HEG Response to the 2025 Autumn Budget: Heading upstream?

Health Equalities Group welcomes several significant new commitments in the 2025 Autumn Budget that represent a meaningful shift towards addressing the upstream drivers of ill-health and inequalities. The Budget introduces several new structural, regulatory and fiscal levers that strengthen the conditions in which people and communities can thrive.

1. A reNEWed focus on child poverty and family income?

The abolition of the two-child limit marks a major departure from the last decade of welfare policy. This is the single most consequential anti-poverty reform in years, with the potential to lift nearly half a million children out of poverty. Coupled with a higher National Living Wage and enhanced childcare support, the Budget signals a new recognition that income is a foundational determinant of health.

2. Tackling commercial determinants?

The Budget introduces a substantial increase in the Remote Gambling Duty, a new Betting Duty, and strengthened enforcement powers. This marks a decisive shift towards regulating high-risk online gambling products in line with tobacco and alcohol. The inflation-linked increase in alcohol duty is a welcome adjustment, bringing alcohol taxation closer to public-health objectives. Moreover, the expansion of the Soft Drinks Industry Levy to high-sugar milk drinks closes a long-criticised loophole, reinforcing fiscal measures as viable tools for improving population health.

3. Ambitions for housing and local regeneration

A £39 billion Affordable Homes Programme, VAT reforms for social housing development, and brownfield remediation funding together signal renewed commitment to housing as a public-health priority. The scale of this investment, combined with devolved, multi-year funding settlements, marks a shift towards long-term, place-based regeneration that could substantially improve housing quality, reduce overcrowding and damp-related health harms, and tackle residential inequality, if targets are met.

4. A new model for local prevention and system leadership

The introduction of place-based budgets across mayoral regions represents a significant structural reform. For the first time, local leaders will have the flexibility to pool budgets across health, housing, transport, and social care – enabling direct investment in prevention. This addresses long-standing fragmentation and offers a pathway to more coherent, system-wide strategies to improve health and reduce inequalities at the local level. However, the Budget overlooks a straightforward measure – returning the public health grant to its real-terms value prior to the reductions imposed by the previous government.

5. From hospital to community neighbourhood

The creation of 250 Neighbourhood Health Centres, backed by capital investment and a redesigned operating model following the abolition of NHS England, signals intent to modernise the primary and community care infrastructure. If realised effectively, this could improve access to preventive services and long-term condition management, especially for disadvantaged communities.

6. Commitments on food affordability and consumer protection

The Food Inflation Gateway and the UK–EU SPS agreement introduce new mechanisms to stabilise food prices and improve access to fresh produce. Coupled with strengthened regulatory oversight over product and food safety, these changes acknowledge that healthy diets depend on a stable, accessible, and safe food environment – not just individual choice.

7. Investments in children’s nutrition and early development

Extending Free School Meals to all families on Universal Credit and expanding school Breakfast Clubs are important new steps toward reducing childhood hunger, improving nutritional equity, and supporting educational readiness. These interventions offer long-term potential for improved physical, cognitive, and social outcomes among children.

Where ambitions may fall short

While the 2025 Autumn Budget contains many promising structural and upstream commitments, several critical challenges remain:

• Funding pressures persist for the NHS and social care. Without additional, sustained investment, workforce shortages, training bottlenecks, and capital backlogs risk undermining these ambitions.
• The transition to new governance structures (e.g., the abolition of NHS England, devolved budgets) creates a risk of short-term disruption. Prevention policies may be deprioritised during reorganisation with knock-on effects for third-sector organisations in particular, in terms of funding to meet the needs of underserved populations.
• Realising the public-health potential of housing, transport, and local regeneration funds will depend heavily on how devolved authorities choose to allocate them. Uneven capacity and (lack of) political will may lead to widening of health inequalities across regions.
• Regulatory and fiscal measures, including those relating to gambling, alcohol, sugar reduction and housing VAT, may face sustained pushback from commercial actors whose interests run counter to population health. It is essential that these measures are not diluted, delayed or reshaped through industry lobbying. Robust enforcement, transparent monitoring, and a firm commitment to protecting public health must ensure that industry is not permitted to water down or weaken policy designed to reduce harm.

Taken together, the new measures in the 2025 Autumn Budget represent a shift in direction. For the first time in many years, national policy appears to acknowledge that health and social outcomes are shaped far beyond hospitals, clinics, and social care: by income security, housing quality, commercial practices, food systems, and the capacity of local government to act systemically on prevention.

However, this shift in policy content is not yet matched by a shift in government narrative. The public framing of the Budget emphasises short-term cost-of-living relief, fiscal stability and NHS activity metrics, while giving far less visibility to the wider socioeconomic and commercial reforms that could have a transformative impact on population health. This narrow presentation sidelines a more effective narrative – one that foregrounds the foundational social and economic conditions that shape health – and, in doing so, reduces the potential to engage communities in a fuller understanding of what meaningful prevention truly involves.

If the government is committed to reducing avoidable ill-health and closing the health gap, it must also update its policy narrative to reflect these upstream ambitions. Doing so would help re-orient national discourse towards long-term prevention, integrated system changes and the conditions that enable communities to thrive, not just operational performance within the NHS.

Health Equalities Group stands ready to work with national and local partners to translate these reforms into sustained upstream action. We urge policymakers to guard against short-termism, resist efforts by vested interests to dilute or delay policy, and embed clear public-health metrics into delivery.