I am writing to you following my question in the House. You suggested that I write to you in order to receive a detailed response to my question, which asked if the Government would commit to the creation of a cross government, cross party strategy, led by the Prime Minister, to address health inequalities as part of the coronavirus recovery, as recommended by the Marmot Review.
I must say that I was surprised by your admission that, in your role as Equalities Minister, you had not read the Marmot Report or his review earlier this year, even more so that you appeared not to have heard of it. I appreciate that Equalities Minister is not the only brief that you hold, however Professor Marmot’s reports are key contributions to the debate and if the Government is to truly commit to tackling health inequalities, then they are essential reading.
In order to help you answer my question, I wanted to offer some detail on Professor Marmot’s work, although I would thoroughly recommend that you read both the 2010 report and the 2020 review in full. This context will hopefully help explain just why these contributions are so valuable.
In 2008, Professor Marmot was asked by the then Health Secretary to chair an independent review designed to propose solutions, based in evidence, to tackle health inequalities in England. His report, ‘Fair Society Healthy Lives’ was published in February 2010 and was well-received on all sides of the political spectrum, as well as across local authorities and the NHS.
The report concluded that for health inequalities to be reduced, the focus must be on six policy objectives:
• 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 healthy standard of living for all;
• Create and develop healthy and sustainable places and communities;
• Strengthen the role and impact of ill-health prevention.
A decade later, the Health Foundation commissioned a review into whether progress had been made since Professor Marmot’s initial report. Its findings were damning. After ten years of Conservative Government, life expectancy had stalled for the first time in a century. In more deprived areas, life expectancy had actually fallen, especially for the least well-off women in society. In addition to this, the health gap had grown between the most deprived and the wealthiest areas. Perhaps the most significant finding of the review was that where someone
lives has a massive impact on their health throughout their life. For example, someone who lives in a deprived area of the North East will likely have poorer health than someone living in a similarly deprived area in London. It is incredible that a public health postcode lottery still exists in 2020.
The review suggests that these issues cannot be solved simply through a well-funded health service, although that is an important element. Instead it demonstrates that health and life expectancy are linked to the conditions in which people are born in, develop in, live in and work in. Or as Professor Marmot so eloquently puts it, ‘What good does it do to treat people and send them back to the conditions that made them sick?’
A reason that Professor Marmot gives for this growth in health inequality is the effect of large-scale funding cuts on the ability of local government to adequately tackle the causes of health inequality. What makes this worse is the fact that these cuts were inequitably distributed and the areas where inequality is highest have not received the required support. Unfortunately, the Government has persisted with this practice by altering the coronavirus relief funding formula so that resources for local authorities were assigned according to population rather than need.
Professor Marmot suggests that the Government should aim to increase the standard of health in deprived areas in the North to the levels of good health that exist in the most affluent areas of the South. For this to happen, there must be action taken across Government, and across party, as well as a funding review that ensures that resources are more equitably distributed in terms of need.
Whilst you said in the House that you will never tire of saying that levelling up is a priority of the Government, for the Government to truly move on from their damaging policy of austerity, then they must do more than promise to ‘level up’. Instead, the Government must actively tackle the socio-economic causes of health inequality and, as a first step, engage seriously with the recommendations of the Marmot Review. We simply cannot continue with a society where you are born into unequal life chances, and where you live so fundamentally determines your health.
I hope this short introduction to the work of Professor Marmot has been useful, however I would urge you again to read his work for yourself. I am sure it will serve you well in your brief.
I look forward to hearing whether the Government will commit to Professor Marmot’s recommendations, especially as to whether the Prime Minister intends to lead a cross-Government, cross-party strategy, aimed at tackling health inequalities as part of the coronavirus recovery.
I await your reply with interest.
Mary Kelly Foy MP
Member of Parliament for the City of Durham