What the 2026 Budget means for your health

A healthier UK starts in the places where we live, work, learn and play.

That means safe homes, a secure income, good work and thriving communities – all of which happen long before anyone walks through a hospital door. Economic policy shapes all of these, so the Budget's impact on our health reaches well beyond NHS spending.

The red book, Breathing space for today, fresh hope for the future, sets out £309 billion of public spending on health in 2027-28. But what makes a Budget healthy isn't how much it spends on treatment. It's whether it tackles the conditions that cause ill health in the first place.

Prevention: a welcome step that now needs detail

The Budget commits to ringfencing prevention spending from the 2027 Spending Review, through a new preventative departmental expenditure limit. This is a significant step, and one RSPH welcomes. Too often, government spends money dealing with problems after they arise rather than preventing them.

But the commitment needs detail to become real. The Budget doesn't yet say what counts as preventative spending, how much will be protected or how it will work across departments. Ahead of the Spending Review, RSPH wants to see:

• a definition that includes local public health and the wider causes of ill health
• a meaningful level of protected spending
• shared accountability across government

Healthy high streets

Health is shaped by the places where we spend our lives. That makes the new High Streets Strategy, Hope on the High Street, one of the most important parts of the Budget for public health. A successful high street is more than somewhere to shop - it's where people connect and take part in community life.

Positive announced measures include:

• bigger business rates reductions for pubs, social clubs and live music venues, recognising their role as community assets
• a £125 million Derelict Buildings Fund, helping councils turn empty buildings into facilities communities need, including health centres and civic spaces
• new rules requiring online marketplaces to collect VAT - a first step towards fairer competition with high street businesses.

RSPH has long called for the tax burden on online and in-person retailers to be equalised, with the revenue used to improve high streets. The government is still reviewing business rates for online retail. This should lead to fair, transparent reform, with the money reinvested locally and plans co-designed with communities.

Tackling the commercial determinants of health

The Budget takes positive steps on products that harm health:

• Business rates: vape shops and adult gaming centres lose their business rates reliefs, so public money will no longer support these businesses on our high streets.
• Gambling: higher tax on gambling machines will help fund high street support.
• Alcohol: alcohol duty will rise in line with inflation.

These are welcome. But money raised from health-harming products should go back into health, including services that tackle gambling harm, alcohol and smoking. These measures should be the start of a consistent approach to commercial determinants, not one-off decisions.

Housing, homelessness and the cost of living

Safe, affordable housing and a secure income are foundations of good health. We were pleased to see:

• an extra £1.5 billion for social and affordable homes, and VAT relief on land sold for social housing
• £432 million towards ending rough sleeping
• a £100 energy payment for 20 million households and the removal of gas standing charges.

These measures can help prevent the poor physical and mental health linked to housing insecurity and fuel poverty in the short term. But housing benefit remains frozen, leaving many low-income households struggling with rents. The test is whether these commitments deliver secure, affordable homes and reduce inequalities for the long term.

Local leadership and public health capacity

The roadmap for fiscal devolution will give mayors a share of business rates from 2027 and of income tax from 2028, along with powers to introduce visitor levies. Local leaders know their communities best, and this gives them more control to invest in healthier places and tackle local inequalities.

But there's no overall funding increase for councils. And the Public Health Grant - which funds stop smoking, drug and alcohol, sexual health and health visiting services - wasn't part of the Budget. Prevention is largely delivered locally. That's why RSPH wants a multi-year Public Health Grant settlement at the Spending Review, so councils have the capacity to make devolution work for health.

Making health everyone's business

A healthy Budget isn't one that simply spends more on treatment. It prevents illness, reduces inequalities and strengthens the places people rely on. This Budget makes real progress, particularly on prevention, high streets and housing.

The 2027 Spending Review is the chance to go further. That means defining and funding prevention properly, and making health a shared responsibility across every government department. Health impact assessments for major fiscal decisions would be a practical place to start.