Health equity in England: the Marmot Review 10 years on
Back in 2010, before austerity had really begun, Professor Sir Michael Marmot published a ground-breaking report. His major conclusion was that ‘health inequalities result from social inequalities’, and so to tackle health inequalities meant action across all the social determinants of health. A decade on, he and others have published a follow-up report which paints a bleak picture.
The report finds that health in the population is declining overall, while health inequality is increasing, and links this to recent trends of rising poverty and cuts to public spending. It demonstrates that poverty is strongly associated with poor long-term physical and mental health and low life expectancy.
For example, it draws a link between the wealth disparity between the north and south of England, and the corresponding difference in the health trends in the two regions. It also notes that “disabled adults face some of the highest risks of poverty” and that “those with disabilities are also experiencing the effects of cuts in local government services, particularly within social care.”
Reinforcing his recommendations of a decade ago, Sir Michael calls for a cross-government approach to addressing the social causes of health inequalities, focusing public investment where the need is highest.
The ability to lead a dignified life is central to health
However, it’s not just about wealth. The report also focuses on control and dignity: “Having control over one’s life is critical to an individual’s health and wellbeing. The ability to lead a dignified life is central to health.”
One of the original conclusions of the 2010 Review was that: “effective local delivery [of public services] requires effective participatory decision-making at local level. This can only happen by empowering individuals and local communities.”
The follow-up report reaffirms this recommendation, and highlights the impact of public spending cuts on ‘interventions that contribute to empowering communities and ensuring services are available to all’.
Sir Michael’s conclusions that serious damage to the nation’s health has been done and done needlessly are stark and well evidenced. This report must act as a call to action to reverse this.
The follow-up report reaffirms this recommendation, and highlights the impact of public spending cuts on “interventions that contribute to empowering communities and ensuring services are available to all.”