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Can Health Become the Fourth Pillar of ESG and Help Deliver Nationwide, High Impact Levelling Up?

Can Health Become the Fourth Pillar of ESG and Help Deliver Nationwide, High Impact Levelling Up?

Legal & General

5 min read Partner content

Health inequality is not just a social issue. It is an economic one too. At a recent webinar, our expert panel debated how businesses, government and investors can partner to deliver the kind of high-impact and scaled-up health outcomes required to deliver the levelling up vision.



Opening the discussion, property and finance writer Anne Ashworth cited former Chief Economist of the Bank of England, Andy Haldane’s warning that worsening health is holding back the nation’s economy for the first time since the Industrial Revolution.

And the cost is not just economic. The human impact of health inequalities was starkly laid out by Labour MP Debbie Abrahams, who chairs the ‘Health in all Policies’ APPG and is a member of the Work & Pensions Select Committee: “The difference in life expectancy between the most and least deprived areas in England is 9.4 years for men and 7.6 years for women… This is mirrored in our healthy life expectancy, how long we are going to be able to live in good health? So, 19 years difference for men and 19.3 years for women. That's really important in the context of our businesses having a healthy productive workforce.”

Those stark differences don’t just exist between areas; they exist within areas too, as Kieron Boyle, Chief Executive of Impact on Urban Health explained: “We work in South London….[and in] two streets, about two miles apart, with an average life expectancy difference of 12 Years. Let’s be clear what that means. That's the difference between seeing your grandkids or not. This stuff really matters.”

Dr Nora Coulton is Director of UCL’s Global Business School for Health. Dr Coulton is clear that the research evidence shows that there is a strong economic case for UK firms to step forward when it comes to health.

“It really is in the interest of businesses to ensure that health and the social determinants of health such as income inequality are addressed,” she explains. “Ill health in the UK costs an estimated £50 billion a year. Healthy staff take less time off. They don't necessarily need to retire early.”

Legal & General’s John Godfrey agreed that the economic cost of poor health is increasingly impossible for individual businesses and policymakers to ignore: “It is undoubtedly true that health is now becoming a headwind holding back economic growth…We're seeing it impacting in a very tight labour market as people exit the workforce. We are starting to realise that health equals wealth. That is true at the individual, family, and community level. It's also true at a city level and the level of a national economy.”

The panellists were keen to articulate answers as well as analysis. Debbie Abrahams MP focussed on the role of national government: “It needs leadership and unfortunately to date, I haven't really seen it…It needs to be front, and centre and it does need to be backed up by resources.”

Jess Attard, the Programme Director at ShareAction, spoke about the impact that investors and shareholders can have in driving businesses to take positive action to support better health. “Investors have an enormous influence,” she explains. “There is a lot that investors can do but we know that they currently aren't doing all that they can to influence better health outcomes.”

However, Attard is optimistic that the way that investors have driven transparency on wider ESG activities can provide a helpful template when it comes to mainstreaming health. “It's not so different to what investors are already doing on climate change,” she observes.

Godfrey also sees an analogy with environmental action. “If you can adopt some of the techniques, arguments, and methodologies that have been used in the climate world, then we can make a similar impact on this equally important problem,” he explains. “Every piece of policy needs to report on what the health impacts of doing it or not doing it would be.”

Mainstreaming health, as a fourth pillar of responsible businesses – creating ESHG – is not just the province of national governments and corporations. Kieron Boyle points to work that his own organisation has done to promote healthy eating in poorer communities: “What we found was that convenience store owners are frequently pillars of their community…They are really important people within that community, and they want to do whatever they can do to make that community successful. Improving the health of the products they’re selling helps do that. They're up for it.”

John Godfrey explained the significance of supply-chains as drivers of change for corporates and small companies alike: “Many SMEs sit in the supply chains of bigger companies,” Godfrey says. “In much the same way that this works for climate, some of the ownership of health can be shared across that supply chain with the bigger companies supporting and helping the smaller ones.”

Kieron Boyle was clear that government has a key role to play, taking advantage of the increasing willingness of businesses of all sizes to help deliver better health outcomes, and he argues that policy works best when it runs with the grain of business: “Businesses want policymakers to create a level playing field…They're not looking for handouts from government, but they just don't want to be penalised for doing the right thing.”

Businesses are ready to play their role in addressing health inequalities but unlocking their potential will require strategic and political leadership from government. However, the reward would be significant for us all, with the promise of a healthier and more economically successful future.

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