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Ten years ago, Professor Sir Michael Marmot published his seminal review of health inequalities in England: Fair Society Healthy Lives. The Marmot review, as it became known, had a profound impact on how people think about health inequalities and many local areas have taken action on the principles it set out. But we have not seen the comprehensive action across government needed to make real progress on the underlying drivers of health inequalities –  the circumstances in which we live. From the support we receive during our early years to our working conditions, housing, and local communities later in life, these circumstances (known as the wider determinants of health) have powerful impacts on our health. 

We commissioned Michael Marmot’s team at the Institute of Health Equity to follow up on their 2010 report. Health Equity in England: The Marmot Review 10 Years On paints a stark picture. We are set to see the weakest decade of improvements in life expectancy for over 100 years and for some people in the most deprived areas, life expectancy is actually declining. We are also seeing an unacceptable decline in the number of years that some people can expect to live in good health. 

Overall it shows that regional and socioeconomic differences in health are large and growing, with major implications for the nation’s wellbeing and economic potential. 

Time to ‘level up’

So, what needs to happen to change those trends? The government has it within their power to show leadership on this. 

Boris Johnson’s government has secured a historic Conservative majority, gaining new seats across ‘red wall’ areas in the Midlands and North of England. Our analysis of healthy life expectancy has shown that people living in many of these newly won constituencies are at the sharp end of health inequalities and it is their future health that will bear the brunt of any failure to act. Levelling up the country requires action to close the gap in the number of years people can expect to live in good health.

Some important promises have been made by the new government. This includes a continued commitment to ensuring an extra 5 years of healthy life expectancy by 2035 and an aim to close the gap between the experience of the richest and poorest. New spending rules being drawn up by the Treasury are also expected to have a greater focus on improving the wellbeing of people in low-income areas.

To level up the country as Boris Johnson’s government aims to do, it will need to go further in order to address the factors that have the strongest influence on people’s health and wellbeing, including social security, children’s services, housing, education and the quality of work.

The need for cross-government action

The new Marmot report calls for an ambitious cross-government health inequalities strategy, backed by a cross-departmental Committee with Cabinet-level accountability. 

The government should act now to implement a package of policies over the next 5 years that will lay the foundations for sustainable improvement over the long-term. This needs to be underpinned by investment in preventative spending and government should begin to track preventative spend and set targets for increasing it. Areas which need immediate investment include the public health grant to local authorities and early years services such as Sure Start.

A national health inequalities strategy will also be more likely to succeed if it is supported by legislation and policy-making processes that are designed to allow long-term decision-making. As outlined in our Creating healthy lives report, this could include:  

  • Adopting a legislative framework, along the lines of the Well-being of Future Generations Act for Wales, designed to encourage long-term joined-up action across all aspects of government policy and spending that can promote good health;
  • Changing the way success is measured, moving beyond GDP and evaluating policy on the basis of health and wellbeing as a primary measure of successful government. Here the UK can learn from the Wellbeing Budget adopted in New Zealand.

What can we do to safeguard future generations?

In this edition of our newsletter, we look to the future and consider some of the things we can do now to safeguard the health and wellbeing of future generations.

  • Learning from Wales: In 2015, the Well-being of Future Generations (Wales) Act enshrined in law a vision to create a Wales that supports wellbeing now and in the future. Five years after the Act was first passed, we talked to Sophie Howe, the Future Generations Commissioner for Wales, about the difference the Act has made. 
  • Focusing on young people: In October last year we published the final report from the Health Foundation’s Young People’s Future Health Inquiry, which set out a range of factors that are putting today’s young people at risk of ill-health later in life. These findings are explored in more detail in this blog by Martina Kane.
  • Making economies work for everyone: Economic growth has sometimes been seen as a good in its own right but there is growing recognition that some types of economy are better for health than others. Yannish Naik and Isabel Abbs look at how economic development strategies can be used to improve health and reduce health inequalities. 


Tim Elwell-Sutton (@tim_esPH) was Assistant Director of Strategic Partnerships in the Healthy Lives team at the Health Foundation. 

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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