Michael Marmot recently described it as ‘no coincidence’ that the Grenfell fire took place in an area with the highest income and life expectancy gap in the country. Such an assertion sparks questions about why such inequalities persist, after efforts to address them over many years?

This is the question I have been trying to answer for the Health Foundation over the last six months – as well as trying to identify what action we could take, in partnership with others, to improve the factors that shape our health known as the social and economic determinants. This includes our housing, education, employment, and our physical and social environment.

Work on the social determinants of health has been underway for decades – this is not something new. The Marmot Review has contributed to increasing recognition of the impact of the wider determinants of health, and to over 70% of local authorities in England working towards implementing its six recommendations for action. As Michael reminded us in his recent blog for the Health Foundation, these six recommendations are:

  • early child development,
  • education
  • employment and working conditions
  • minimum income for healthy living
  • healthy and sustainable places to live and work
  • taking a social determinants approach to prevention.

We have reached four main conclusions about progress to date:

  1. While the evidence demonstrates that as little as 10% of our health is determined by our access to health care, this is not widely understood by members of the public or professionals outside of public health. We are hoping to raise awareness through our recent infographic on what makes us healthy.
  2. There has been progress in addressing factors that impact on health, with many examples of good practice, but overall it is patchy and requires scale.
  3. The focus on this agenda is often for different and disconnected purposes. Some people, groups or organisations might be working on inclusive growth, and others on social mobility, or workplace engagement. All of these will be delivering on many of the Marmot recommendations. The question is whether, if we did more to make explicit the relationship between these issues and people’s long term health, we may collectively have more impact.
  4. As I know from experience, if you are trying to tackle these complex issues locally, it can feel overwhelming. It requires joint solutions and a long-term view. Within a context of shrinking resources and ‘space’ to build partnerships (particularly community-led ones), there is often a lack of capacity, know how, and levers to create change.

In thinking about a way forward, we have taken inspiration from the Robert Wood Johnson Foundation in the US. They have made a 10-year commitment to creating a ‘culture of health’. To support this, they have developed an Action Framework, which combines a wide range of actions, and includes a focus on changing mind-sets and expectations to make health a ‘shared value’.

This focus is an area where our Healthier lives for people in the UK strategy identified a gap in action in the UK. Our belief is that we will only tackle the rising public health challenge in the UK by aligning purpose and action across all sectors of society. We are delighted that eight national organisations – representing the interests of the public sector, business and civil society – have agreed to explore the scope for collaboration in order to: 

  • translate and link the wealth of existing data and evidence, so that it provides insights, and is acted on beyond the sector that has generated it.
  • amplify these insights through sustained communications efforts to reach new audiences and generate new connections, particularly at local level.
  • provide access to support on the know-how of change.

To make the most of this collaboration, we’re now looking for an organisation to facilitate a co-design process over a six month period, starting in early November 2017. This will continue to build a sense of shared purpose among the participating organisations, surface ambitions, and facilitate a collective discussion on potential next steps. Through this process, we aim to build some mutually beneficial activities that increase collective understanding and action on the wider determinants of health.

This guest blog was contributed by Emma De Zoete, a Senior Fellow for the Health Foundation from October 2016 to July 2017.

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Wael Arab



You failed to mention that some people are ignored by local councils and by the NHS when they report failures in their services. Those people are usually taken around in costly and time wasting correspondence for months and years by the parties that are supposed to be looking after us and who also seem to be unaccountable to any one. And I can name some.



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