People in Wales’ most deprived areas are living fewer years in good health than those in more affluent parts of the country. 

In response to the publication of the Wellbeing of Wales report 2026, the Future Generations Commissioner for Wales, Derek Walker, has today (October 15) called for a major shift in how health inequality is addressed, warning the NHS cannot tackle the problem alone.  

The report reveals an increasing gap between the most and least deprived areas, with women facing a difference of approximately 19 years of healthy life and men 18.1 years – the widest on record for Welsh males.  

Plus, it shows that Wales’ healthy life expectancy has fallen for the fourth consecutive reporting period, with women expected to live just 58.5 years in good health, compared with 59.2 for men. 

The commissioner argues that decisions made across government on housing, income, employment, transport, food, clean air and access to green space all influence people’s health long before they need medical treatment. 

Research by Public Health Wales highlights the potential benefits of investing in these areas, with access to green and blue spaces (eg public parks and green roofs, and lakes, ponds, fountains and sustainable drainage systems) linked to improved mental health and social returns of up to £28 for every £1 invested. 

Welsh Government’s Well-being of Wales: 2026 report shows the situation for younger people is also concerning, with mental well-being in decline and only 18.3% engaging in physical activity for at least an hour a day. 

However, the report also highlights areas where long-term progress has been made, including significant improvements in air quality since the 1970s. The commissioner says this shows change is possible when action is taken over the long term to address conditions that affect people’s health. 

He wants prevention to become a shared responsibility across Welsh Government and public services in Wales – with the aim of improving long-term well-being, reducing inequalities and easing pressure on already stretched services across the country. 

The commissioner has made several recommendations here, including for Wales to become the first Marmot nation, to reduce health inequity.  

He is also working to increase fair pay via more people paying a Real Living Wage, and more equitable access to food and is supporting health boards to spend more on health prevention for all our communities. 

 Future Generations Commissioner for Wales, Derek Walker, said:  

“Where someone lives should not determine their chances of living a healthy life, and reversing the trend will require sustained investment and coordinated action across government, well beyond the NHS. 

“Investing in prevention means in addition to support for all people to maintain and improve their health, investing in warm homes, clean air, a vibrant environment, healthy, accessible food, fair work and public services working together to remove the barriers that stand in people’s way. 

“We cannot keep paying for the consequences of poor health without doing more to address its causes, especially as the report shows that our health is still deteriorating with inequalities widening and a lot of it is avoidable. The choices we make today will shape the health of Wales for generations.” 

The value of prevention and of equity above acute NHS costs are well known. But the commissioner’s work to date suggests investment in prevention might be less than anticipated (less than 5% for health boards as an example).  

Public Health Wales estimates that preventative interventions can generate returns of up to £14 for every £1 invested. Yet, preventative spending has been historically difficult to identify and track. 

To address this, the commissioner’s team has developed a first-of-its-kind prevention budgeting tool.  

Launcing October 22, it will help public bodies to better understand how much they spend on preventing problems before they arise. 

The approach could put Wales at the forefront of investment in prevention, helping to drive a longer-term shift towards addressing problems at the source rather than paying for their consequences. 

In January 2025, the Commissioner urged Welsh Government to ringfence funding for prevention and increase it year on year, warning that short-term budget pressures risk undermining long-term investment.  

Now, ahead of the autumn supplementary budget, he is renewing that call to the Plaid Cymru-led Welsh Government – urging ministers to demonstrate how their spending decisions will address the causes of poor health and help close the widening gap in healthy life expectancy. 

Wales now has its first Deputy Minister for Prevention, who has asked Welsh Government to protect prevention spending in the next budget. 

The commissioner will analyse this as part of his work to address the urgency and scale of the challenge.