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Reducing health inequalities in Luton, the first ‘Marmot Town’

Luton has a bold and ambitious vision, a healthy, fair sustainable town where everyone thrives and no-one lives in poverty. To support this Luton Borough Council, in collaboration with the Institute of Health Equity (IHE) at University College London, has initiated the ‘Marmot Town’ approach to tackling health inequalities. The Luton Marmot report, published in September 2022, put forward a model for the town anchored in 8 key principles, targeting a range of health determinants. This case study describes the impact of the Luton Marmot report 18 months after its publication, the strategies employed, and recommendations identified for future work.

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The challenge

Health inequalities are unfair and avoidable differences in health across communities and between different groups within society. These can affect life expectancy, the illnesses people experience and the care that is open to them. Creating a town based on fairness and social justice is a core pillar of the Luton’s 2040 vision.

In 2022 Luton became a “Marmot Town” – having worked closely with the IHE to develop our Health Equity report and develop our approach to system working and actions to tackle the causes of health inequity.

Luton, with a population of just over 210,000 people, is a relatively deprived area, and this is reflected in its health outcomes. Luton’s life expectancy lags behind the England average. It has higher preventable mortality, as well as cardiovascular and cancer mortality. 

To evaluate the early impact of collaborating with the IHE and declaring Luton a Marmot town, two Public Health Registrars conducted an assessment. They aimed to measure the impact and propose long-term quantitative metrics. This process involved engaging stakeholders to promote actions addressing health inequalities, aligning with Luton’s 2040 ambitions.

The solution

Collaborative multi-agency workshops supported the development of the 2022 report, 'Reducing Health Inequalities in Luton: A Marmot Town'. This report, based on an assessment of data and local evidence, established recommendations against the 8 Marmot principles. The recommendations direct Luton's approach to developing healthy lives, community structures and environments for all.

The Council have taken a phased approach to implementation based on these principles. Priority work streams for the first round of implementation have focused on the areas of employment, skills and business; giving every child the best start in life; pursing environmental sustainability; housing; warm spaces and communities. This implementation aligned with significant stakeholder and resident engagement to develop the Luton 2040 vision. 

The impact

An evaluation of the first year of activity has been completed, including stakeholder qualitative analysis, and reviewing and establishing ongoing impact measures to use. While early in its implementation journey, the Marmot report has already fostered increased multi-sectoral collaboration in Luton. The framework has been a catalyst for projects expected to reduce health inequalities, with a focus on wider determinants of health. Improvements in population health equity are expected to emerge as the policies are implemented. A set of measures aligned to the 8 Marmot principles have been agreed to monitor progress. These indicators also feed into assessment of progress towards realization of Luton’s 2040 ambitions.

How is the new approach being sustained?

The Luton Borough Council public health team plays an advocacy and coordination role, ensuring Marmot principles are integrated into town-wide meetings and strategies.  Key findings from the year 1 evaluation give recommendations on how to sustain impact.

There have been various iterations and refinements of governance structures to find an approach with sufficient linkage into the Health and Wellbeing Board (HWB) whilst also providing the breadth of engagement required to tackle this agenda.  The Health Equity Town Partnership Board has been established with a direct link into the HWB.

Stakeholders across Luton have committed to strategic and operational change to align to the Marmot Town work to help tackle health inequalities. An example of this is the Active Luton strategy, that was developed based on the Luton Marmot Report findings. 

Existing and emerging projects and workstreams have been built with a strong focus on measuring impact, using logic models to ensure that input, process and output align with the Luton Marmot report's findings and recommendations.

Lessons learned

A number of recommendations have emerged from the mixed methods evaluation of the initial implementation of the Marmot approach. The implementation of these recommendations should involve the whole health equity system across Luton, led by the Health Inequalities Board. 

  • Ensure system-wide clarity and strengthening of governance and accountability.
  • Broaden the agenda of the Marmot steering group and other associated working groups to get more non-Local Authority and Healthcare input.
  • Ensure all stakeholders understand the role they can and are playing in tackling health inequalities.
  • Embed Marmot and health inequalities within workforce development across the system.
  • Develop a coherent workplan around the seventh Marmot principle; tackling discrimination and structural racism and its outcomes.
  • Develop our communications and engagement approach with stakeholders and members of the public, including the use of terms such as Marmot Town, Health Equity etc. Luton should celebrate success where existing work is making a difference and learn from what does and doesn’t work. Ensure Marmot principles influence resource allocation decisions across the system to ensure that they are proportionate to need, starting with our anchor institutions.
  • Building on Marmot data reporting and monitoring, linking to JSNA and Luton 2040 success measures.
  • Use of logic models may be a useful method to build on for future workstreams associated with Luton’s Marmot Town ambitions.
  • Translate the Marmot principles, into a more specific and practical workplan.
  • Ensure that we learn from best practice amongst Luton partners and from national and international evidence base, whilst also sharing our own knowledge and learning. 

Next steps

Work for the coming year includes strengthening the governance through the health equity town partnership, developing clear action plans for the topic based working groups, using gap analysis and logic models, to continue to hold learning events and disseminate findings, and to evaluate and promote smaller projects being undertaken as part of the Marmot approach. 

Contact: Sally Cartwright, Director of Public Health Luton Borough Council- [email protected] 

Links to relevant documents: 

Luton Marmot Town Report 

Luton 2040

Active Luton Strategy 2023-2028