Key Points

• Published in 2010, The Marmot Review: Fair Society, Healthy Lives was a landmark study of health inequalities in England.¹
• While there has been some progress since 2010, there is growing evidence that health inequalities are in fact widening, and life expectancy is stalling.
• The Health Foundation commissioned Professor Sir Michael Marmot and his team at the Institute of Health Equity to examine progress in addressing health inequalities in England and propose recommendations for future action.¹

The Marmot Review into health inequalities in England was published in February 2010. It addresses the social conditions in which people are born, grow, live, work, and age. It set out a strategy to address those health inequalities associated with such social conditions.

Underpinning the Review was an ambition for a strategy of fairness and health for all regardless of the social gradient. “The report, titled ‘Fair Society, Healthy Lives’, proposes a new way to reduce health inequalities in England post-2010. It  suggests that traditionally, UK government policies have focused resources and attention only on some segments of society.”¹ To improve health for everyone, regardless of socio-economic group, action was needed, and the Marmot Review planned that very action.

Marmot Review in 2010

What were the Key Findings of the Report in 2010?

The detailed report contains many significant findings. Key findings of the Marmot Review 2010 indicate:

• People living in the most impoverished areas in England will, on average, die seven years earlier than people living in the wealthiest areas.
• People living in more deprived areas not only have a shorter life span but spend more of their lives with a disability – an average total difference of 17 years.
• The Review highlights the social gradient of health inequalities – the lower your social and economic status, the poorer your health is likely to be.
• Health inequalities arise from a complex interaction of many factors – housing, income, education, social isolation, disability – all of which are strongly affected by one’s economic and social status.
• Health inequalities are largely preventable.
• Action on health inequalities requires effort across all the social determinants of health, including education, occupation, income, home and community.²

Having revealed the key findings; action could then be planned as a framework.

A framework for action

The Review sets out a framework for action under two policy goals: 

1. To create an enabling society that maximises every person and every community’s potential.
2. To ensure social justice, health and sustainability must be at the heart of all policies.

At the core of the Review is the recognition that social and health inequality begins before birth and accumulates through the life span. Something the Government needs to address cross-sectionally in order to lift social injustice with health issues. A strategy based upon fairness and equal access regardless of status or wealth needs to be implemented.

The Review set out an approach that is embedded with the six policy objectives below: 

1. Giving every child the best start in life
2. Enabling all children, young people and adults to maximise their capabilities and have control over their lives
3. Creating fair employment and good work for all
4. Ensuring a healthy standard of living for all
5. Creating and developing sustainable places and communities
6. Strengthening the role and impact of ill-health prevention.

Having looked at the Review 2010- What happened ten years on?

The Marmot Review 10 Years On, published on February 26th, shows that in the last decade, the UK has had the weakest growth in life expectancy for over a century. There remains a health-gap between rich and poor, and since 2010, the health inequalities in the UK has worsened. So, what are we doing so wrong?

“A striking finding is that while people living in wealthy areas in the north and south of England can expect a similar lifespan, for people living in the most deprived areas, there is a 5-year gap in life expectancy between north and south.” ³ So, it is not only poverty that impacts health, but it also appears to be place – particularly if you live in the north.

Data of Interest

• In England, the regional inequalities are most stark comparing the North East with London.
• For males living in the 10% most deprived areas, life expectancy has fallen since 2010 in the North East, Yorkshire and Humber, and the East of England.
• For females in the most, 10% deprived areas life expectancy fell everywhere except London, the West Midlands and North West.
• The authors of Marmot Review 10 Years On, actually found that austerity has taken its toll on societal factors, from child poverty, declining education funding, and increases in violent crime and precarious employment.³
• Between 2009/10 and 2018/19 public sector spending fell by 7% from 42% of GDP to 35%, and council spending per head fell most sharply in the most deprived areas.³
• The slowdown in life expectancy since 2010 is seen in many other countries but is most vivid in the UK, USA and the Netherlands.
• There is evidence of social media related negative influences on particularly teenage girls with increased mental health issues, and an all-round picture of low-waged work and augmented stressful lifestyles have contributed to the findings.

What to do next?

The Government must now address the findings that illustrate an almost stalling in life expectancy and an ever-increasing health inequality society.

Strategies will need to be planned, implemented and reviewed to make the UK a fairer, healthier and more just place for all, regardless of socio-economic background or status.

Leadership must prevail, and guide healthcare, employment, housing, poverty, aged-care, education and all else social.

Action is required; the evidence is clear, and if used as a planning tool to focus on social protection, particularly in areas affected the most, there can be an improvement.

Marmot makes suggestions for policies in five areas to tackle the ‘wider determinants’ of health, from improving the availability of children’s centres to reducing child and in-work poverty.³ The Government need to plan to reduce health inequalities for its people.

Conclusion

The UK government faces a challenge but backed by the Marmot Review findings, clear definitions of what is needed are highlighted, and the strategy based on those findings can work to create equality for all.

Every citizen has the right to a fair and equal shot at a good life, and a good society provides for that.

References

1. https://www.health.org.uk/funding-and-partnerships/our-partnerships/health-equity-in-england-the-marmot-review-10-years-on
2. https://www.local.gov.uk/marmot-review-report-fair-society-healthy-lives
3. https://www.health.org.uk/news-and-comment/blogs/the-evidence-is-clear-and-the-solutions-are-there-%E2%80%93-what-is-needed-is-the

Further Reading

http://www.instituteofhealthequity.org/resources-reports/marmot-review-10-years-on/the-marmot-review-10-years-on-full-report.pdf

Professor Marmot Video on Facebook- https://www.facebook.com/368899676508186/videos/373701670131938/