Oxfordshire County Council: tackling hidden inequalities

In Oxfordshire, it is the mix of rural and urban geography in a predominantly affluent county with hidden pockets of deprivation that set it apart from other Marmot Places.

The county council has joined forces with the IHE team and developed a new high-level work health inequalities plan that will take it through the next two years. 

Chief Executive Martin Reeves, who spearheaded Coventry’s Marmot City status, fully embraces the Marmot approach as relevant for every area, both politically and professionally. 

It actually binds all LGA members. There is nothing here that creates tension,” said Chief Executive Martin Reeves.

Reeves was chief executive at Coventry City Council when it launched as a Marmot city 11 years ago. It experienced a stabilising of life expectancy in the city between women in the most and least deprived areas, despite a national increase, as well as a six-month reduction in the gap in male life expectancy compared to a national increase. 

Unlike Coventry, Oxfordshire is a two tier council with five districts providing a mix of city, town and rural areas. It faces distinct challenges, such as rural isolation, including older people with significant assets who are living alone and isolated from their communities, alongside significantly deprived households in pockets of deprivation that can be hard to detect.

Initially, Oxfordshire will focus on two key Marmot principles: Give every child the best start in life, and Ensure a healthy standard of living for all. An early years’ board has been established to lead the children’s work to address the impact of the pandemic on child health, school readiness and school attendance. 

Director of Public Health Ansaf Azhar and his deputy David Munday acknowledge Professor Sir Michael Marmot’s view that all the principles are interrelated. “To start well, you need good quality homes,” says Munday.

Reeves is particularly focused on improving the quality of existing housing stock, linking it directly to public health outcomes. “Rather than focus on energy funding to retrofit homes, you use mainstream health money,” he says, describing high levels of respiratory illnesses among children as a disgrace. 

With £1.5 million secured from the Integrated Care Board, the council is using this to retrofit homes and tackle damp and mould to reduce respiratory illnesses in children - a pressing issue Reeves describes as “a disgrace.”

This holistic approach extends to other public health measures, such as increasing rates of physical activity, aimed at improving population health and reducing the impact on health services.

According to the 2019 Index of Multiple Deprivation, 10 of Oxford City Council’s 83 neighbourhood areas ('Super Output Areas') are among the 20 per cent most deprived areas in England. Community profiles reveal that even in seemingly affluent areas, two or three streets can experience severe deprivation.

The council is piloting innovative approaches, such as deploying community connectors – people who are part of the community but have some training in providing support, setting goals and encouraging people to engage with activities and make connections with others. A GP scheme (still early in development) will provide intensive support to a small number of patients in different areas. There are also plans to link this support with approaches by social care colleagues for a more cohesive impact. 

As with other Marmot Places, there is already much work going on to reduce health inequalities and those programmes will continue but what Marmot brings is a methodology and a framework that works for everyone.  

“It is like having an umbrella that everything fits under and brings cohesion.” said Ansaf Azhar, Director of Public Health at Oxfordshire County Council.

The council has formed an alliance with Oxford and Oxford Brookes universities called the Policy Lab, which aims to promote relationships and bridge the gap between research and local policy. It will give the council world-class research capacity to address policy research relevant to Marmot principles. 

The universities’ role as anchor institutions is also vital and they are committed to effective local engagement, using their broader resources for the benefit of local residents.

Munday says, “We have assets and good programmes of work, so we are starting from a high base. The Marmot methodology brings it all together, like having an umbrella that everything fits under.”

Reeves agrees, “It’s absolutely going to be the glue,” highlighting that having an external expert like Marmot leading the work brings credibility and cohesion.