The two-year decline in healthy life expectancy in Britain, set out in new analysis from the Health Foundation thinktank, is devastating. In a wealthy country like the UK, at a time of rapid advances in the treatment of illnesses including obesity and cancer, people should not be living with sickness or disability earlier than they were a decade ago.

The report draws on a survey that relies on self-reporting, so is less objective than statistics based on births and deaths. Worsening mental health among younger adults is the area of sharpest deterioration and in some age groups, physical health was reported as having improved. But healthy life expectancy is a useful measure of quality of life and the findings have serious implications for public services. When, in 2028, the retirement age rises to 67, the average person will be in poor health more than six years before they are due to stop work. The researchers state that the decline cannot be put down to the pandemic. Northern Ireland was excluded due to a lack of data.

Having fallen several places down a table of 21 high-income countries, the UK now sits in 20th place just above the US (Japan remains at the top). Most people would surely agree with the thinktank’s call for ministers to put health “on a par with delivering economic growth”. But how?

Cutting the vast hospital waiting lists that built up under the Tories was the current government’s top priority. This delivery-focused approach was undermined by the decision to abolish NHS England. But whatever Wes Streeting’s missteps, or flaws in administration, neither can be blamed for the underlying problem of worsening population health.

The government’s promised shift to prevention shows that it recognises this. Laws such as the new ban on tobacco should reduce the toll of smoking-related illness over time. But other determinants of health are less easily targeted. The socioeconomic causes of physical and mental illness have been known for decades to include insecure or unsafe work and housing – when Aneurin Bevan became the first minister in charge of the NHS, his brief encompassed housing. The deep cuts to council budgets imposed by austerity reduced the opportunities open to millions of people.

On housing, change is under way with stronger tenants’ rights and ambitious building targets, while regional inequality is being addressed through the £5bn Pride in Place programme. One of the report’s starkest findings is huge geographical disparities, with nearly half of London boroughs seeing improvements in healthy life expectancy while the steepest declines were in Blackpool and Hartlepool.

There are more levers that ministers could pull, if they had the courage and conviction. New policies to address worsening health and economic inactivity among young people are expected soon. But while Britain is the most obese country in western Europe, the government has so far been unwilling to challenge the food and drink industry, by insisting that products are reformulated, or by imposing minimum unit prices on alcohol – probably in part out of fear of right-wing “nanny state” headlines.

Most experts see this as the government’s single biggest failure in relation to public health. But even changes to the food system will not be enough. As well as taking action from the centre, ministers must empower local authorities to act on the knowledge that health is closely tied to the wider social and economic conditions in which people live.