HAPI Zones? More Orwell than Beveridge
A critique of the recent report of the IPPR Commission on Health and Prosperity – By Brendan Martin and Cormac Russell
The Institute for Public Policy Research (IPPR) has declared Our Greatest Asset, the Final Report of its Commission on Health and Prosperity, “the most ambitious blueprint for the nation’s health since Beveridge”.
The report, published last month, provides a description of the well-known health challenges facing our communities, predicated on the link between health and prosperity, and therefore addressing stark correlative inequalities.
To tackle these challenges it asserts the need for an ‘enabling state’. However, its understanding of what that means is revealed in detailed proposals that would perpetuate the existing hierarchy of power and resource allocation.
Nowhere is this more clearly expressed than in its proposal (pp. 89 – 95) for Health and Prosperity Improvement (HAPI) Zones, which central government would have the power to create if and where local authorities or mayors suggest them.
Each zone would cover a “defined population where poor health and economic outcomes cluster”. They would be “prioritised for new health investment or pilots” and for funding to renew depleted “community infrastructure”, such as libraries, green spaces, swimming pools and youth centres.
The report claims that the proposal draws on “the idea of ‘asset-based’ or ‘strengths-based’ approaches”, which “try to move away from thinking about communities as simply settings for services, and towards using the full strengths of a community to deliver positive health and wellbeing”.
Yet its detail about ‘HAPI Zones’ reveals a vision of communities as just that, ‘settings for services’, and its strategy, far from building on the strengths within communities, would increase their dependence on outside institutions.
Its approach, the report says, is consistent with the principle of ‘subsidiarity’. This, to quote the Cambridge Dictionary, is “the principle that decisions should always be taken at the lowest possible level or closest to where they will have their effect, for example in a local area rather than for a whole country”.
However, the report’s understanding of ‘subsidiarity’ appears blind to institutional overreach, as though good intentions and the odd government-managed consultative exercise are enough to produce an enabling state. There is no analysis of how institutions make the shift from supplanting to supplementing community assets.
To the contrary, the Commission assigns to local authority leaders the power to propose a HAPI zone, while “national government should ultimately retain sign-off on the final designation of HAPI Zones, to ensure consistency in approach and basic alignment with national priorities.”
Why? Why not support neighbourhoods to find their own ways, suited to their own understanding of their needs? Why not create the conditions for successful approaches to proliferate through example rather than pre-ordained standardisation?
Above all, why not invest in the restoration of that “community infrastructure” unconditionally, with the aim of bringing the most economically marginalised and structurally oppressed areas up to the level of the wealthiest?
These are not rhetorical questions. They and many more need to be explored if we are to really understand how to mobilise and build upon the strengths within communities and redistribute power and resources from institutions, both national and local.
It is true that the potential of asset-based community development is undermined by the inadequacies of publicly provided facilities that have been systematically dismantled by the austerity policies of recent years.
To respond by expecting communities to jump through qualifying hoops in a competition for their restoration is not only to add insult to injury but also – even in terms of the report’s own logic — to perpetuate those deepened inequalities.
Why, you might ask, are we so exercised about yet another think tank report? The reason is that the commissioners behind the report include people with great political influence, and IPPR itself has the ear of government, having provided at least two recruits to the new Prime Minister’s policy unit.
Well, we hope they reflect on the PM’s own reference, in his recent Labour Party conference speech, to communities such as the Grenfell campaigners fighting for justice following the horrors inflicted on them by the national and local state.
“They have all shown that the difference between service and government – true service – is that service must listen to people far beyond the walls of the state and empower them to make our country better,” said Keir Starmer.
Not just ‘listen’, note, but also ‘empower’ – to which we would add that means starting with the power already there in communities and serving and reinforcing rather than trying to control or direct it.
The 1942 Beveridge Report was indeed the blueprint for the construction of Britain’s welfare state, and does indeed need to be superseded by a modern equivalent better suited to the world as it is more than eight decades later.
Our Greatest Asset doesn’t come close. In fact, its idea of ‘HAPI Zones’, complete with an acronym we assume is intentionally homophonic, brings to our minds not so much the work of Beveridge as of that other great 1940s author, George Orwell.
Brendan Martin is founder and MD of Public World. For more of Brendan’s writing on health and public services see here. You can reach Brendan at brendan@publicworld.com, X (formerly Twitter) at @brendanfmartin, and LinkedIn by clicking here.
Cormac Russell is founding director of Nurture Development. For more of Cormac’s writing on health, see here, and on community power, see here. You can reach Cormac at cormac@nurturedevelopment.org, X (formerly Twitter) at @CormacRussell, and LinkedIn by clicking here.