This document summarizes the key recommendations from The Marmot Review report on reducing health inequalities in the UK. The review calls for action across six policy objectives: 1) giving every child the best start in life, 2) enabling all people to maximize their capabilities, 3) creating fair employment, 4) ensuring a healthy standard of living for all, 5) creating healthy and sustainable communities, and 6) strengthening illness prevention. It emphasizes that reducing the social gradient in health requires proportionate universal action and participatory local decision-making.
3. Key themes
•Reducing health inequalities is a matter of
fairness and social justice
•Action is needed to tackle the social gradient in
health through ‘proportionate universalism’
•Action on health inequalities requires action
across all the social determinants of health
•Reducing health inequalities is vital for the
economy, the cost of inaction
•Effective local delivery requires effective
participatory decision-making at the local level.
9. Policy Objective A
Recommendations
• Increase proportion of expenditure
allocated to early years
• Support families (pre and post natal,
parenting, parental leave, transition points)
• Quality early years and outreach
10. POLICY OBJECTIVE B
Enable all young people, children and adults
to maximise their capabilities and take
control over their own lives
11.
12.
13. Policy Objective B
Recommendations
• Continued priority to reducing inequalities
in education outcomes
• Prioritise inequalities in life skills (whole
child approach, full service schools,
workforce)
• Increase access and use of quality lifelong
learning (16-25 yr old support, work based
learning, non-vocational courses)
18. Policy Objective C
Recommendations
• Prioritise active labour market
programmes
• Quality of jobs improved (equality
legislation, well being, stress and mental
health at work)
• Security and flexibility of employment
(retirement and people with poor health
and caring responsibilities)
25. Policy Objective E
Recommendations
• Combining policies to mitigate climate
change and health (active travel, green
space, food environment, energy
efficiency)
• Integrate planning, transport, housing
environmental and health systems
• Regeneration based on reducing social
isolation and remove barriers to action
28. Policy Objective F
Recommendations
• Prioritise investment – up from 4% of NHS
budget
• Medicalise drug treatment
• Gradient in smoking, obesity and alcohol
• Public Health - social determinants
29. Local Delivery and Indicators
• Framework for indicators
• Local practitioners want principles for action
rather than specific recommendations
• Develop locally appropriate plans
• Develop local performance improvement
framework
• Systematic approach to engaging communities
through the development of LSPs
• Commissioning, employment, planning, adult
social care and children’s services.
Proportionate universalism: actions that are universal, but with a scale and intensity that is proportionate to the level of disadvantage.
Economic growth is not the most important measure of a country’s success. The fair distribution of health, well-being and sustainability are important social goals.
We were always told that our recommendations would be expensive, a comprehensive cost-benefit model of reductions in health inequalities does not exist. We calculated ‘the cost of doing nothing’: 1.3 to 2.5 million extra years of life; productivity losses of £31-33B; reduced tax revenue and higher welfare payments of £20-32B; increased treatment costs well in excess of £5B.
Delivering the Review’s policy objectives will require action by central and local government, the NHS, the third and private sectors and community groups.
Effective local delivery can only happen by empowering individuals and local communities.
- Components of the framework: life course, social determinants, health outcomes, including wellbeing.
We have developed an indicators framework, including process, output and outcome indicators.
Up to local practitioners to select targets after strategic needs assessment and prioritisation.
Monitoring must be aimed at measuring the impact on the social gradient.
- Locally appropriate plans through SCS, JSNA, LSPs, LAAs, CAAs
Role of local government:
- Opportunity to tackle cross-cutting issues through the Local Performance Framework
- Well placed to lead on partnerships
- Commissioner of Services
- Democratic/community engagement
- Community safety and place shaping (planning)
- Could act as model employer
- Provider of adult social care and children’s services, as well as leisure services.