Introduction: Inequalities in Gateshead

In February 2020, Sir Michael Marmot published, Health Equity in England: The Marmot review 10 years on (Institute of Health Equity (Feb 2020). Health Equity in England: The Marmot Review 10 Years On.), in which he demonstrated that since 2010 life expectancy in England has stalled, something that has not happened since 1900.

In Gateshead we have seen our populations healthy life expectancy at birth slowing and in the case of female children, it is falling. Marmot says "the worsening of our health cannot be written off as the fault of individuals for living unhealthy lives. Their individual circumstances and poor life chances are to blame.

Austerity has taken its toll over the last 10 years, in the foreword to the report Marmot says "From rising child poverty and the closure of children's centres, to declines in education funding, an increase in precarious work and zero hours contracts, to a housing affordability crisis and a rise in homelessness, to people with insufficient money to lead a healthy life and resorting to food banks in large numbers, to ignored communities with poor conditions and little reason for hope ... Austerity will cast a long shadow over the lives of the children born and growing up under its effects." Marmot 2020.

Public funding cuts have had most impact on the most deprived communities outside of London and the South East and have accentuated the North South divide. Government funding for local authorities has fallen by an estimated 49.1% in real terms from 2010 to 2018. This equates to a 28.6% real-terms reduction in 'spending power'. (Local Government finance and the 2019 spending review.)

The COVID-19 pandemic has hit the country unevenly with a disproportionate effect on the North of England. In the 'Health for Wealth' report (2018), the Northern Health Science Alliance found that: improving health in the Northern Powerhouse would reduce the regional gap in productivity by 30% or £1.20 per-person per-hour, generating an additional £13.2 billion in UK GDP. However, the COVID-19 pandemic has vastly changed the regional context. (Bambra, C., Munford, L., et al (2020) COVID-19 and the Northern Powerhouse, Northern Health Science Alliance, Newcastle.)

Analysis by the Human Rights commission in 2018 shows that, overall, changes to taxes, benefits, tax credits and Universal Credit (UC) announced since 2010 are regressive, and that the largest impacts are felt by those with lower incomes. Those in the bottom two deciles have lost, on average, approximately 10% of net income, with much smaller losses for those higher up the income distribution. (Portes J, Reed H. (March 2018) The Cumulative Impact of Tax and Welfare Reforms. Equality and Human Rights Commission: 2018.) 

Poverty and health inequalities are placing an increasing demand on our services, so we need more than ever to focus our work and the money we have to spend, on what matters most. We want to help our communities not just survive, but to flourish, prosper and succeed.  

Around 32,700 (16%) people in Gateshead live in one of the 10% most deprived areas of England.

There are ten wards containing areas within the 10% most deprived in England. It is estimated that around 3.7% (7,500) of the Gateshead population are from a black, Asian or minority ethnic (BAME) group. This does not include Gateshead's orthodox Jewish community; over 3000 people state that their religion is Jewish, although this also includes the non-orthodox Jewish population. (Gateshead JSNA)

Gateshead's increasing diversity and the uneven distribution of groups within our localities may have implications in terms of support for different communities. Bridges ward is home to the largest number of people from BAME groups, followed by Saltwell ward.

We are also welcoming increasing numbers of asylum seekers who are adding to the diversity of our population. Many have significant challenges due to the trauma they are fleeing and also the complexity of the UK asylum seekers process.

The map below, produced on the Gateshead Local Index of Need (LIoN) mapping tool clearly shows the our most deprived areas. The wards that have a high proportion of children in poverty are clustered in or around the central area of Gateshead and include Felling (40.4%), High Fell (33.8%) and Deckham (33.1%). Small pockets of significant child poverty are evident in Old Fold, North Felling, Beacon Lough East, Springwell Estate and Sheriff Hill, where more than four in 10 children live in families below the poverty line. (Gateshead JSNA Local Index of need)

A recent report by the Institute for Fiscal Studies7 (June 2020) comments that the economic shock associated with COVID-19 has exacerbated old inequalities. Most people in the bottom tenth of the earnings distribution are in sectors that have been forced to shut down.

These are people who are unlikely to have been able to work from home and who are now facing significant hardship and job losses. Employment is changing, many were dependent on the gig economy with zero hours contracts. Current forecasters are talking about unemployment rates of 10-15%. 

Making Gateshead a place where everyone thrives, is driving the major policy directions for Gateshead Council, aiming to redress the imbalance of inequality, championing fairness and social justice. Poverty and health inequalities are placing an increasing demand on our services, so we need more than ever to focus our work and the money we have to spend on what matters most. Gateshead Council have committed to five pledges to help and guide us when we make decisions. 

We know that over half of people and families in Gateshead are either just managing or just coping, but more than 30% are in need or in vulnerable situations. We want to change those statistics and aim to make Gateshead a place where there are less people in need of council support and more people are thriving. We are working differently, with partners and others, to achieve the right outcome for those people and families who require more support. 

Our strategic approach: To make Gateshead a place where everyone thrives, underpins our revised Health and Wellbeing Strategy: 'Good jobs, homes, health and friends', which is based on the key Marmot principles:

• giving every child the best start in life
• enabling all people to maximise their capabilities and have control over their lives
• ensuring a healthy standard of living for all
• creating fair employment and good work for all
• creating and developing healthy and sustainable places and communities.
• strengthen the role and impact of ill health prevention

The diagram below demonstrates the complexity of the issues which cause ill-health and allow inequalities to develop. It shows the different factors that impact our health, where they originate, and how they interact, multiply, and reinforce each other. At the centre of this are people and the communities in which they live. When viewed this way we can see that acting on single factors in isolation is likely to provide only a partial and incomplete response. Rather than acting on individual issues we recognise the need for a place-based approach. 

Our Health and Wellbeing Strategy recognises that to deliver improvements at a population level we will need comprehensive action across the whole system of community, civic, and service interventions. We accept that approaches which are multifaceted and complementary are more likely to be successful in reducing inequalities and helping people in Gateshead thrive.

We will develop methods which consider and address this complexity as a whole system. The Population Intervention Triangle8 below illustrates how the different elements required for a joined-up approach fit together:

• Civic led interventions refer to a wide range of functions, across a range of public sector organisations, such as planning, broadband, water, housing, road infrastructure and schools
• Service-based interventions refer to the range of public services, for example the NHS
• Community centred interventions recognise the vital contribution that the community themselves make to health and wellbeing

While each element makes an important contribution, when isolated from each other the impact is not as great as it could be. No one part is more important than any other, but the ambition must be to effectively combine these parts into a coordinated, multifaceted whole through place-based planning. 

This report will examine some of the progress and lessons learnt in tackling inequalities in the last 3 years and consider our current position. Finally, we will briefly discuss the implications of the COVID-19 pandemic and inequalities. 

Section 2: Economic inequality in Gateshead