Waltham Forest: progressing health equity in a London Borough

The local Marmot report, A Fairer and Healthier Waltham Forest: Equity and the Social Determinants in Waltham Forest, exposed the scale of health inequalities across the borough, and how some residents experience unfair and avoidable differences in their health because of their ethnicity, postcode, age, household income, and other wider factors. 

There are large inequalities in health in the borough. In 2020, average female life expectancy fell by 2.6 years, more than twice the national decline and sharper than London’s overall decrease. Male life expectancy dropped below the England average for the first time since 2015. 

Life expectancy varies by 7.6 years for women and 6.2 years for men between wards, largely reflecting deprivation levels. Eight wards in Waltham Forest have lower male life expectancy than the England average, whilst two wards fall below it for women. 

According to the 2019 Indices of Multiple Deprivation (IMD), Waltham Forest ranks twelfth most deprived out of all London Boroughs (excluding the City of London) and number 79 most deprived out of all 317 authorities in England. 

Deprivation can lead to poor physical and mental health, including loneliness and depression. IHE’s report for the borough notes the rise in depression in the area since 2015.

Public health consultant, Matilda Allen, explains that it these disparities, coupled with  relatively poor access to green space and the comparatively high gap in employment for people with long term conditions, were key drivers for focussed action amongst the councils and its partners. Poverty rates and the impact of poverty in the preceding decade also helped to inspire local action.

The drive to become a Marmot Place was council-wide and had significant buy-in across directorates. According to Allen, “The initial engagement was from the Chief Executive and the Leader, who wanted to research health outcomes and inequalities after the pandemic. The public health team ensured a focus on health inequity through suggesting working with the IHE team.”

The Chief Executive and Senior Leadership team are still driving the programme forward, which is really beneficial.” said Matilda Allen.

Building a fairer and healthier Waltham Forest: our response to the Marmot recommendations set out the council’s response to the IHE report. This approach focussed around the eight Marmot Principles, and identified three accelerator areas in which to speed up action to tackle some of the most intractable health inequalities:

The council made public commitments to act under each of these co-produced accelerator areas. While there was already much work underway locally, the Marmot review provided a sharper focus and helped to drive collective action to reduce health inequalities. 

The council has recently launched a new strategic plan, Mission Waltham Forest which builds on Marmot and other work. The plan details six ‘borough missions’ which aim to tackle the issues and challenges that residents are currently facing between now and 2030, recognising that there is inequity across the borough:

The council’s Promoting Wellbeing Board, chaired by the Director of Public Health, Joe McDonnell, helps to drive several of the Marmot actions, particularly on housing and employment. 

Funding from the Integrated Care Board Health Inequalities Fund is allocated via this Board, and specific projects include funding for fuel poverty interventions and for employment support for people with long-term conditions. 

Some teams, such as housing and health, have embedded the Marmot accelerator commitments into their strategies.

“Our theory of change here is much more about embedding it in the work of the Council,” said Matilda Allen. 

This, rather than labelling specific projects as ‘Marmot’ projects. A good example of the strategic impact of the Marmot work is the recent housing strategy, which centralises health and equity. 

By the first anniversary of its Marmot implementation in March 2025, Waltham Forest aims to identify and report on a set of mid- to long-term indicators of the impact of the Marmot and associated work. These will be drawn from the borough’s corporate performance indicator dashboard, where possible. 

Waltham Forest is also working externally to build partnerships for health equity, including with the King's Fund to address the mental health needs of men and boys from Black communities. Some funding for this work has also come from the ICB Health Inequalities Fund.

This work incorporates Marmot’s eighth principle and ties in with IHE’s recent report: Structural Racism, Ethnicity and Health Inequalities in London, which looks to tackle the structural drivers of health that enable and facilitate institutional and interpersonal racism. It also responds to a specific recommendation in the Waltham Forest Marmot review around building local partnerships for health equity.

This report highlights the transformative potential of the Marmot approach in tackling health inequalities. 

Across the country, Marmot Places are leading the way in integrating health equity into local policies and actions. This work reflects a shared commitment to addressing the social determinants of health and ensuring no one is left behind.

Key messages: 

• Collaborative leadership is crucial: Success relies on partnerships between elected members, councils and their public health teams, the health sector, voluntary organisations, businesses and communities. Strong local leadership is at the heart of this progress. Senior-level buy in can help solidify commitment to this work. 
• Communication is key: Clear and consistent communication within the council and among its partners is essential at every stage. By embedding and integrated the eight Marmot principles within council strategies, it allows them to become a shared reference point that aligns all departments and creates a collaborative approach to addressing health inequalities.  
• Whole-system approaches are effective: Embedding Marmot principles requires breaking down silos and ensuring health equity is central to decision-making.
• Local efforts can inspire national change: While much of the work is local, the cumulative effect offers a blueprint for a future national strategy to address health inequalities.
• Proportionate universalism delivers results: Balancing universal access with targeted interventions helps to improve health outcomes and reduces disparities.
• Health equity is everyone’s responsibility: Reducing health inequalities demands collective action across all sectors, from government to community organisations and businesses.

As this report shows, the journey to becoming a Marmot Place is about more than implementing policies; it is about building upon existing partnerships and forging new ones. It is a commitment to continued learning and to fairness. 

Now is the time to act decisively, ensuring this work is sustained and scaled up. Building on these important case studies, we hope this report inspires further action to create healthier, more equitable societies where no one’s health is determined by their postcode or circumstances.