalogue to support local areas to get started on, or continue to take action on this agenda
• share place-based practice examples of action to create inclusive and sustainable economies

Making the case for inclusive and sustainable economies

An inclusive and sustainable economy is one that works for everyone, with no one being left behind. It also protects the needs of future generations by ensuring that these can be met within the means of our planet.

Over the last decade in England life expectancy has stalled, years spent in poor health have increased and health inequalities have widened. Those living in the most deprived areas die up to a decade earlier and spend an average of 19 extra years in poor health than those living in the least deprived areas.

Health inequalities occur due to differences in the social, economic and environmental factors that shape our lives. It has been estimated that the unequal distribution of such factors accounts for between 40% and 50% of the variation in health outcomes (health inequality) between the most and least deprived areas.

There is a social gradient in health: the lower an individual’s socioeconomic position, as defined by their job, qualifications, income, wealth, and where they live, the worse their health. It has been estimated that, between 1 January 2003 and 31 December 2018, over a third of deaths in England were attributable to socioeconomic inequality. Such avoidable inequalities are unjust, and there is both a moral and economic argument for acting at scale to reduce health inequalities.

Before COVID-19, health inequalities in England were estimated to cost the NHS an extra £4.8 billion a year, cost the UK between 31 and 33 billion pounds each year in lost productivity and between 20 and 32 billion pounds a year in lost tax revenue and higher benefit payments. Health is therefore a major determinant of economic performance and an important contributor to economic prosperity. Acting on health inequalities is essential for the national economy, local prosperity and to build back better from COVID-19.

An inclusive and sustainable economic approach requires universal action that is proportionately targeted towards the most disadvantaged. Such efforts will help reduce the gap between and within regions, help those population groups that are furthest away from the job market into employment, and contribute to lifting 13.5 million people in the UK out of poverty, 7.4 million (55 percent) of which are in working families.

Inclusive and sustainable economies can support COVID-19 recovery

The COVID-19 pandemic is a crisis like no other experienced in our lifetime.

It has become increasingly clear that COVID-19 has had a disproportionate impact on many who already face disadvantage and discrimination. A review of the disparities in risk and outcomes from COVID-19 by Public Health England (PHE) found that its impact has replicated existing inequalities and, in some cases, has increased them.

The most deprived neighbourhoods in England have a COVID-19 mortality rate more than twice that of the most affluent. Certain population groups such as Black, Asian and Minority Ethnic (BAME) communities, older people, men, those who are obese and who have other long term health conditions, people with a learning disability, those with a severe mental illness, and those working in people facing occupations such as heath and care services, retail, hospitality, transport and security have suffered the greatest detrimental health impacts from COVID-19.

The indirect impacts of the mitigation measures put in place by the government to reduce the spread of COVID-19 have disproportionately affected those most vulnerable in society. For example, school closures led to a generation of children losing out on months of education, with children from more deprived households having been left at a greater disadvantage to continue their learning from home.

The Institute for Public Policy Research has predicted an increase in unemployment from 3.9% at the beginning of 2020 to 9.8% in 2021. The retail, tourism, entertainment and hospitality sectors have been the most hard-hit by the economic fall-out of COVID-19 – all of which disproportionately employ low-income workers, women, ethnic minority communities and young people.

As local areas look towards the future, what is clear is that it will not be possible to, nor should it be desirable to, revert to the way things were. An inclusive and sustainable economies approach is a mechanism to reduce the inequalities that have been exposed and exacerbated by the COVID-19 pandemic and to build back better, leaving no one behind.

A place-based, integrated and collaborative approach is required

Building inclusive and sustainable economies requires collaboration between a wide range of place-based organisations including local and combined authorities, local enterprise partnerships, sustainability and transformation partnerships and integrated care systems, schools, colleges and academic institutions, voluntary and community sector organisations, social enterprises and local businesses. This report focuses on action at the local and regional level, supporting place-based approaches to establishing inclusive and sustainable economic development.

A framework for an inclusive and sustainable economies approach

An inclusive and sustainable economies framework has been developed as a tool to focus whole system action. It illustrates that to achieve healthy people and thriving communities, increased productivity and shared prosperity, and healthy and sustainable places, action is required across the social, economic and environmental determinants of health. These are the 3 domains of an inclusive and sustainable economy.

The framework shown in Figure 1 has been developed to bring together the aims, domains and sub-domains of inclusive and sustainable economies in one diagram.

The inner red circle of the framework shows the 3 domains of an inclusive and sustainable economic approach, which requires action on the social, economic and environmental determinants of health.

The middle green layer shows the 12 sub-domains, or building blocks of an inclusive and sustainable economy:

• good work
• income
• inclusive labour markets
• community wealth buildings
• green economy
• transport, travel and connectivity
• natural environment
• built environment
• empowered and engaged communities
• social capital and community infrastructure
• services and amenities
• education, training and skills

Through action across the 3 domains and 12 sub-domains, an inclusive and sustainable economy strives towards the vision detailed in the outer blue layer, consisting of:

• healthy people and thriving communities
• healthy and sustainable places
• increased productivity and shared prosperity

Figure 1. Framework to support planning and action on inclusive and sustainable economies.

Taking a 6-step approach to using the inclusive and sustainable economies framework and data catalogue

The following 6 steps can be used by local systems to support a place-based approach to using the inclusive and sustainable economies framework and data catalogue to identify shared priority areas for local action.

1. Establish place-based inclusive and sustainable economy networks – building inclusive and sustainable economies requires coordinated and collaborative action across a broad range of cross-cutting sectors.
2. Set a holistic vision – use the inclusive and sustainable economy network to set a local vision which looks beyond gross domestic product (GDP) as a measure of economic success.
3. Measure and benchmark – use the inclusive and sustainable economy framework and data catalogue to consider each of the 12 building blocks, identify areas of need and benchmark local performance.
4. Consider the local context – reflect on local economic, environmental and social conditions, strengths and assets, and political factors that may constrain or support the development of inclusive and sustainable economies.
5. Consult with citizens and communities – adopt a participatory approach through capturing local citizen and community insights.
6. Prioritise areas for action – prioritise areas for action based on the above considerations ensuring that effort is targeted towards the areas of greatest need.

The potential for inclusive and sustainable economies to tackle health inequalities is becoming increasingly recognised. To support wider action, PHE is developing a repository of place-based practice examples. A selection of these practice examples can be found in the main document.

A data catalogue has been developed to be used, in combination with the framework, to support the development of joint strategy and action. This can be found in the main document. The framework and data catalogue are intended to support local systems to consider each of the 12 building blocks of an inclusive and sustainable economy, identify areas of needs, prioritise areas for action and to monitor progress against locally agreed indicators.

PHE has also developed a range of other useful resources to support action on health inequalities. Those resources that are relevant to this approach are described and signposted to in Appendix 3 of the main document.

Recommendations for place-based action

Based on the existing evidence base, local case studies and consultation with experts in the field, this report’s conclusion makes 9 recommendations for place-based action. They are proposed as specific actions that can be adapted to local circumstance, building on existing local structures and assets.

1. Consider the 6-step inclusive and sustainable economies approach to support local whole system planning and action on this agenda.
2. Seek opportunities to achieve social value to generate the greatest possible social, environmental and economic value from public spending.
3. Unleash the potential of local anchor institutions to develop the integral role that anchor institutions play in local economies to increase the social, economic and environmental wellbeing of local populations and places.
4. Support access to fair and good quality employment to drive new business and good quality employment opportunities locally.
5. Promote inclusive labour markets to support those who are typically excluded from the labour market into training, volunteering or employment opportunities.
6. Capitalise on local assets to build community wealth and vice versa: to retain more of the local wealth that they generate and reinvest in community assets that matter to local people.
7. Build back greener to build back better to maximise the potential opportunities which green local economies offer for skills development, employment and sustainable economic growth.
8. Leverage local policy and financial levers to better involve health and care organisations in the development and delivery of local industrial strategies.
9. Ensure equitable access to local services so that services are targeted towards those with disproportionate need.