ABSTRACT
BackgroundLocal authorities (LAs) provide Cultural, Environmental, and Planning (CEP) services, such as parks, libraries, and waste collection, that are vital in supporting the health of the communities they serve. There have been significant changes to LA funding recently, most notably due to the UK government’s austerity programme. These changes have not affected all places equally. To understand potential impacts on health inequalities, we investigated the extent to which areas have been differentially affected by declines in CEP services spending based on local characteristics.MethodsWe conducted a longitudinal ecological study using routinely available data on LA expenditure, as collated in the Place-Based Longitudinal Data Resource. We used generalised estimating equations to determine how expenditure trends varied across 378 LAs in Great Britain between 2009 and 2018 on the basis of country, deprivation, rurality, and local government structure. We investigated the gross expenditure per capita on CEP services, and the CEP expenditure as a proportion of total LA budgets. We conducted analysis using R v4.0.2.ResultsExpenditure per capita for CEP services reduced by 36% between 2009 and 2018. In England, the reduction in per capita spending was steepest in the most deprived quintile of areas, falling by 5.9% [95% CI: 4.7;7.0] per year, compared to 3.3% [95% CI: 2.5;4.1] in the least deprived quintile. Budget cuts in Scotland and Wales have been more equitable, showing little differentiation between most and least deprived areas. Welsh LAs have reduced the proportion of total LA budget spent on CEP services more than any other country (-2.9% per year [95% CI: -4.0;-1.8]), followed by Scotland (-1.5% [95% CI: -2.8;-0.3]) then England (-0.5% [95% CI: -1.0;0.1). In England, rural LAs have reduced their CEP spending share more than those in urban areas, and unitary authorities have reduced their share more than those in a two-tier structure.ConclusionThere have been distinct inequalities in the reduction of spending for CEP services. LAs with a higher baseline level of deprivation, those with a single-tier local government structure, and English rural LAs have been worst affected. These inequalities in cuts to services that impact public health risk widening geographical and social health inequalities. Understanding these inequalities will provide crucial evidence to inform the UK government’s ‘levelling up’ strategy as the country recovers from the COVID-19 pandemic. One limitation of our study is that we were unable to investigate how resources have been distributed within LAs.
ABSTRACT
Child health is at risk from the unintended consequences of the COVID-19 response and will suffer further unless it is given proper consideration. The pandemic can be conceived as a systemic shock to the wider determinants of child health, with impacts on family functioning and income, access to healthcare and education. This article outlines COVID-19 impacts on children in England. Key priorities relate to the diversion of healthcare during lockdown; interruption and return to schooling; increased health risks and long-term impacts on child poverty and social inequalities. We provide an overview of mitigation strategies and policy recommendations aimed to assist both national and local professionals across child health, education, social care and related fields to inform the policy response.