Marmot review urges action on wider causes of ill health

The review was led by Michael Marmot (pictured), 10 years after his landmark report on health equality. The latest report, Health equity in England: the Marmot review 10 years on, said increases in life expectancy have stalled since 2010, with the slowdown greatest in more deprived areas. Women have been particularly affected, with female life expectancy declining in the most deprived 10% of neighbourhoods between 2010/11 and 2016-18. Increases in male life expectancy in these areas were negligible.

Though Sir Michael acknowledged the difficulty in establishing the link between cause and effect, he reported that austerity had ‘taken its toll’ on areas he had examined in the 2010 report. These included rising child poverty, declines in education funding and an increase in homelessness. But he added: ‘We can say that austerity has adversely affected the social determinants that impact on health in the short, medium and long term. Austerity will cast a long shadow over the lives of the children born and growing up under its effects.’

It added that a health system designed to reduce health inequalities must focus on place – small areas – and understand the population health and risks, including the wider determinants of health. It must ensure communities at greatest risk of poor health are not excluded. The health system must move away from reactive care for those who are already ill, to supporting good health by improving living conditions.

The report said health and social care integration with a range of other public services in Greater Manchester had enabled the development of ‘a truly place-based population health system, appropriate for taking action on health inequalities’.

Jennifer Dixon, chief executive of the Health Foundation, which commissioned the report, said health inequality was worse than 10 years ago, especially for women.

She added: ‘There has been a decrease in the proportion of our lives that we can expect to live in good health. And not only has the health gap grown between wealthy and deprived areas, it has also grown between deprived areas. Living in a deprived area of the North East is worse for your health than living in a similarly deprived area in London, to the extent that life expectancy is nearly five years less. Place matters.’

She called for a national, cross-government health inequalities strategy to join up action on the causes of ill health, including poverty, employment, housing and education.

‘Areas that need immediate investment include addressing child and in-work poverty, the public health grant to local authorities, and children’s services such as Sure Start,’ she said.