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10 years after his landmark review of health inequalities in England, Director of the UCL Institute of Health Equity, Professor Sir Michael Marmot, has published Health Equity in England: The Marmot Review 10 Years On. The report confirms that, for the first time in over a century, life expectancy has failed to increase for a decade across the country. Furthermore, for the poorest 10% of women, life expectancy has in fact declined.
Health inequalities have widened overall over the last decade, and the amount of time people spend in poor health has increased since 2010.
The original report, Fair Society, Healthy Lives revealed the human cost of health inequalities.
The 10-year on review confirms an increase in the north/south health gap, where the largest decreases were seen in the most deprived 10% of neighbourhoods in the North East, and the largest increases in the least deprived 10% of neighbourhoods in London.
The 2020 review discounts the theory that the slowdown in life expectancy increase can be attributed solely to severe winters or flu. It shows that in excess of 80% of the slowdown, between 2011 and 2019, results from influences other than winter-associated mortality. In addition, the slowdown in life expectancy improvement in the UK is more marked than in most European and other high-income countries, except the USA. Deprived areas and areas outside London and the South East have experienced larger cuts.
The review demonstrates that health is closely linked to the circumstances in which we are born, grow, live, work and age. Large funding cuts, under the banner of austerity, have had an adverse effect. The review highlights that our health is not just a matter of how well the health service is funded and functions.
Key findings include:
- The more deprived the area, the shorter the life expectancy. This social gradient has become steeper over the last decade, and it is women in the most deprived 10% of areas for whom life expectancy fell from 2010-12 and 2016-18.
- There are marked regional differences in life expectancy, particularly among people living in more deprived areas.
- Child poverty has increased (22% compared to Europe’s lowest of 10% in Norway, Iceland and The Netherlands); children’s and youth centres have closed; funding for education is down.
When health stops improving it is a sign that society has stopped improving. Evidence from around the world shows that health is a good measure of social and economic progress. When a society has large social and economic inequalities there are large inequalities in health.
Despite the cuts and deteriorating outcomes, some local authorities and communities have established effective approaches to tackling health inequalities. There is considerable technical and practical experience about how to reduce health inequalities learned from some local areas and other countries. Government action is needed to build on these success stories.
Professor Sir Michael Marmot said: “This damage to the nation’s health need not have happened. It is shocking. The UK has been seen as a world leader in identifying and addressing health inequalities but something dramatic is happening. This report is concerned with England, but in Scotland, Wales and Northern Ireland the damage to health and wellbeing is similarly unprecedented.
“Poverty has a grip on our nation’s health – it limits the options families have available to live a healthy life. Government health policies that focus on individual behaviours are not effective. Something has gone badly wrong. We will be monitoring and reporting on inequalities in health and expect the government to listen.”
Dr Jennifer Dixon, Chief Executive of the Health Foundation, which commissioned the report, said: “We urgently need a new national health inequalities strategy, backed by investment in the factors that have the most powerful impact on health such as early years and youth services, housing, education, social security and good quality work.”