Building Fairer Towns, Cities, and Regions: Insights from Marmot Places

In the wake of the influential 2010 report "Fair Society, Healthy Lives" and its follow-up in 2020, by Professor Sir Michael Marmot, the concept of Marmot Places has emerged as a beacon for addressing health inequalities across the country. These places focus on the social determinants of health (SDoH) to create fairer, healthier communities.

A Marmot Place is a locality that recognises the profound impact of those social determinants such as education, employment, and housing on health and life expectancy. The UCL Institute of Health Equity (IHE), led by Professor Marmot, collaborates with local councils to understand local inequalities, strengthen health equity systems, and develop actionable recommendations.

Central to the Marmot approach is the concept of proportionate universalism, which advocates for universal services delivered at a scale and intensity proportionate to need. This aims to improve overall population health and reduce health disparities.

Marmot Places operate based on eight core principles:

1. Give every child the best start in life.
2. Enable all individuals to maximise their capabilities and control over their lives.
3. Create fair employment and good work for all.
4. Ensure a healthy standard of living for all.
5. Create and develop healthy and sustainable places and communities.
6. Strengthen the role and impact of ill health prevention.
7. Tackle racism, discrimination, and their outcomes.
8. Pursue environmental sustainability and health equity together.

Building fairer towns, cities and regions: Insights from Marmot Places

More than 50 local areas across England, Wales and Scotland have signed up to be Marmot Places. You can read about them in our report, Building fairer towns, cities and regions: Insights from Marmot Places.

Cheshire and Merseyside

The COVID-19 pandemic highlighted and exacerbated existing health inequalities in Cheshire and Merseyside. The region's response involved a collective effort to address poverty, housing, and employment issues, with a focus on reducing health disparities.

Manchester

Manchester's five-year plan targets the leading causes of premature death, heart disease, stroke, cancer, and lung disease, by addressing underlying behaviours such as tobacco use, poor diet, and physical inactivity. The plan emphasises the critical role of community engagement and tackling structural discrimination.

Coventry

As the first Marmot City, Coventry has integrated Marmot principles across various council departments. The city focuses on employment and young people, developing strong partnerships with a shared vision to drive health equity.

Oxfordshire

Oxfordshire's unique mix of rural and urban areas presents distinct challenges. The county focuses on early years and housing, addressing issues like rural isolation and hidden pockets of deprivation.

Luton

Luton has used the Marmot framework to address health disparities highlighted by the pandemic. The town focuses on housing, young people, and employment, aligning its efforts with the broader Luton 2040 vision.

Waltham Forest

Waltham Forest's commitment to health equity is driven by a council-wide approach. The borough focuses on housing, employment, and green spaces, with significant buy-in from senior leadership and a strategic plan to tackle health inequalities.

Challenges in implementation

While these initiatives have made significant strides, they face several challenges that can hinder their progress.

One of the primary challenges faced by Marmot Places is the limitation of resources. Many local councils struggle with insufficient funding, which can impede the implementation and sustainability of health equity programmes. Additionally, limited staffing and capacity within these councils can affect their ability to carry out extensive programmes aimed at reducing health inequalities.

Health inequalities are deeply rooted in complex social, economic, and political systems. Addressing these inequalities comprehensively requires navigating these intricate systems, which can be challenging. Effective collaboration across different sectors, such as health, education, employment and housing, is essential but often difficult to achieve due to differing priorities and resource constraints.

Evaluating the impact of health equity initiatives is inherently complex. Robust data collection and analysis systems are necessary to measure progress accurately. Moreover, health equity improvements often take time to manifest, requiring long-term commitment and patience from all stakeholders involved.

Putting the challenges to one side, the Marmot approach has significantly influenced both local and national policies. Councils are leading the way, demonstrating the importance of a comprehensive, long-term approach to tackling health inequalities.

Our new report highlights how local areas can use the Marmot principles to create fairer, healthier communities. It’s about tackling the root causes of poor health and working together across different sectors. Achieving health equity means rethinking the way we do things, and we’re still at the start of that journey.

Councillor David Fothergill
Chairman
LGA Community Wellbeing Board