The great health challenge: levelling up the U.K.

Around the world, there are persistent and growing health inequalities both between and within countries. The U.K. Government’s flagship policy for addressing inequalities is called ‘Levelling Up’. One of its missions is to narrow the gap in healthy life expectancy (HLE) between the healthiest and unhealthiest areas in England and to improve overall HLE by 5 years by 2035. We show that smoking is one of the major causes of health inequalities. We find a 17-year difference in HLE between local authorities, and that the number of years spent in ill health tended to be greatest in areas with the highest mortality from smoking-related disease. Our aim is to see if the 5-year target could be achieved, assuming there were drastic controls on the sale and consumption of tobacco. We show that never smokers enjoy six more years of good health at age 20 than current or ex-smokers. A complete ban on smoking would lead to a 2.5-year improvement in HLE, and also lengthen the working lives of both men and women. We conclude that while a complete tobacco ban is significant, other public health measures are needed for the full achievement of the target. The paper briefly considers wider issues and suggestions for further research and its international significance.