Seven Things We’ve Learned About How Economics Shapes Our Health

The UK’s health problem runs deeper than the NHS.
Life expectancy has stalled for more than a decade, and healthy life years are falling in parts of the country. The gaps between richer and poorer places — in income, opportunity, and health — are stark. These patterns don’t begin in hospitals or GP surgeries. They begin in the economy: in the jobs people do, the homes they live in, and the local systems that shape daily life.
Earlier this year, I led on a structured evidence review for the Growth and Reform Network and The Health Foundation, looking at 144 studies from around the world. It explored how economic and social policies — from housing and regeneration to childcare, welfare, and employment — influence health outcomes.
The studies ranged widely in focus, but a consistent message emerged: what matters most isn’t what governments do, but how they do it. Across the evidence, seven features stood out — the things that make the difference between good ideas that fade and good ideas that last.

1. Combine, don’t compartmentalise

The best results came from programmes that tackled several issues together — not in isolation.
The Dutch District Approach integrated employment, housing, education, safety, and social cohesion into a single, place-based strategy. Its strength lay in treating disadvantage as a system, not a checklist. Similarly, the Nurse-Family Partnership’s success depended on its blend of home visiting, parenting support, and health education. Early-years schemes like the Carolina Abecedarian Project coupled childcare with nutrition and family support, producing measurable metabolic and cardiovascular gains decades later.
Even housing repairs worked better when combined with social engagement or welfare advice. The lesson is clear: synergy amplifies impact. Complex problems rarely yield to single solutions.

2. Stay the course

Good health takes time. The strongest interventions were the ones that lasted.
Home-visiting programmes such as the Nurse-Family Partnership sustained engagement for 18–36 months and showed clear gains in child health and maternal wellbeing. The Experience Corps only delivered measurable improvements when volunteers worked at least 15 hours per week across a full school year.
In contrast, short-term or underfunded projects consistently fell short. The review identified clear duration thresholds — typically six months or more for employment support and multi-year commitments for regeneration or early years programmes.
Health improvement is cumulative. Stopping early is one of the easiest ways to waste effort.

3. Fit the policy to the place

Context makes or breaks success.
The Moving to Opportunity experiment in the United States offered families housing vouchers to relocate to lower-poverty areas. Its results differed sharply between cities — some saw mental health gains and improved wellbeing; others, none at all — depending on local housing markets and job access.
Urban regeneration schemes showed the same pattern. When tailored to neighbourhood conditions and community priorities, they improved wellbeing and social cohesion. When imposed from the centre, they risked stress or even short-term deterioration, as seen in a Manchester housing trial.
National context mattered too. Inclusive migration regimes, like the Netherlands’, reduced health inequalities, while restrictive approaches, like Denmark’s, were associated with worse migrant mortality.
There’s no one-size-fits-all. The best policies adapt to the grain of local economies and institutions, rather than expecting people to fit the policy.

4. Back the people who deliver

The quality of delivery mattered as much as design.
Programmes led by trained professionals — nurses, teachers, social workers — achieved stronger outcomes than those relying on under-trained or volunteer staff. The Nurse-Family Partnership’s insistence on using registered nurses was crucial to its impact.
Support and supervision made an equal difference. German workplace “health circles” succeeded because facilitators received continuous professional development. In England, Sure Start’s flexible model allowed local authorities to tailor services while keeping a focus on quality, producing long-term reductions in child hospitalisations.
The evidence is consistent: underinvestment in the workforce undermines everything else. Skilled, supported professionals are the bedrock of effective delivery.

5. Build infrastructure — and fund it to last

Short-term grants rarely create long-term change.
Programmes that invested in delivery infrastructure — systems, governance, and sustained funding — achieved far more consistent results. The Head Start programme in the US functions through a national-to-local delivery network that provides stability and accountability. Closer to home, Communities First in Wales demonstrated the payoff from sustained commitment: a decade of investment improved mental health and community wellbeing.
Sustainable financing mattered as much as design. Multi-year, predictable funding outperformed annual renewals. As the evidence shows, policies with stable infrastructure and clear financial architecture simply work better.

6. Keep learning as you go

Policies that learn perform better than those that don’t.
The District Approach in the Netherlands tracked delivery in real time, allowing mid-course corrections that strengthened results. In Glasgow, the GoWell evaluation followed regeneration over a decade, revealing how wellbeing effects evolved long after initial physical improvements.
Flexibility proved crucial. The best programmes standardised by function, not by form — keeping their core principles constant but adapting delivery to local needs.
And continuity mattered politically. Sure Start endured through multiple governments, allowing long-term outcomes to emerge. Denmark’s “flex-jobs” policy succeeded through coordination between national and local partners.
In short: treat implementation as learning, not compliance.

7. Make equity intentional

Not all progress is fair progress.
Many programmes improved average health while widening inequalities. Labour market initiatives benefited higher socioeconomic groups and men more than others. Urban renewal sometimes strengthened wellbeing for established residents but displaced lower-income households.
By contrast, structural or “upstream” policies — such as food taxation, housing insulation, and workplace reform — tended to yield larger relative benefits for disadvantaged groups. But these equity effects were often accidental.
The most effective designs combined universal coverage with proportionate intensity — everyone eligible, but more support for those facing the steepest barriers. Without that, even successful interventions risk deepening divides.
Equity has to be built in — not hoped for as a by-product.

A final reflection

After reviewing 144 studies, one conclusion stands out: health improvement depends as much on how policies are implemented as on what they contain.
Integration, duration, local fit, workforce strength, infrastructure, learning, and equity aren’t technical details — they’re the difference between good intentions and lasting impact.
The UK doesn’t lack policy ideas. It lacks consistency — the patience to stay the course, invest in delivery systems, and build shared capacity across sectors.
If we want growth that’s genuinely inclusive — growth that extends healthy life expectancy as well as incomes — these are the lessons we need to remember. That’s what the evidence tells us.