CPC Director responds to Marmot health equity review

Ten years on from his original report, Professor Sir Michael Marmot has today (25 February 2020) led the launch of the latest update review ‘Health equity in England: The Marmot review 10 years on’.

The report has confirmed that overall life expectancy has stalled and is declining for the poorest women. Health inequalities have widened and health has deteriorated across England.

In his introduction to the review, Professor Sir Marmot said: “Put simply, if health has stopped improving it is a sign that society has stopped improving.”

The review, undertaken by Professor Sir Marmot at the Institute of Health Equity, UCL, is a follow-up to ‘Fair Society Healthy Lives, the Marmot Review’ published in 2010. The original report analysed the causes of health inequalities in England and what needed to be done to address them. This latest review was commissioned by The Health Foundation to explore what has happened to address them in the decade since the first Marmot review.

In what has been described as a damning report of social and health policies in England over the last decade, the report authors have called for immediate action to “level up population health”, citing that “government policies focusing on individual behaviour change without addressing social circumstances don’t reduce inequalities.”

In the report’s recommendations, the authors call for “a reordering of national priorities. Making wellbeing rather than straightforward economic performance the central goal of policy will create a better society with better health and greater health equity.”

The reports main recommendations are:
- Giving every child the best start in life
- Enabling all children, young people and adults to maximise their capabilities and have control over their lives
- Creating fair employment and good work for all
- Ensuring a healthy standard of living for all
- Create healthy and sustainable places and communities
- Taking action

Professor Jane Falkingham OBE, Director of the ESRC Centre for Population Change and Dean of the Faculty of Social Sciences at the University of Southampton, has responded to the review’s findings:

“I have read with great interest today’s follow-up Marmot review on health equity in England. The reported stalling of life expectancy, widening health inequalities, and declines in life expectancy for some groups, are a sobering read.

The report is a clear ‘call to action’. While it can be easy to focus on the NHS and our health services when it comes to life expectancy and healthy lives, we must not neglect to address the complex influences of broader social policy on society and communities. This neglect in recent years is why we are now seeing so many health inequalities across the UK.

Mortality is the crudest measure of health in any society. Healthy longer lives do not merely come from medical input. They happen because of improvements in how people live and how our societies develop. When assessing how to improve life expectancy, we must take a life-course perspective, investing in social policy that supports people across the whole of their lives.

At the ESRC Centre for Population Change, we take a broad approach to studying how changes in society affect our lives from birth until death.

For example, the welcome recommendation in the Marmot review to ‘Give every child the best start in life’ not only means investing in improved education (which is critical) but also investing in families. This means spending on services to help mothers, fathers and carers to provide a safe, stable and healthy environment in which children can grow up. Our work on cohabitation and separation has found that there is a pattern of disadvantage associated with children born outside of marriage, and we are extending this research to take into account people’s relationship and childbearing choices concerning education, the labour market and housing.

Education, income and economic uncertainty impact upon the age at which people leave home, buy or rent houses, get married, live together, separate, have children, and indeed if people choose to have children at all. All of these factors work together to create very different life experiences, aspirations and feelings of control over one’s own life among children and young people across the UK.

In mid-life to later-life, many of us are now providing care for our parents, grandparents and grandchildren. These unpaid caring responsibilities have a knock-on effect on our employment, finances, physical and mental health, but there is a lack of help and support for the people taking on these roles. With increases to the retirement age, we must investigate what this will mean for work-life balance and ‘good’ employment conditions in mid- and later life.

Through our research examining health differences across different ethnic groups, we are also learning about the diverse economic and cultural needs of the older population. From this, we have learnt that a one-size-fits-all approach will not be sufficient.

As a result, our research has found that it is vital to strengthen the relationships between different generations if we are to reduce the public health burden. For example, we must find out how parents and adult children care for each other; what it is like to be a carer and how this affects paid work; and how younger and older people live together.

Are adult children more likely to care for their older parents if they have received some support from them earlier in life? Are parents with better-educated children healthier? We must understand how all of these societal factors, alongside personal and community relationships, work together to contribute to more robust and longer lives.

With this in mind, it is clear to me that, now more than ever, the government must take note of social sciences research, and how society is changing. Progress, economic and otherwise, is dependent on a healthy population. The implications for society going backwards are too great to ignore, not just in terms of life expectancy, but among the social, economic and wellbeing indicators that influence life expectancy.

I urge the government to respond on these terms, shaping policy that is holistic in embracing the complex, interwoven societal structures that have led to a stalling/decline of life expectancy.

The government proposes there is “still much more to do”. I agree. Still, it will take a bold government to look broader and deeper to heed the findings of the social sciences community, and to make the changes that are desperately needed by individuals, families and communities in order to thrive.”

Read the full report: Health equity in England: The Marmot review 10 Years on.

Posted 25/02/2020 17:01