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The great health challenge – levelling up the UK

Mayhew, L. ORCID: 0000-0002-0380-1757, Chan, M. S. & Cairns, A. J. G. (2024). The great health challenge – levelling up the UK. Geneva Papers on Risk and Insurance: Issues and Practice, doi: 10.1057/s41288-024-00317-0


Around the world there are persistent and growing health inequalities both between and within countries. The UK 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 five 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 6 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.

Publication Type: Article
Additional Information: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit
Publisher Keywords: Inequalities, healthy life expectancy, smoking cessation,economic impact
Subjects: H Social Sciences > HN Social history and conditions. Social problems. Social reform
H Social Sciences > HV Social pathology. Social and public welfare
R Medicine > RA Public aspects of medicine
Departments: Bayes Business School
Bayes Business School > Actuarial Science & Insurance
SWORD Depositor:
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