Prof. Anne-Marie-Bagnall reflects on the recent publication of the ‘Marmot Review 10 Years On’ and how it relates to what we do in CHPR.
On Tuesday 25th February a new report was launched from the Institute of Health Equity, to mark 10 years since the publication of the Marmot Report “Fair Society, Healthy Lives”. The report, commissioned by the Health Foundation, highlighted that, in England in the last 10 years:
- people can expect to spend more of their lives in poor health
- improvements to life expectancy have stalled, and declined for the poorest 10% of women
- the health gap has grown between wealthy and deprived areas
- place matters – living in a deprived area of the North East is worse for your health than living in a similarly deprived area in London, to the extent that life expectancy is nearly five years less.
As it says in the new report, “this damage to health has been largely unnecessary”. Social injustice is still killing people on a grand scale.
In the Centre for Health Promotion Research, tackling health inequalities and the social determinants of health is a central theme of our research and three of our members were at the report launch: Professor Jane South, Jenny Woodward and Susan Coan.
I was asked to give a short interview on BBC Radio Leeds about my reaction to the report. My first response was that, while I wasn’t surprised about the gap in life expectancy and good health between rich and poor areas, or between the North and the South, as this has been evident for decades, what I find absolutely shocking is that the Marmot report set out clear guidance 10 years ago on policy actions that should be taken to reduce this gap, and this guidance has not been followed.
The six policy objectives set out in The Marmot Report, 2010:
1. Give every child the best start in life
2. Enable all children, young people and adults to maximise their capabilities and have control over their lives
3. Create fair employment and good work for all
4. Ensure healthy standard of living for all
5. Create and develop healthy and sustainable places and communities
6. Strengthen the role and impact of ill-health prevention.
In addition, the large funding cuts to local authorities, public health and many other services as part of austerity measures have, in my opinion, made things even worse. The cuts have fallen disproportionately in deprived areas and in the North. The statistics revealed in the report are truly shocking (e.g. 4 million children living in poverty in England) but in the light of government policy on the social determinants of health over the last decade, it is not surprising that the health gap has increased.
However, like Professor Sir Michael Marmot, I am an evidence-based optimist and, as it says in the new report, we know the steps that should be taken to reverse this trend, as well as practical experience of how to do this from cities such as Coventry (a ‘Marmot city’ since 2013), Gateshead and Greater Manchester. Our current Prime Minister talks of ‘levelling up’ and there can be no more pressing need than reducing inequalities in the social determinants of health to increase health equity.
The new Marmot report sets out six priorities for action:
1. Develop a national strategy for action on the social determinants of health with the aim of reducing inequalities in health.
2. Ensure proportionate universal allocation of resources and implementation of policies.
3. Early intervention to prevent health inequalities.
4. Develop the social determinants of health workforce.
5. Engage the public.
6. Develop whole systems monitoring and strengthen accountability for health inequalities.
Our research at CHPR has been contributing to the evidence base and transfer of knowledge in these areas for the last 22 years – here are some examples:
- Professor Jane South is seconded to Public Health England as National Adviser on Communities;
- Workstreams around vulnerable populations at risk of health inequality such as prisoners, people with severe mental health issues, black and minority ethnic communities, women at risk of domestic violence, people at risk of homelessness;
- Work on the wider public health workforce such as health trainers and new models of care;
- Our MSc in Public Health- Health Promotion which emphasises the social model of health. Several of our graduates have gone on to become Directors of Public Health;
- Work around whole systems approaches to public health challenges.
Here at the Centre for Health Promotion Research we will keep striving to fight the injustices that are demonstrated so clearly in this report. We will keep listening to the voices of those experiencing these injustices, whilst working with others to build the evidence base for action, and raising our own voices to advocate for change.