Health Economics

Overview

Health inequities have significant social and economic costs to individuals and societies. In Wales, the Socio-economic Duty highlights the Welsh Government’s commitment to safeguarding equality and human rights, and places tackling inequality at the heart of decision-making.

Reducing health inequalities is an important policy objective, from a social justice perspective. An economic argument can potentially add weight to the objective of reducing health inequalities.

Health economics is about using resources efficiently to improve the population’s health. It focuses on equity, efficiency, effectiveness, values and behaviours for the allocation of healthcare resources to meet the health needs of the population it serves.

Economic evaluation compares the costs and consequences of alternative courses of action and provides evidence to inform decisions on how to allocate limited healthcare provision. Decisions on the allocation of resources need to be made in such a way that achieves effective and equitable outcomes and value for money.

There is growing economic evidence underpinning public health interventions. Evidence suggests that local and national public health interventions are highly cost-saving, and that cuts to public health budgets in high income countries are likely to generate billions of pounds of additional costs to health services and the wider economy.

The Five Essential Conditions

This section contains examples of resources on the nature and impacts of health inequalities, linking to the Five Essential Conditions for health. These resources include:

• An interactive dashboard
• Reports
• Guides
• Research articles

Stay up to date. The Welsh Health Equity Solutions Platform is continuously updated with the latest resources and materials, including data, policies, reports and case studies. Contact us to be notified of updates to the Solutions Platform.

Get in touch to get involved. We are working with stakeholders and users to update and expand the Solutions Platform with projects, case studies and spotlight features focused on health equity. Contact us to share your projects and success stories, to feature on the platform.

Health and Health Services

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Health and Income Security and Social Protection

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Health and Living Conditions

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Social and Human Capital

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Health and Employment and Working Conditions

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Policy

Overview

Wales is a small nation, yet it has a proud history of being outward and forward-looking, and committed to achieving sustainable development and prosperity for all within and beyond Welsh borders. The ground-breaking Well-being of Future Generations (Wales) Act 2015, implemented in synergy with a number of modern Welsh laws, positions Wales at the forefront of the sustainability agenda and enables transformative cross-sector work that benefits the people, the economy and the planet. It places an explicit commitment on public bodies towards achieving a healthier and more equal Wales. More recently, the Socio-economic Duty 2020 cements a commitment to safeguarding equality and human rights, and places tackling inequality at the heart of decision-making.

The concept of Health in All Policies (HiAP) is increasingly accepted by governments and the scientific community as an important pre-condition for improved population health and an overall fairer and more cohesive society. HiAP entails working synergistically across sectors to take account of the health implications of decisions, aims to avoid health harm and rebalance social and health equity. To accelerate progress in reaching those being left behind because of poor health, and in preventing others from falling behind, policy action is required that reaches not only the most vulnerable but also those disproportionally at risk of avoidable poor health.

The WHESRi and the Solutions Platform can help bring health and equity in all policies in Wales and beyond, through informing and supporting policies, plans and investment prioritisation across different sectors and key stakeholders, in order to accelerate action and progress towards closing the health gap and achieving healthy prosperous lives for all in Wales and beyond.

The Five Essential Conditions

Many policies or legislation adopted in Wales help to reduce inequity and create a more sustainable and fairer Welsh society.

Stay up to date. The Welsh Health Equity Solutions Platform is continuously updated with the latest resources and materials, including data, policies, reports and case studies. Contact us to be notified of updates to the Solutions Platform.

Get in touch to get involved. We are working with stakeholders and users to update and expand the Solutions Platform with projects, case studies and spotlight features focused on health equity. Contact us to share your projects and success stories, to feature on the platform.

Health and Health Services

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Health and Income and Social Protection

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Health and Living Conditions

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Health and Social and Human Capital

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Health and Employment and Working Conditions

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UK and International

Overview

Long-standing and persistent health inequity is as evident in Wales as it is across Europe and the rest of the world.

The United Nations 2030 Agenda for Sustainable Development sets 17 Sustainable Development Goals (SDGs, or Global Goals) with Goal 10 explicitly focusing on reducing inequalities; and all other Goals having a direct or indirect impact on people’s wellbeing and the health gap. Particularly relevant Goals are Goal 1 No poverty; Goal 2 Zero hunger; Goal 3 Good Health and Well-being; Goal 4 Quality education; Goal 5 Gender Equality and Goal 8 Decent work and economic growth.

SDGs explicitly related to improving health and equity

Improving health and well-being for all, reducing health inequities and ensuring no one is left behind can bring wider economic, social and environmental benefits to populations, contributing to inclusive economic growth and sustainable development.

However, progress towards the SDGs across the world has been stalled by the Coronavirus pandemic.

Aligned with the SDGs, the WHO’s Thirteenth General Programme of Work 2019–2025 aims to ensure healthy lives and promote well-being for all at all ages. To drive and facilitate implementation, the WHO European Office for Investment for Health and Development in Venice, Italy, developed the Health Equity Status Report initiative (HESRi) looking into the key challenges, opportunities and options to: a) remove the barriers that are holding people back in health and in life; and b) create the conditions for all people to prosper and flourish in health and in life. It also provides a cutting-edge methodology and a suite of tools to promote and support policy action for health equity and well-being.

Following from this, the first Resolution on Accelerating progress towards healthy, prosperous lives for all, increasing equity in health and leaving no one behind in the WHO European Region was adopted, recognising that reducing and eradicating health inequities are a necessary contribution to inclusive growth and sustainable development.

The WHO European Programme of Work, 2020–2025 “United Action for Better Health in Europe” has put a strong emphasis on ‘leaving no one behind’ to address the persistent challenge of health inequities across the European Region. In the UK, the UCL Institute of Health Equity has been leading and collaborating on work to address the social determinants of health and improve health equity, developing and supporting reviews, approaches and capacities.

There has been a long-standing collaboration between Wales and the WHO, strengthening know-how, capacity and international partnership for improving well-being and health equity, preventing and tackling threats to people and society; and achieving sustainable development. The WHO Collaborating Centre on Investment for Health and Well-being (WHO CC) at Public Health Wales has been working closely with the WHO Regional Office for Europe and the European Office for Investment for Health and Development in Venice, Italy to strengthen Wales’ leading role in driving sustainable investment in population well-being and health equity, and supporting prosperity for all. Through establishing the WHESRi, Wales has been recognised as a global influencer and a live innovation site for health equity, providing an example and inspiration for other countries and regions; as well as learning from international best practice, expertise and innovative approaches.

Initiated to inform and support the COVID-19 pandemic response and recovery, the Public Health Wales’ International Horizon Scanning and Learning reports provide extensive international evidence on the health, well-being, social and economic impacts of COVID-19. These impacts have not been felt equally and have led to increased health gaps and vulnerabilities, bringing new and unprecedented challenges for populations, health systems and governments worldwide. They have further exposed social inequities, discrimination and health gaps within and between countries, leading to calls to ‘build back fairer’. The reports have now expanded in scope to include priority public health topics.

The Five Essential Conditions

This section contains examples of resources on the nature and impacts of health inequalities, linking to the Five Essential Conditions for health. These resources include:

• An interactive dashboard
• Reports
• Guides
• Research articles

Stay up to date.

The Welsh Health Equity Solutions Platform is continuously updated with the latest resources and materials, including data, policies, reports and case studies. Contact us to be notified of updates to the Solutions Platform.

Get in touch to get involved.

We are working with stakeholders and users to update and expand the Solutions Platform with projects, case studies and spotlight features focused on health equity. Contact us to share your projects and success stories, to feature on the platform.

Useful resources:

Health and Health Services

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Policies that aim to ensure availability, accessibility, affordability and quality of preventative and health care services and interventions.

Health and Income and Social Protection

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Policies that aim to provide economic security and support to reduce the health and social consequences of poverty and low income throughout a person’s life.

Health and Living Conditions

Policies that aim to ensure opportunities for, and access and exposure to living conditions and environments that have a positive influence on people’s health and well-being.

Resources

Health and Social and Human Capital

Policies that aim to develop and strengthen social relations and community assets, including education, skills, community resources and meaningful social interactions to promote learning, and protect and promote health and wellbeing throughout a person’s life.

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Employment and Working Conditions

Policies that aim to improve the health impact of employment, working conditions and workplace equality. 

Resources

Vulnerability and Unmet Needs

Overview

The differences that create health gaps undermine health equity. They arise from a range of factors, including the circumstances in which we are born and live, such as our housing, education and work. They are often made worse by discrimination, stereotyping, and prejudice based on individual-level factors, many of which are protected characteristics under the Equality Act 2010, such as our sex, race, gender or age. Each of these factors can lead to health gaps on their own, but they can also overlap and, in turn, create multiple disadvantages and deepen health inequities.

Health inequities have long been linked to processes and conditions that systematically prevent or restrict population groups from gaining economic, social, political and cultural inclusion. More recently, the COVID-19 pandemic has worsened existing health inequities, drawing further attention to structural disadvantage and discrimination. The pandemic has also led to new gaps in areas such as the ability to work from home and digital access, creating emerging drivers of vulnerability and unmet needs. Furthermore, cost of living pressures are having significant impacts that can undermine health inequity, particularly on the poorest households in Wales.

The Five Essential Conditions

This section provides examples of resources exploring health inequalities in the context of vulnerability and unmet needs, aligned to the five essential conditions. The resources cover a range of the protected characteristics, including where they overlap and lead to multiple disadvantage, sometimes referred to as the ‘intersectionality’ of protected characteristics. Other circumstances that are not considered protected characteristics, such as deprivation and homelessness, are also covered.

Featured resources include reports, policy briefs, research briefs and research articles in peer-reviewed academic journals. All resources focus on health inequalities in Wales (see UK and international for non-Wales resources).

Stay up to date. Come back to this page for spotlight features focusing on health equity and the protected characteristics.The Welsh Health Equity Solutions Platform is continuously updated with the latest resources and materials, including data, policies, reports and case studies. Contact us to be notified of updates to the Solutions Platform.

Get in touch to get involved. We are working with stakeholders and users to update and expand the Solutions Platform with projects, case studies and spotlight features focused on health equity. Contact us to share your projects and success stories, to feature on the platform.

Health and Health Services

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Health and Income and Social Protection

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Health and Social and Human Capital

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Health and Employment and Working Conditions

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Solutions

Overview

Health inequities are the result of many and varied factors that are often outside people’s direct control. It is not enough to identify the big issues that need addressing but to identify a range of tools, actions, investments, policies and practical solutions for improving health and well-being and reducing inequalities. 

Health inequities are not inevitable; they can be reduced or prevented. Solutions are required that address the unmet needs of populations made vulnerable by systemic inequity. Real health benefits can be attained at an affordable cost and within resource constraints if effective strategies are adopted. 

Healthcare alone cannot close the health inequity gap. Health inequities are multi-faceted, often demonstrating the interlinked nature of multiple factors, not least avoidable social inequalities in factors such as where we live, our household earnings, and our opportunities for good work. 

This complexity means there is no simple ‘one size fits all’ solution to reduce health inequities. Rather, efforts to reduce health inequities requires action on all the social determinants of health – the five essential conditions – across the life course. As such, actions in all areas of government policy affect health.

Coordinated policy action on the determinants of health, combined with well-designed and implemented governance and policy approaches can have effect on 1) reducing the health gap; 2) improving overall population health and well-being; and 3) achieving inclusive and sustainable economic growth and prosperity for all.

Ongoing challenges – not least the COVID-19 pandemic, the cost of living crisis and climate change – emphasise that we live in an increasingly changing and globalised world, posing both challenges and opportunities. Despite its catastrophic consequences, the pandemic has opened a window of opportunity to adopt and accelerate new approaches and solutions to achieve healthier and more resilient people, societies and economies. As well as potential solutions to ‘build back fairer’ from the pandemic, there is also potential for a ‘green recovery’ by identifying opportunities to support population health through sustainable means and to put health in all policies to identify and influence the health and equity impacts of policy decisions. 

The Programme for Government commits the Welsh Government to ‘move to eliminate inequality in all its forms’. Making the case and advocating for investment in well-being and health equity are essential to enable evidence-informed, sustainable and fair policy and action for the benefit of people, communities, societies, the economy and the planet. The scale and nature of the challenge calls for a co-ordinated, whole-sector response, making a strong case for community-centred approaches to public health and whole-system approaches to health equity. 

How public policy and decision making responds to persistent and new challenges in uncertain times will rely heavily on the ability to shape responses to big trends. The challenge is how to implement change across a complex system so that it endures over time. 

Futures work is about thinking and planning for the long term. It can help when considering the challenges we are likely to face in Wales that could influence and shape the future, as well as those that are unforeseen or uncertain, while supporting the development of policies or strategies that will prove robust in the face of many different futures. The Future Trends Report 2021 and associated Evidence Pack can support decision-makers understand Wales’ future better and make more informed decisions for current and future generations. The Three Horizons Toolkit can also help public bodies to think and plan for the longer term. Efforts to consider what inequality in a future Wales might look like can be supported by the framework established by the Well-being of Future Generations (Wales) Act 2015, which compels us to think differently about our approach to health inequalities. The Future Generations Commissioner has set out case studies and big ideas from Wales and further afield on what individuals, communities and public bodies are doing to meet the well-being goals. 

The Five Essential Conditions

Understanding ‘what works’ can inform decisions about public services. There are many tools, resources, practical frameworks and software applications to help measure and understand health inequalities. Also, the WHO Europe Health Equity Status Report Initiative (HESRi) has brought together case studies of success stories, promising practices and lessons learned from the local, national and European levels. The case studies show how countries have overcome the challenges related to disinvestment in policies and approaches that impact on health equity, and maximised new opportunities for advancing objectives to increase equity in health.

This section brings together information on potential solutions and good practice, and directs those attempting to tackle health inequalities to reports, practical guides, toolkits and techniques that have been implemented. Different tools and techniques are appropriate at different stages of development. For example, when a new service is being planned it might be relevant to undertake a Health Impact Assessment, whereas if services have been in place for some time but are under review, tools such as Multi-Criteria Decision Analysis or Programme Budgeting and Marginal Analysis may be more appropriate. 

The solutions-focused resources in this section are presented within a broader context, which acknowledges the underlying factors driving health equity. The WHO Regional Office for Europe report Driving forward health equity – the role of accountability, policy coherence, social participation and empowerment, suggests that evidence increasingly demonstrates that addressing one or a combination of the conditions that are crucial to giving people an equal chance in life (e.g. living environment, education, employment) in isolation from broader social and institutional factors in society has led to progress not being as fast as expected. Rather, to scale up action on health equity and enable the conditions necessary to lead healthy and prosperous lives, action needs to be taken on underlying factors driving health equity. The report presents the findings of a scientific expert review that identified four key drivers of health equity – accountability, policy coherence, social participation and, underlying them, empowerment – as social and institutional factors that drive health equity on their own, but are also dynamic and interact with each other. Work on these drivers has informed the Health Equity Status Report initiative and has resulted in independent companion papers each elaborating further on accountability, policy coherence and social participation as drivers of health equity. A further policy brief presents evidence showing that political participation, representation, accountability and transparency are also important preconditions for health equity.

The role of behavioural science in addressing health inequalities

Increasing health equity requires both the social and behavioural causes of health inequalities to be addressed in parallel. Behavioural science, the scientific study of behaviour, provides evidence-based approaches to understanding and influencing behaviour in specific populations in a given context. This scientific approach ensures an accurate understanding of behaviours and what drives them rather than relying on assumptions of what is believed to influence behaviour. It also facilitates consideration of both conscious and automatic processes that have an influence on our behaviour.

Behavioural science methods support the identification of populations/sub populations most at risk of, or affected by, health inequalities and provides evidence base frameworks for exploring the determinants of behaviour from the perspective of the population of interest. This enables targeted intervention for segments of the population experiencing health and/or social inequalities. The systematic approach offered by behavioural science prompts consideration of equity at every stage in process of developing and implementing policies, services, and communications.

A guide to using behavioural science, which comes from a Public Health Wales and UCL Centre for Behaviour Change partnership, Improving health and well-being: a guide to using behavioural science in policy and practice offers an introduction to behavioural science and a step-by-step process for developing/optimising interventions (policy, service or communications) designed to start, stop, continue or change behaviours.

Stay up to date. Come back to this page for spotlight features on practical, sustainable health equity solutions. The Welsh Health Equity Solutions Platform is continuously updated with the latest resources and materials, including data, policies, reports and case studies. Contact us to be notified of updates to the Solutions Platform.

Get in touch to get involved. We are working with stakeholders and users to update and expand the Solutions Platform with projects, case studies and spotlight features focused on health equity. Contact us to share your projects and success stories, to feature on the platform.

Health and Health Services

The Inverse Care Law describes the relationship between the need for health care and how it is used, acknowledging that often, people who are in most need of health care are the least likely to receive it. Throughout the COVID-19 pandemic it was noted that those living in more disadvantaged areas had worse outcomes, once again shining the spotlight on inequalities. 

When there is acute demand (e.g. hospital waiting lists following the pandemic) it can be difficult to allocate spend to prevention, but this is the only way to reduce further acute demand at a later time point. Tools such as Return on Investment and Social Return on Investment can be helpful. 

When planning and delivering healthcare services, there are many tools and techniques that can be applied to reduce inequalities. These include the use of health impact assessment, health needs assessment, and economic assessments. 

Decisions on services are based on data: information from the people in need (e.g. health needs assessment and epidemiological data), where it is best to spend resources (e.g. NICE guidelines or return on investment studies) and data on reducing inequalities (e.g. health impact assessment or integrated impact assessment). Investment is often driven by need and data but this is not always the case.  

Multi-criteria Decision Analysis and Programme Budgeting and Marginal Analysis

As a tax-funded system, the NHS is under constant strain as the demand for healthcare is close to infinite, whilst healthcare resources are finite. To create a balance between finite resources and infinite wants and needs, choices are necessary and consequently costs and benefits must be compared. Prioritisation is also required to assist this decision-making so resources are used in a way that maximises their benefit. 

Multi-criteria Decision Analysis (MCDA) and Programme Budgeting and Marginal Analysis (PBMA) are tools that aid decision-making and resource allocation so that benefits are maximised. They offer a framework to identify interventions that are cost-effective and address socio-economic equity, that improve productivity and keep people in work in Wales (e.g. addressing musculoskeletal issues and mental health). These frameworks require information on quantifiable indicators for interventions, for example how many people access services; what services cost; their reach; whether they are evidence-based and cost-effective; their benefits (e.g. how many people quit smoking as a result of the intervention). These frameworks can also assist in the development of key performance indicators prior to undertaking an evaluation.

Useful Resources

Health and Income and Social Protection

In order to live a healthy and happy life people need economic security. In Wales, the Socio-economic Duty came into force on 31 March 2021. Public bodies subject to the Duty must, when making decisions of a strategic nature about how to exercise their functions, have due regard to the desirability of exercising them in a way that is designed to reduce the inequalities of outcome which result from socio-economic disadvantage. The Welsh Government has published a progress tracker to support public bodies in meeting the requirements of the Duty. Public Bodies should use the progress tracker for benchmarking how requirements of the Duty are being met; understanding how to take forward improvements to effect meaningful culture change, beyond the requirements of the Duty; and for encouraging reflection and the recording of progress. 

Many organisations have explored potential solutions to the issue of income security and social protection. The Institute of Fiscal Studies produced a report exploring income inequalities in the UK. The report presents options for addressing the effects of rising unemployment, namely reducing the cost of employing people using the tax system; raising public service expenditure and public sector employment; increased funding of (re-)training programmes; boosting out of work benefits; or more fundamental changes to introduce more social insurance into the welfare system. 

The Welsh Government has outlined plans to extend support for care-leavers through a Basic Income pilot in Wales. The pilot is designed to extend support for care-leavers and will provide a test for the stated benefits of basic income, such as addressing poverty and unemployment and improving health and financial well-being. Public Health Wales has produced a Basic Income report which considers a range of evidence and explores the potential impacts on health and well-being. It also looks into the different approaches to policy design and implementation internationally. The report identifies options for policy-makers who are thinking about basic income, such as carrying out economic modelling, placing health and well-being as a core aim of any scheme, and carrying out feasibility studies to understand how basic income could be introduced in Wales.

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Useful Resources

Health and Living Conditions

A number of the wider determinants of health derive from our health and living conditions; for example, housing. The need for security in relation to having and keeping a home and being surrounded by a safe and consistent home environment, and its impact on both physical and mental health and well-being, has long been recognised.

Public Health Wales has produced a number of reports that highlight the issues of poor quality housing and its impact on health. These reports include potential solutions, including the case for investment in housing which outlines the need to tackle housing as a fundamental determinant of health and presents solutions including: eliminating cold damp and mouldy homes; improving ventilation; energy efficiency measures and fuel poverty schemes; support for vulnerable households instead of area-based interventions. 

In Europe, a project mapping trends and policies to tackle homelessness in Europe. This has included setting out recommendations to address homelessness, including the right to adequate housing for all (vulnerable) people in Europe and the integration of health services within housing solutions.

During times of uncertainty, such as the COVID-19 pandemic, a home can provide a secure and stable base for individuals and households. A health impact assessment of the impact of COVID-19 on housing was undertaken by Public Health Wales, and made further recommendations for the future including: investment in affordable, safe and sustainable housing as part of a ‘green’ pandemic recovery, and support for sustainable place-making as outlined in Planning Policy Wales; encouragement of longer-term tenancies to give tenants greater security and greater protection from eviction- balancing this with the needs of landlords, to reduce barriers to gaining future secure accommodation. 

Useful Resources

Health and Social and Human Capital

Human capital and social capital are known to have an impact on health and well-being. Evidence from Europe suggests that policy interventions targeted at improving individual social capital can directly improve individual health and contribute to community social capital, reinforcing the beneficial role of individual social capital.

Human Capital

Definitions of human capital encompass the notion that there are investments in people such as education, training or health, and that these investments increase an individual’s productivity. Human capital is the value of individuals’ skills, knowledge, abilities, social attributes, personality and health attributes. These factors enable individuals to work, and therefore produce something of economic value. It is measured as the sum of the total potential future earnings of everyone in the labour market. The Office of National Statistics (ONS) produces human capital estimates for the UK. 

Harvard University has produced a summary of how to boost human capital and the factors that are important, including: education; vocational training; a climate of creativity; and infrastructure. In the UK, the Chartered Institute of Personnel and Development (CIPD) has published widely on human capital. The CIPD technical report on human capital theory makes the case for investment in people as individuals and from the organisational level, and provides a series of recommendations for improving human capital including: formal training; mentoring; coaching; tracking mood and productivity; and talent management to retain human capital within an organisation or location. 

Social Capital

Social capital is the networks of relationships among people who live and work in a particular society, enabling that society to function effectively. Social capital arises from the human capacity to consider others, to think and act generously and co-operatively. There are three core aspects to social capital: social relationships; the quality of relationships and shared understanding. The ONS produces findings on social capital in the UK. 

A systematic review has presented strong evidence to suggest that people with a lower socio-economic status generally have lower levels of social capital, and that lack of social capital is related to socioeconomic inequalities in health. Further, that social capital between close relations or tight-knit communities can buffer some of the negative effects of low socio-economic status on health. 

Health literacy is a key feature of social capital. It is the social resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health. Health literacy empowers people to make positive choices and is an enabler that supports the promotion of equity by improving people’s access to health information, and their capacity to use it effectively. Digital health advances have the potential to help increase access, decrease healthcare system costs and improve health outcomes. However, technology solutions to digital health literacy have the potential to both promote health literacy and be a barrier. Also, evidence on how various aspects of social capital affect different health outcomes for different actors remains unclear, and there is limited literature on the health benefits of social capital interventions.

Resources

Health and Employment and Working Conditions

Being in good employment is protective of health, while unemployment contributes to poor health. Ill health can also affect people’s participation in the labour market, with costs to the individual, families, communities, employers and public services; combined costs from worklessness and sickness absence amount to approximately £100 billion annually in the UK, presenting a strong economic case for action. 

There is growing evidence on what works to increase employment and improve working conditions. The National Institute for Health and Care Excellence (NICE) has produced guidelines and recommendations on workplace health. This guideline includes new and updated recommendations on: workplace culture and policies; assessing and certifying fitness for work; statement of fitness for work; making workplace adjustments; keeping in touch with people on sickness absence; early intervention; sustainable return to work and reducing recurrence of absence and how to support people with a health condition or disability who are not currently employed. In addition, NICE has produced a guideline on mental well-being at work that includes recommendations on: strategic approaches to improving mental well-being in the workplace, organisation-wide approaches and having a supportive work environment; external sources of support; training and support for managers; individual-level approaches, employees who have or are at risk of poor mental health and those in high-risk occupations; engaging with employees and their representatives; local and regional strategies and plans and considerations for small and medium-sized enterprises (including micro-enterprises).

In Wales, the Healthy Working Wales (HWW) programme aims to support and encourage employers to create healthy working environments, take action to improve the health and well-being of their staff, manage sickness absence well, and engage with employees effectively, all of which can help to achieve a range of positive business and organisational outcomes. HWW offers health advisor support, training events, workshops, information and guidance. The Welsh Local Government Association works with local authorities to assist them meet their health and safety requirements, and provides a broader skills and capacity role including support for development opportunities such as apprenticeships, work placements and graduate schemes and action to engage with and provide opportunities for those who are not in employment, education or training (NEET) and/or economically inactive. Also, the Equality Impact Assessment in Wales Practice Hub is a collective source of information and practice, with resources promoting and supporting the development of good quality, robust EIAs that meet the legal duties of the Equality Act 2010 and the Welsh Public Sector Equality Duties 2011.

During the COVID-19 pandemic it became even more evident that economic insecurity was not evenly distributed amongst the population in Wales, and inequalities widened. A report by Public Health Wales exploring the link between COVID-19 and employment changes in Wales highlighted the issues and identified potential solutions. Promising interventions for different groups included: investing in interventions that offer employment support, career guidance, vocational training and apprenticeships; job creation and job search assistance; education and training; employment protection legislation and more.  

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Useful Resources