Living a long, healthy life shouldn't depend on where you call home - but it does.

That's why the government's promise to halve the health gap between England's richest and poorest regions is so important.

It's an ambitious target – and rightly so – though the stubborn persistence of these inequalities over the past decade shows just how tough this challenge will be.

So how can this pledge be turned into real change? We brought together the new ONS healthy life expectancy data with Nesta analysis to find out.

Healthy life expectancy tells us how many years people can expect to live in good health, not just how long they'll live. It's the government's chosen measure for tracking whether people are living healthier, for longer.

The health gap in England tells a shocking story – and the closer you look, the starker it is.

Between England’s regions, there's almost seven years difference in how long people live in good health.

Zoom in to compare smaller local authority areas, and the picture gets much worse.

Take Wokingham and Blackpool – there's an 18-year gap between how long their residents can expect to live healthily.

While the government appears to be most focused on closing the gap between regions, it’s important to remember that there's also great variation between local areas within regions themselves. It will also be necessary to tackle those in order to increase regional healthy life expectancy.

The current half-way mark between the healthy life expectancy of the best and worst performing regions, and best and worst performing local authorities, is 61 years.

If every place could achieve this healthy life expectancy, it would cut the regional health gap from six years to three years, and the local health gap from 18 years to nine years.

While five of nine regions don’t reach this mark on average, every region contains local authorities falling behind - that’s 68 of the 151 local authorities for which we have data having a healthy life expectancy of less than 61.

The North East faces the toughest challenge, where not a single local authority within the region currently reaches 61 years. And even within better-off regions like the South East, many local areas are still struggling.

Setting a target in this way is just one option for halving the healthy life expectancy gap.

Alternative approaches could be considered, such as setting tailored targets for each area or focusing efforts exclusively on poor-performing regions.

However, setting a universal minimum target could provide a clear, measurable, and equitable goal that illustrates the scale of intervention needed in particular areas falling behind.

Healthy life expectancy is calculated based on two things: life expectancy and self-reported health (how people describe their own health when asked).

We’re likely to have more success increasing healthy life expectancy over the next decade by focusing our efforts on the latter. That’s because healthy life expectancy as a measure is much more sensitive to changes in self reported health than changes in life expectancy.

This means focusing on improving the things that have the biggest day-to-day impact on people's assessment of their own health - like their ability to move around without pain, their mental wellbeing, and their capacity to carry out daily activities independently.

In the most deprived parts of England, more people report being in poor health, and they report poor health earlier, than in less deprived parts of England.

Halving the health gap will require reducing the total number of people who report being in poor health, and increasing the age at which the average person reports poor health, in the most deprived parts of England.

This doesn’t mean improving life expectancy isn’t also important.

But focusing on the things that enable people to be and feel well for longer, rather than die later, will have a relatively bigger impact for a target focused on healthy life expectancy.

And they’re not mutually exclusive - improvements in day-to-day health will have flow-on on impacts for life expectancy too.

Having a long-term (chronic) health condition and/or living with two or more long-term health conditions (what is known as multi-morbidity) are the clearest drivers of self-reported poor health.

Having a chronic condition significantly increases the likelihood of reporting poor health compared to having none, and additional conditions have a compounding effect. Almost one-third (29%) of people with a single health condition report poor health. This rises dramatically to four in five people (81%) when someone has three or more conditions.

More people in the poorest parts of England have chronic health conditions, and they are more likely to have several. Every common condition is more prevalent among the most deprived, with particularly large inequalities for conditions such as obesity and mental disorders.

When we consider which health conditions were most likely to make people report they were in poor health, and how common the different conditions are, two high-priority areas stand out: obesity and musculoskeletal conditions (like knee pain or arthritis).

These conditions have the greatest impact on self-reported health for everyone in England, but the impacts are much greater for the most deprived. As a result, it’s unlikely to be possible to make meaningful progress to close the gap without prioritising tackling these conditions.

The outsized impact of these conditions in deprived areas is driven in large part by their role in multimorbidity.

Obesity and musculoskeletal conditions often occur together and can trigger or worsen other health problems, creating a complex web of health challenges, exacerbating feelings of poor health.

Closing the gap requires tackling multimorbidity head-on.

For people living in England's most deprived areas, who are more likely to have multiple health conditions, addressing a single condition may not be enough to improve their health from 'poor' to 'good'.

Success will therefore depend on prioritising the conditions that contribute most to the health gap, and on making progress across multiple health conditions simultaneously.

To halve the gap in healthy life expectancy we’ll need to see significant reductions in the prevalence of common health conditions right across the country, but particular places will have a much greater effort on their hands.

Comparing the health of regions and localities in England highlights the extent of the health uplifts required in some places.

We’ve drawn out three places to bring this to life: Wokingham, an affluent local area with the highest healthy life expectancy, Leeds, a moderately deprived local area with the target healthy life expectancy of 61, and Blackpool, a deprived local area with the lowest healthy life expectancy.

For Blackpool to reach disease prevalence levels similar to those seen in Leeds, it would need to reduce musculoskeletal conditions by over 30% and obesity by around 20%, among other reductions.

To put this in perspective, even a 1-2 percentage point reduction in these conditions would ordinarily be considered a significant achievement. These much larger reductions would be equivalent to around 20,000 Blackpool adults no longer living with musculoskeletal conditions, and nearly 10,000 no longer living with obesity.

Further analysis is required to understand the exact reductions in disease prevalence in Blackpool that might achieve a target healthy life expectancy of 61 years. Based on our initial findings, achieving this target would require comprehensive interventions across multiple priority health conditions.

It's true that in general, places with higher average income have a higher average healthy life expectancy. This is a reflection of better access to healthcare, nutrition, and overall living conditions. However, healthy life expectancy can also vary substantially between areas with similar income levels.

For example, despite similar deprivation levels, Barnsley and Wirral’s healthy life expectancy differs by more than six years. Peterborough and Dudley differ by five. In general, London boroughs fare better than average for their deprivation levels, but even within London there is significant variation, with Lewisham and Haringey for example separated by nearly six years.

The different prevalence of common health conditions in these local authorities can help explain the healthy life expectancy gaps. For example, obesity rates between Haringey and Lewisham differ by nearly 10 percentage points.

Increasing incomes remains a crucial government priority. Alongside this, understanding why some deprived areas achieve better health outcomes than others could offer valuable insights for improving health in similar communities.

Local factors like work quality, food environments, access to green spaces, quality of healthcare services, and social isolation strongly influence health outcomes beyond what income alone would predict.

We won’t meet the scale of the challenge through more of the same, or by tinkering at the edges.

Making the leap from current health outcomes to those needed to halve the gap demands action at an unprecedented scale.

The government will need a plan - one that puts the conditions most associated with the healthy life expectancy gap in the limelight and empowers local places with what they need to see drastic improvements.

A two-pronged approach is required: strong national policy to tackle the systemic or societal drivers of poor health, combined with localised plans for intensive action in the areas falling furthest behind.

This means tackling fundamental health inequalities at the national level - from ensuring safe working environments to making healthy food more affordable and accessible. It also means matching this ambition locally by better connecting with existing health infrastructure, as our colleagues at the King's Fund and IPPR have advocated.

While this government is attempting to show its commitment to NHS reform, achieving its pledge to halve the healthy life expectancy gap requires more.

It demands bold national action on root causes of health problems like musculoskeletal conditions and obesity, alongside a reimagined partnership between national and local health systems that provides intensive, tailored support to our most disadvantaged communities.