Health equity in England, 10 years on from the Marmot Review

26 February, 2020


In February 2010, a major review of health equity in England was published, called Fair Society, Healthy Lives (The Marmot Review).

Commissioned by the Secretary of State for Health at the time, the independent review chaired by Sir Michael Marmot was designed to show the best ways to reduce health inequalities. It identified six policy objectives:

  1. Giving every child the best start in life.
  2. Enabling all people to maximise their capabilities and have control over their lives.
  3. Ensuring a healthy standard of living for all.
  4. Creating fair employment and good work for all.
  5. Creating and developing healthy and sustainable places and communities.
  6. Strengthening the role and impact of ill health prevention.

A decade later, the Health Foundation and the Institute of Health Equity have commissioned their own report, Health Equity in England: The Marmot Review 10 Years On, to measure the progress made towards reducing health inequalities and meeting five of the six objectives (ill health prevention was addressed generally as a goal).

Key findings from this new report include:

  • The amount of time people spend in poor health has increased since 2010.
  • Mortality rates have increased for people aged 45-49.
  • ‘Despite the cuts and deteriorating outcomes in many social determinants, some local authorities and communities have established effective approaches to tackling health inequalities.’ (See below for how Bristol has addressed this).
  • Geographical inequalities remain between regions and their levels of economic deprivation: affluent areas of London and the South fare far better than the North.

Writing about the new report, Sir Michael Marmot said: ‘The health of the population is not just a matter of how well the health service is funded and functions, important as that is: health is closely linked to the conditions in which people are born, grow, live, work and age and inequities in power, money and resources – the social determinants of health.’

Fundamentally, the report emphasises that ‘The increase in health inequalities in England points to social and economic conditions, many of which have shown increased inequalities, or deterioration since 2010.’

Looking at the socio-economic factors of health and wellbeing, the report mentions cuts to youth services, increased school exclusions and youth crime, increased workers on zero hours contracts and other part-time insecure work, rising rates of in-work poverty, declining social mobility, higher housing costs, and much more.

However, many of the report’s recommendations – such as carbon neutrality, reducing school exclusions and increasing higher education attainment – fall in line with existing plans for Bristol as a city. For example:

  • The One City Plan for Bristol includes goals such as: a carbon neutral city by 2030, mental health will be as important as physical health, and health inequalities will be reduced.
  • Many Bristol organisations from the public, private and VCSE sector are working towards the UN Sustainable Development Goals, which include reduced inequalities (e.g. higher education attainment rates for Bristol are currently lower than the national average; cancer and respiratory disease rates are significantly higher in Bristol than the national average). You can join the Bristol SDG Alliance to get involved.
  • Bristol Impact Fund has small and medium to large grants to build on community strengths and reduce inequalities, particularly in areas of deprivation. Organisations to benefit so far include Bristol Women’s Voice, St Werburgh’s Community Association and Unseen. The most recent round of funding has been allocated, and new funding rounds will be announced on the Voscur website and by Bristol City Council.
  • City Funds is helping Bristol tackle inequalities, to create a fairer and healthier society. Areas of funding include initiatives that support the No Child Goes Hungry campaign, and community initiatives.

There are also goals towards joined up health sector provision in Bristol, North Somerset and South Gloucestershire (BNSSG), such as a plan for the Sustainability Transformation Partnership (STP). Voscur is also working on a current project with BNSSG STP and local VCSE organisations which will set precedents and guidelines for successful partnership working, to improve community healthcare. 

Mark Hubbard, Voscur’s Head of Partnerships and Commissioning, said:

“The Marmot Report was a key moment in public service delivery: it proved the link between the environment in which people live and their life opportunities. The updated report makes for difficult reading but it should be the new ‘go to’ resource for Bristol’s VCSE organisations – to make sure that their work in communities aligns with national thinking, local strategies and impact in their communities.

“This new report represents a great opportunity to bring the social models to medical systems – so that our sectors’ collaborative efforts make the biggest difference to people and communities that experience major challenges.”

With local projects and programmes such as these, Bristol’s VCSE sector and its partners are on the right track to reduce health inequalities locally and transform outcomes for our communities.