By 2040, an estimated 9.1 million people in England will be living with major illness; 2.5 million more than in 2019, according to the Health Foundation’s REAL Centre. That’s nearly one in five adults. This surge is largely due to an ageing population, but it’s also tied to lifestyle-related conditions like diabetes, cancer, kidney disease, and mental health disorders such as anxiety and depression.
As someone who will be 84 in 2040, I write this not just as an elected councillor, but as a citizen who has witnessed decades of change—and who believes in the power of local action to shape a healthier, fairer future.
England’s healthcare landscape is poised for profound transformation. Driven by demographic shifts, technological advances, and evolving disease patterns, the next 15 years will challenge public health in local councils in new ways.
By 2040, an estimated 9.1 million people in England will be living with major illness; 2.5 million more than in 2019, according to the Health Foundation’s REAL Centre. That’s nearly one in five adults. This surge is largely due to an ageing population, but it’s also tied to lifestyle-related conditions like diabetes, cancer, kidney disease, and mental health disorders such as anxiety and depression.
The population is not just growing; it’s getting older. Most of the additional 3.5 million people expected in England by 2040 will be over 70. While life expectancy is projected to rise by 1.4 years, people will also spend more time living with illness—from 11.2 to 12.6 years on average.
This shift will place immense pressure on health and social care systems, especially in managing multimorbidity—when individuals live with multiple long-term conditions. The Health Foundation projects that many of these conditions will be managed in primary care and community settings, underscoring the need for investment in prevention and local services. Councils will face growing demand for integrated health and social care, requiring new models of community-based support and age-friendly infrastructure.
Despite medical advances, health inequalities are expected to persist or even worsen. The burden of illness will not be evenly distributed. People in more deprived areas are likely to experience higher rates of chronic disease and reduced access to care unless targeted interventions are made. The Health Foundation estimates that 80 per cent of the increase in major illness will occur in the most deprived communities. Local authorities will need to tackle the root causes—poverty, housing, education, and employment—while managing the health consequences of inequality.
A powerful example of this is found in Liverpool, where the city council’s State of Health in the City: Liverpool 2040 report projects that without urgent action, up to 38,000 additional residents could be living with major illness by 2040. Rates of depression are expected to double, and the burden of illness will fall disproportionately on the city’s most deprived communities. In response, Liverpool is pursuing a bold, evidence-based agenda focused on health equity, prevention, and embedding health in all policies—from housing to transport. The city is also calling for greater national support, including fairer funding and devolved powers, to meet these challenges head-on.
Mental health is expected to be one of the most pressing public health issues of the 2040s. Rising rates of anxiety, depression, and loneliness—especially among young people and older adults—will demand a robust, locally led response. Councils will need to invest in community resilience, early intervention, and accessible mental health services. Climate change will increasingly shape public health. From heatwaves and air pollution to food insecurity and climate-related displacement, local governments must prepare for a future where environmental health risks are more frequent and severe. Public health teams will play a key role in climate adaptation and emergency preparedness.
Despite growing responsibilities, local public health teams may continue to face uncertain funding and workforce shortages. Without long-term investment and strategic workforce planning, councils may struggle to deliver the ambitious, preventative agenda needed for 2040.
Health is no longer just about hospitals and clinics—it’s about the places we live, work, and connect. In 2040, councils will be the architects of healthier communities, using place-based approaches to tackle the root causes of ill health. This means addressing poverty, poor housing, unemployment, and social isolation—not as separate issues, but as interconnected determinants of health. Councils will work hand-in-hand with residents, community groups, and the voluntary sector to co-design services that reflect local needs and aspirations.
Community empowerment will be at the heart of this transformation. Residents will have a voice in shaping their health futures, and local knowledge will be valued as much as clinical expertise.
By 2040, sexual health services in England are expected to be more integrated, inclusive, and digitally enabled—but they will also face growing complexity and demand. Local councils will continue to play a central and evolving role in shaping these services.
Public health will be more deeply embedded in everyday life—from urban planning to school curriculums—creating environments that support healthy choices by default.
By 2040, local councils will be at the heart of a public health system that treats alcohol harm not just as a medical issue, but as a social and community challenge.
The future of public health in England will depend on a strong partnership between central and local government. Central government must act as an enabler—providing the vision, tools, and resources—while trusting local councils to lead on delivery, innovation, and community engagement.
Technology will be a key enabler of this transformation. From AI-driven diagnostics to remote monitoring and predictive analytics, digital tools will help clinicians make faster, more accurate decisions and allow patients to receive care at home.
Dynamic modelling and better data integration are already helping policymakers forecast future needs and allocate resources more effectively.
While digital health tools—like AI diagnostics and remote monitoring—will transform care delivery, they also risk exacerbating inequalities. Not all communities will have equal access to digital infrastructure or the skills to use it. Local authorities must ensure that digital innovation is inclusive and equitable.
Smoking rates are projected to drop below 5 per cent in most areas.
The future isn’t set in stone. The road to 2040 won’t be easy. It will require sustained investment, political will, and a commitment to long-term thinking. But the foundations are already being laid.
Councils are uniquely positioned to lead this transformation. They understand their communities, they work across systems, and they are trusted by the people they serve. With the right support, they can turn today’s challenges into tomorrow’s opportunities.
The future of public health is not just about surviving—it’s about thriving. It’s about creating a society where everyone, regardless of background or postcode, has the opportunity to live a healthy, fulfilling life. And that is a future worth working for.
Councillor David Fothergill
Chairman, LGA Community Wellbeing Board