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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. (2023). The great health challenge – levelling up the UK. Geneva Papers on Risk and Insurance: Issues and Practice,


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 is a post-peer-review, pre-copyedit version of an article to be published in Geneva Papers on Risk and Insurance - Issues and Practice. The definitive publisher-authenticated version will be available online at:
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:
[thumbnail of levelling up__final_Mayhew_11_01_24.pdf] Text - Accepted Version
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