Everything is connected: Addressing inequalities now to create better futures

Levelling up brings an opportunity to address deep societal inequalities. To do this, we believe a systemic approach that embeds participation can begin to create social systems that collectively work to improve our abilities to live a good life.

In this series of blogs, we will explore key themes that underpin the programme to share our research so far and how we hope to work with people and places to increase participation, reduce inequalities and develop systems that centre wellbeing and move away from siloed models.

Two years ago, I wrote a blog – ‘Why we shouldn’t use war metaphors to talk about healthcare’ – which spoke to the use of language in describing the response to the Covid-19 pandemic; so, bear with me while I briefly compare levelling up to a (real) war currently being waged in Ukraine. As soon as the Russian invasion began, ripples were felt. Fuel prices went up, refugees started to arrive in Poland, small communities across the UK began to receive donations for their families and friends in Ukraine and sanctions were being imposed on Russia. “What has this got to do with levelling up Ruth?” I hear you mumble. Well, it shows the interconnected and systemic nature of our lives and what happens if we develop a partial solution to a problem (just look at the complexity of the financial sanctions against Russia). It will remain just that - a partial solution.

Before comparing levelling up to a major war, I’ve been thinking about it a lot. I’ve worked with families affected by serious illness, disability including mental illness and, as its currently presented, levelling up won’t make much difference for those who are experiencing inequality most acutely. A new road, museum, building a factory or investing in grassroots football won’t level across as well as up. People experiencing acute inequality lead complex lives – we all do. Areas experiencing severe economic deprivation will also be experiencing severe health inequalities. The interconnection with these are felt by a whole family or household and the ripples play out across generations.

Levelling up, across and around

If we are to “level up” we must level across, level around. Essentially, take a whole system approach. We must invest in, and develop, new models of public services that recognise the interconnection between economic insecurity and health. Or like the excellent Human Learning Systems, creates a ’bespoke by default’ model that moves away from targets as the measure of success. We must have clear routes of participation and deliberation for residents. Our work in Nechells demonstrated a need and want for residents to be involved in decisions about where they live. This will mean the systems that support residents will have to have their voices at their core. They should reflect their lives rather than tackle a single aspect of that life. We must move rapidly to decarbonise our systems, and more besides because everything is connected. Two great examples show this: the incredible Obesity System Influence diagram that shows the small part of the system that health services can affect; and Barbara Pointon’s Web of Care diagram showings the different services that came into her home to support her husband who had dementia and the lack of connection between them.

I worked with unpaid carers and their families for years. During this time, I saw evidence that poor support for disabled people, older people and those with long-term conditions not only affected the individual but the whole household or family. Unpaid carers were giving up work, experiencing poor health, young people dropped out of education. All of this has a huge cost (both personally and financially) on individuals and the wider system. Yet solutions continued to be presented in isolation; standalone offers of support, lack of connection in the system, poor information provision and employers still not recognising that it costs less to be flexible and keep an experienced and skilled worker in a role than it does to recruit and train a new one.