Towards a new framework

In a programme of joint working launched at the start of 2024, the Centre for Local Economic Strategies (CLES), The King’s Fund and the Health Foundation have joined forces to explore the effectiveness of devolution in narrowing health inequalities in England.

This paper provides preliminary insights from our ongoing programme of work aimed at informing government policy on addressing health inequalities through devolution. It contains a critical analysis of devolution policy and practice which reveals that – despite substantial efforts by mayoral combined authorities to address the wider determinants of health – progress in narrowing health inequalities is hindered by several key barriers. The paper then presents emerging insights on how devolution policy could be developed further to enable mayoral combined authorities and their partners to overcome these barriers and narrow health inequalities, with three priority areas for the government to take action:

1. Thinking beyond growth
2. Raising expectations of joint working to tackle health inequalities
3. Fairer funding