HEALTH IN MIDDLESBROUGH

Reframing Health Through a Doughnut Economics Lens

Traditional health metrics tell us what is happening—life expectancy gaps, obesity rates, physical inactivity. But they rarely explain why these patterns persist or how they connect to broader economic and ecological systems.

Using the Doughnut Economics framework, we can visualize Middlesbrough's health challenge as a system operating outside the "safe and just space for humanity." This approach, developed by economist Kate Raworth and operationalized through tools like the Biological Inequities Index (BII) from Centric Lab, reveals health as an outcome of systemic factors rather than individual choices.

The Biological Inequities Index: Measuring Systemic Health

Current Score: 13.6 out of 20

(68% of maximum possible inequality)

Threshold for Safe & Just Space: 0

The BII measures how biological inequality manifests across populations based on environmental and social exposures. Unlike traditional health metrics that focus on outcomes, the BII captures the systemic drivers that create health disparities.

What this means for Middlesbrough:

A score of 13.6 indicates a significant social foundation shortfall

We are operating far below the minimum standard for population health

The "doughnut hole"—the gap between current reality and the social foundation—is substantial

Against a threshold of 0 (representing biological equity), Middlesbrough is far from the desired result. This isn't a failure of healthcare provision; it's evidence of structural inequality embedded in our economic and social systems.

The Data: Where We Stand

Life Expectancy Crisis

Males: 75.4 years (Middlesbrough) vs 79.3 years (national) — 3.9-year gap

Females: 79.8 years (Middlesbrough) vs 83.1 years (national) — 3.3-year gap

Physical Activity Deficit

Only 56.5% of adults meet activity guidelines vs 67.3% nationally

10.8 percentage point gap10.8 percentage point gap represents thousands of residents missing protective physical activity.

Obesity & Overweight

Rates exceed national averages for both children and adults

Creating intergenerational health burdens and reduced healthy life expectance

The Doughnut Framework: Two Boundaries

1. The Social Foundation (Inner Boundary)

The BII score of 13.6 shows we've fallen into the "doughnut hole"—failing to meet the minimum social foundation for health. This includes:

Economic security (poverty reduction)

Housing quality (warm, safe homes)

Education access (foundations for life)

Environmental quality (clean air, green spaces)

Employment security (decent work)

Social inclusion (community connection)

2. The Ecological Ceiling (Outer Boundary)

While our immediate crisis is the social shortfall, we must also ensure health improvements don't breach planetary boundaries:

Green space protection (mental health, physical activity)

Air quality (respiratory health)

Sustainable food systems (nutrition)

Waste reduction (environmental health)

The "safe and just space" lies between these boundaries where all residents have the resources needed for health without exceeding environmental limits.

Systemic Drivers: Beyond Individual Behavior

The BII reveals three interconnected layers:

Systemic Causes (Structural)

Economic inequality and poverty

Poor housing quality and affordability

Limited educational access and attainment

Environmental degradation

Employment insecurity

Social exclusion and discrimination

Intermediate Factors (Mechanisms)

Chronic stress from financial insecurity

Limited healthcare access and quality

Poor nutrition (food deserts, affordability)

Physical inactivity (unsafe environments, lack of facilities)

Social isolation

Environmental toxin exposure

Health Outcomes (Manifestations)

Reduced life expectancy

Chronic disease prevalence

Poor mental health

Obesity epidemic

Infant mortality disparities

Intergenerational health inequality

The 2024-2027 Action Plan: Moving Toward the Safe & Just Space

Middlesbrough Council's response recognizes that health is created outside the clinic—in homes, schools, workplaces, and communities.

The Family Hub Model: Foundation of Change

Rather than treating health as a medical issue, Family Hubs address the social determinants where they intersect with family life:

Prevention & Early Detection: Catching issues before they become crises

Best Start in Life: Ensuring children develop strong foundations

School Readiness: Breaking the link between disadvantage and educational attainment

Resilience Building: Supporting families to thrive, not just survive

Public Health Strategy: Structural Intervention

Working with partners to address the root causes identified in the BII:

Disease prevention through population-level interventions

Early detection reducing late-stage treatment burden

Acting on structural factors: housing, employment, environment

Promoting wellbeing across all council services

Green Strategy: Ecological & Health Co-Benefits

Protecting the ecological ceiling while improving health:

Recycling rates: Reducing environmental harm

Green space protection: Mental health and physical activity opportunities

Environmental stewardship: Community ownership of local spaces

From Measurement to Action

The BII score of 13.6 isn't a label—it's a baseline. The 2024-2027 Action Plan represents our trajectory toward the safe and just space:

Target: Reduce BII toward 0 (biological equity)

Approach: Systemic intervention, not symptom management

Partnership: Health creation requires cross-sector collaboration

Equity: Focusing resources where need is greatest

The Path Forward

Doughnut Economics teaches us that endless growth isn't the goal—meeting human needs within planetary boundaries is. For Middlesbrough, this means:

Closing the social foundation gap through poverty reduction, housing improvement, and educational investment

Respecting ecological limits through sustainable practices and green space protection

Measuring what matters—tracking BII and life expectancy gaps, not just healthcare activity

Building regenerative systems that improve health without depleting community or environmental resources

The question isn't whether we can afford to invest in health equity.

The Biological Inequities Index shows we cannot afford not to.