Luton Borough Council: reducing health inequalities in the first Marmot Town

The town's population is younger than the national average, with life expectancy at 78.1 years for men and 82.4 years for women, slightly below the national averages of 78.6 years and 82.6 years, respectively. There is a significant disparity in life expectancy across different parts of the town, with a six-year difference for women and a similar pattern for men.

Health inequalities and deprivation have long been a feature across the town. In 2019, three of Luton’s wards had more than 40 per cent of children living in poverty. 

The COVID-19 pandemic became a catalyst for Luton to address these health disparities. The impact of the pandemic, coupled with two stabbings in the town centre in the summer of 2021, brought urgency to the town’s discussions on improving the health and prospects of its residents. 

In the October of 2021, Luton began engaging with the UCL Institute of Health Equity (IHE), initiating stakeholder engagement, workshops and workstream meetings to develop the report, Reducing Health Inequalities in Luton: A Marmot Town. 

A Marmot oversight group, chaired by the Chief Executive, was set up to guide the process, including overseeing the mapping of resources against the workforce to identify gaps and opportunities. The town has aligned the report's priorities with its Luton 2040 vision, which has a strong focus on social justice.

Chimeme Egbutah, Public Health Service Manager (Health Inequalities and Communities), says that the Marmot report, plus the two town centre stabbings in 2022, 'helped crystallise what we wanted to focus on,' and these were five priority areas:

• Housing and health: chaired by the Head of Private Sector Housing (Luton council).
• Children and young people and health: chaired by a Consultant in Public Health.
• Net zero and health: chaired by an independent advocate, Earth Bound Adventures.
• Business, employment, skills and health: chaired by Head of Community Learning and Economic Growth (Luton council).
• Health and built environment: chaired by a Project Design and Delivery Manager (Luton council).

Each priority area group is supported by a public health colleague. 

Luton frames its work around health equity rather than focusing solely on being a Marmot Town, as the term ‘Marmot’ does not resonate with many outside public health. Health equity is something that chimes across the system.

Luton has focused on achieving "small wins" across all Marmot principles but believes that a more focused effort on "health and wealth" could have resulted in more significant impacts in fewer areas.

The trick is getting the system to do it themselves and work across all priorities” says Chime Egbutah.

By which she means that if partner organisations take on their role as part of Marmot, then ambitions can be achieved more widely. 

The private sector is an important partner in working to improve health equity in Luton and, as the Marmot report for Luton states, apart from the moral case, businesses will benefit from a healthier and more productive workforce, and increased attractiveness to potential employees, customers, and investors.

Increasing employment, especially for young people who are not in education, employment, or training, is a key priority for the business and skills priority group.

Engagement with business and commerce was difficult originally, and Egbutah says there was little interest when they first launched a Health Equity town prize, but since then, they have engaged with the Chamber of Commerce and have focused on anchor organisations to increase the impact on addressing structural inequalities. Bringing system leaders together to work on plans to improve skills and shape interventions has benefited communities.

Luton has developed a set of measures aligned to the eight Marmot principles to monitor progress. These indicators also feed into the assessment of progress towards the realisation of Luton’s 2040 ambitions.

The town has evaluated its work to date to ensure it is getting interventions right and maximising impact. The evaluation had three main aims:

1. To understand the impact of the Luton Marmot report on system-wide efforts to tackle health inequalities through the wider determinants of health.

2. To develop a set of measures to illustrate early impacts of the Luton Marmot report and set out an approach for future outcome measurement structured around the eight Marmot principles

3. To activate the health equity system through the process of evaluation, through stakeholder engagement and re-enforcement of priorities and direction of travel.

Now into its second year as a health equity town and working to Marmot principles, Luton is focused on delivery. A logic model approach is being used to demonstrate how initiatives are planned, implemented and evaluated.

The challenge, says Egbutah, is to keep partners engaged and focused on health equity. She is developing a ‘ways of working’ toolkit to ensure the system keeps focused on health inequalities and doesn’t exacerbate them unintentionally. She has developed a microsite of 20 to 30 case studies for Luton 2040 and Marmot and produces a newsletter to engage people in what’s happening to drive forward health equity.