Judith Schrenk, Research Consultant provides a short synopsis of the latest Marmot Report
The Marmot Review Ten Years On
In 2010, the British Government commissioned Professor Sir Michael Marmot to review health inequalities in the United Kingdom. The 2010 review concluded that the path to a sustainable improvement of equality was not policy focusing on healthcare systems but rather an improvement in the social determinants of health. He introduced the concept of ‘proportionate universalism’ which has, in pockets, been adopted and used to shape and influence health policy.
Public health was reported to be determined by a social gradient. To improve equality in public health, according to Professor Marmot, policymakers need to be sensitive to this and respond to need proportionally.
Ten years after the publication of the landmark review, the Institute of Health Equity was commissioned to look at the progress made in improving the key social determinants. Led by Professor Marmot, the review examines the developments in health equality in the last ten years.
Life and Health Expectancy since 2010
Based on data from the 2011 census, the Marmot Review Ten Years On shows that the increase in life expectancy has slowed down. This is especially true for more deprived areas of the country. The increase of life expectancy in the United Kingdom is lower than in most European and high-income countries.
There are significant inequalities in life expectancy in the country, with people from more deprived areas and women being negatively affected. In the most deprived areas, life expectancy for women decreased since 2010. In the North East, life expectancy is approx. 2.8 years lower than in London.
There is a similar correlation reported between the degree of deprivation in an area and the expectancy of a healthy life. People living in more deprived areas are not only likely to live shorter lives but also spend a greater proportion of those lives in bad health. Avoidable mortality rates (deaths that could have been avoided by effective healthcare) are the highest in deprived areas of the country.
The Marmot Review Ten Years On criticizes deterioration in public health since 2010, referring to the 2010 report, labelling health inequalities both as ‘unjust’ and ‘unnecessary’.
The Social Determinants of Health
The 2010 Marmot Review defined five objectives to address the issue of health inequalities. The Marmot Review Ten Years On examined developments in those areas.
1. Give every child the best start in life
While the development of children in early years has improved, child poverty in the United Kingdom has increased since 2010. The rate of child poverty in out-of-work families exceeds 70%. The funding for childcare and children’s services have been cut since 2010, especially in more deprived areas.
2. Enable all children, young people and adults to maximize their capabilities and have control over their lives
The Marmot Review Ten Years On reports the continued existence of the socioeconomic inequalities in educational attainment laid out in the 2010 report. There are still substantial regional inequalities in educational attainment in the country. The review further notes a decrease in funding of educational attainment, particularly after the age of 16 and for higher education.
3. Create fair employment and good work for all
While there has been a decrease in employment rates, zero-hour-contracts and poor-quality jobs have increased. The review notes an elevated level of incidents of stress caused by work. There is an increased risk of job loss due to automatization. This is especially the case for lower-income jobs and the north of England.
4. Ensuring a healthy standard of living for all
Both the income and wealth in the country have increased slowly. The inequalities have widened due to tax and benefit reforms. The regional inequalities in wealth have increased notably, with London and the South enlarging their share of the national wealth. The level of food insecurity in the country has risen.
5. Create and develop healthy and sustainable places and communities
The review reports more deprived areas to be in the North, the Midlands and Southern coastal towns. Government funding for these places has been cut significantly. Another threat to public health is the growing impact of climate change. 46% of London’s most deprived areas are above the EU limits for nitrogen dioxide.
Conclusion and Recommendations
Marmot Review Ten Years On concludes that health in England is on the decline. It is especially getting worse for people living in more deprived communities of the country. Inequalities in public health are growing.
Almost all the recommendations the Marmot review 2010 made have not been implemented. In fact, the country has been moving into the opposite direction. Professor Marmot and his team insist that the growing inequalities and disadvantages of people from more challenging backgrounds must be addressed immediately.
Based on community, government and international action, the review sets out principles for governance for health equity. It calls for whole-government action to reduce health inequalities. Deprived communities can for instance be positively affected through investment and provision of e.g. leisure or mental health services.
Health and health inequalities are good measures for the wellbeing of a society. The review also stresses that investments in the wellbeing of children lead to a decrease of antisocial behavior and crime together with positive effects on mental and physical health. The main advice given to government by the Marmot Review Ten Years On is to implement an ambitious health-inequalities strategy supported by a cross-departmental committee.
Michael Marmot, Jessica Allen, Tammy Boyce, Peter Goldblatt, Joana Morrison (2020) Health equity in England: The Marmot Review 10 years on. London: Institute of Health Equity.