Childhood obesity and the Marmot phenomenon

When the Black Death swept through London in 1348, wiping out around a third of the population, differences in socio-economic status didn’t really matter. Chances were, you would be infected.

Today, however, England has some serious health inequalities, despite having one of the most equitable health systems in the world. One such example are the deep inequalities seen in prevalence of childhood obesity.  

Data from QualityWatch, our joint programme with the Nuffield Trust, shows that the overall proportion of children aged 4-5 in England who are obese has remained pretty stable from 2006-2013, while for children aged 10-11 there has been a slight increase (1.5%). However, studies from 1994-2003 show that the likelihood of childhood overweight and obesity increased by 8.1% per year. So this is progress.

However, there’s a glitch.

Firstly, by European standards we’re not doing so well. English children are some of the most overweight in Europe.

Secondly, not all children are benefitting equally from the recent trend. Data from the National Child Measurement Programme 2012/2013 show us that the most deprived 4 to 5-year-olds and 10 to 11-year-olds are twice as likely to be obese than the least deprived:

In fact, in some cases, obesity prevalence has been increasing for the most deprived children, while it has fallen for the least deprived. For example, between 2010 and 2013 for 10-11 year olds, obesity prevalence increased for the most deprived (from 23.7% to 24.7%), whereas it fell for the least deprived (from 13.8% to 13.1%). 

So although general trends show that we have made progress, beneath the surface, huge disparities in health remain. And as the proportion of working families living in poverty rises, this is only likely to get worse.

So, what can we do?

The earlier, the better

With childhood obesity, it’s crucial to intervene as early as possible (even as early as pre-pregnancy). It’s well-evidenced that early life conditions have a huge impact on health outcomes in later life – an obese child is more likely to become an obese adult. Being overweight or obese both influences and reinforces health inequalities, so it’s easy to see how the vicious cycle of health inequality continues down the generations.

We also need to make sure we aim interventions at all levels of society. Although it disproportionately affects disadvantaged children, childhood obesity also affects the rest of the social spectrum. Clearly, a ‘one size fits all’ approach is not going to work, and policy interventions must be tailored accordingly to the specific needs of communities.

Ultimately, we need a fundamental change at the population level on the scale of the culture shift we’ve previously seen for smoking and seat belt wearing. This will take time, but work to initiate this shift has already begun, and is rapidly gaining momentum (improving population health is an area the Health Foundation is moving into in 2015).

Above all, we must take action to close the already widening gap in prevalence of obesity between deprived and less deprived children. When it comes down to it, if we want to tackle childhood obesity, we need to tackle health inequality.

Tackling the causes of the cause

The good news is that we know how to do this. At the request of the Labour government in 2008, Michael Marmot produced Fair Society Health Lives (The Marmot Review). The report focuses on six main policy recommendations for reducing health inequalities:

• Give every child the best start in life
• Enable all children, young people and adults to maximise their capabilities and have control over their lives
• Create fair employment and good work for all
• Ensure a healthy standard of living for all
• Create and develop healthy and sustainable places and communities
• Strengthen the role and impact of ill-health prevention

These ‘Marmot Principles’ have become something of a phenomenon, and everyone seems to be jumping on board – from politicians and health organisations in the UK, to health commissioners in New York, Tunisia and Sweden. In London, for example, interventions range from Boris Johnson’s Health Inequalities Strategy to the Healthy London Schools model and the Healthy Workplace Charter. In Europe, Finland has recently had noteworthy success using Marmot’s ‘health in all policies’ approach.

In fact, these notions are so popular, a new catchphrase has been created, and some health experts now describe their research and recommendations as ‘Marmotian’.

However, although we are seeing hints of change across England, they are not systematic, nor is health inequality top of any of the main political parties’ agendas. And as we head towards the election, the main health debates are shaping up to be the role of the private sector, waiting time performance and NHS funding. Against this backdrop, health inequalities and health more generally will struggle to get the attention they deserve. Labour have produced a considered public health strategy, but in their 10 year plan for health, preventing ill-health features sixth out of six.

Children are among some of the most vulnerable groups in society, and they all deserve an equal chance at a healthy life. As Sir Michael rightly says: ‘Health is a human right. We need to do something. We need to do more. And we need to do it better.’

Natalie Lovell is a Policy Intern at the Health Foundation