The Marmot Review – 10 Years on

Introduction:

Very rarely that we get a review after ten years to measure the impact of an initial review. Sir Michael Marmot has done exactly this with The Health Foundation.

The review is important in how services work in partnership with each other, how services are commissioned and how data informs the commissioning.

It also identifies the need to resource and provide appropriate interventions.

We have written a small summary from the paper. Further information is available at The Health Foundation.

Context

The publication of “The Marmot Review – 10 Years On” is the kind of document that I dread to read. Despite all the changes and the political changes in healthcare during this period (2010 – 2020) has anything actually changed for the better? Are things changing across all our society or just parts? Do we have social equity across healthcare provision? Is there anything new that we need to learn from?

In 2010 Sir Michael Marmot published a review called “Fair Society Healthy Lives” (Marmot Review) which set out the causes of health inequality across England and what needed to be done to try and improve equality across the communities. One of the key factors in the review was the importance of social determinants of health acting through the life course.

In the Marmot Review, there were recommendations made across six domains:

• Give every child the best start in life
• Enable all children, young people and adults to maximise their capabilities and have control of 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.

The phrase ‘proportionate universalism’ was coined where a sliding scale of deprivation and health inequalities needed to be addressed, as a spectrum not as individual groups of individuals. Demanding that resources and services were at a scale and intensity that was proportionate to need. That services and resources were based on degree of need not an all or nothing approach or where specific groups of individuals or geographic areas were targeted/excluded.

Over the last 10 years what has changed?

We cannot deny 10 years is a significant period for changes to be made. Across the country we have seen changes based on austerity measures to recover from the financial crash which took place in 2008. So there has been significant social, economic and political changes which have directly impacted on the health of the population and health inequalities across England.

The austerity has seen the rolling back of public spending. This has led to reduction in interventions and at the same time social, economic and regional inequalities have widened. For the first time life expectancy has stalled, and in some areas reversed – particularly the North of England.

More than ever the relationship between deprivation and healthy life expectancy has been stronger. The poorer the area, the worse the health.

There is a clear social gradient in the proportion of life spent in ill health, with those in poorer areas spending more of their life in ill health, a life that is already shorter.

Healthy life expectancy has declined for women since 2010 and the percentage of life spent in ill health has increased for both men and women.

What is the solution?

The solution is around the investment in society to reduce the inequity across provision and resources on the appropriate gradient. The Health Equity in England report – The Marmot Review Ten Years on lays clear actions to the Government, Health and Local Authority leadership across areas. Start to focus on the health detriments and the social factors that affect health and the benefit to society becomes greater.

How does this relate to LivingCare Group?

LivingCare continue to champion healthcare that is based in the community and that healthcare is made up of social detriments and the impact that this has on individuals as patients within the healthcare setting.

LivingCare provide quick access as a principle. We always endeavour to offer patients appointments within the week to ensure that patients are not unnecessarily suffering, that it impacts their earnings or their social networks.

We work across various health networks and wish to increase the whole systems approach including strengthening the accountability for health inequalities.

We have been championing the impact that health has on an economy. The economic impact of waiting for diagnosis and treatment of conditions, the economic impact of long term conditions both on a financial and societal basis.

We do need to see more and will continue to push within the circles we can influence. Social Inequity is not appropriate when the health of future generations is at risk.

References:

The Marmot Review – Fair Society Healthy Lives

The Marmot Review – Health Equity in England (Ten Years On)

The full report is available here.