The Marmot Review into health inequalities in England was published on 11 February 2010. It proposes an evidence based strategy to address the social determinants of health, the conditions in which people are born, grow, live, work and age and which can lead to health inequalities.
It draws further attention to the evidence that most people in England aren't living as long as the best off in society and spend longer in ill-health. Premature illness and death affects everyone below the top.
The report, titled 'Fair Society, Healthy Lives', proposes a new way to reduce health inequalities in England post-2010. It argues that, traditionally, government policies have focused resources only on some segments of society. To improve health for all of us and to reduce unfair and unjust inequalities in health, action is needed across the social gradient.
Summary of findings and recommendations
The detailed report contains many important findings, some of which are summarised below.
- People living in the poorest neighbourhoods in England will on average die seven years earlier than people living in the richest neighbourhoods
- People living in poorer areas not only die sooner, but spend more of their lives with disability - an average total difference of 17 years
- The Review highlights the social gradient of health inequalities - put simply, the lower one's social and economic status, the poorer one's health is likely to be
- Health inequalities arise from a complex interaction of many factors - housing, income, education, social isolation, disability - all of which are strongly affected by one's economic and social status
- Health inequalities are largely preventable. Not only is there a strong social justice case for addressing health inequalities, there is also a pressing economic case. It is estimated that the annual cost of health inequalities is between £36 billion to £40 billion through lost taxes, welfare payments and costs to the NHS
- Action on health inequalities requires action across all the social determinants of health, including education, occupation, income, home and community
The case for action
The Marmot Review looks at the differences in health and well-being between social groups and describes how the social gradient on health inequalities is reflected in the social gradient on educational attainment, employment, income, quality of neighbourhood and so on. In addressing health inequalities the Review asserts that it is not sufficient just to focus on the bottom 10 per cent because there are poorer outcomes all the way down from the top. Universal action is needed to reduce the steepness of the social gradient of health inequalities, but with a scale and intensity that is proportionate to the level of disadvantage.
Key to Marmot's approach to addressing health inequalities is to create the conditions for people to take control of their own lives. This requires action across the social determinants of health and beyond the reach of the NHS. This places renewed emphasis on the role of local government who along with national government departments, the voluntary and private sector have a key role to play.
Marmot looks beyond economic costs and benefits towards a goal of environmental sustainability. The Review contends that creating a sustainable future is entirely compatible with action to reduce health inequalities though promoting sustainable local communities, active transport, sustainable food production, and zero carbon houses, all of which have health benefits.
A framework for action
The review sets out a framework for action under two policy goals: to create an enabling society that maximizes individual and community potential; and to ensure social justice, health and sustainability are at the heart of all policies.
Central to the Review is the recognition that disadvantage starts before birth and accumulates throughout life. This is reflected in the 6 policy objectives and to the highest priority being given to the first objective:
1. giving every child the best start in life
2. enabling all children, young people and adults to maximize their capabilities and have control over their lives
3. creating fair employment and good work for all
4. ensuring a healthy standard of living for all
5. creating and developing sustainable places and communities
6. strengthening the role and impact of ill-health prevention.
The importance for local government
The Marmot Review is a timely reminder of the continuing social and economic cost of health inequalities. It presents a robust and well-evidenced business case for national and local action to address health inequalities through concerted action. The substantive report identifies local government as a pivotal partner in addressing the social determinants of health inequalities.
Local councils have a vital role in building the wider determinants of good health and working to support individuals, families and communities. The report relates strongly to the core business of local councils as local leaders for health improvement and the reduction of health inequalities. The Local Government Association (LGA) has argued for clearer recognition of this key role and welcomes the proposed transfer of responsibility for public health from the NHS to local government.
Fair Society, Healthy Lives - on the Marmot review website.