Alan Taman is Communications Manager for Doctors for the NHS and is completing a PhD on the public perceptions of health inequality solutions and policy engagement at Birmingham City University.
Austerity kills and its legacy will keep killing – unless government makes health and well-being the heart of its policy. That is one of the stark and uncompromising conclusions to be made from Michael Marmot’s Review, Health Equity in England: The Marmot Review 10 Years On, published earlier this week.
The original Marmot Review, published 10 years ago, was hardly happy reading: the gap in life expectancy between the richest and poorest and between least and most deprived regions was widening then. But at least we could all expect to live longer than our parents did, on average.
Not any more: a female child born in the poorest areas of England can now expect to live a shorter life than her mother, while life expectancy continues to increase for the most well off – but even that is visibly slowing, year on year. The life expectancy gap on average between the richest and poorest in England is now 9.5 years for men and 7.7 years for women.
The 2020 Review points out that the poorest areas have been the hardest hit since 2010, with cuts in funding to promote good health, improve the environment, and make working lives or surviving on benefits better for the least advantaged disproportionately affected. The number of years people can expect to spend in ill health also follows a social gradient, with the poorest not only leading shorter lives but spending more of that shorter life in ill health.
They live less and suffer more for it.
As Marmot himself put it:
“Not just increasing inequalities but actual decline in life expectancy. That’s not supposed to happen. We’ve got used to the fact that life expectancy and health improves year on year. That’s what we’ve come to expect, and it’s not happening any more.
“This is a health crisis. And if you accept the argument that health is telling us something fundamental about the nature of society, it’s a social crisis.”
England, as he puts in the Foreword, is faltering.
Marmot lays the blame firmly on the social and economic causes for ill health – there is no suggestion that this is down to ‘bad’ individual behaviours (though yes, they of course make a difference; just nowhere near the biggest).
The Review also gives clear areas for stopping the blight of health inequality. Giving every child the best possible start, enabling children and young people to achieve their best and have control, creating fair employment and good work for all, ensuring a healthy standard of living, and creating and developing healthy and sustainable places to live are outlined after carefully describing the underlying evidence.
The effects of climate change are linked to ill health for the first time, and addressing climate change is an explicit point of action.
But perhaps the most encouraging part of the Review is its boldest: Marmot and his team call on the Prime Minister to make addressing health inequality a key concern for government, and put well-being – not fiscal growth – at the heart of government policy.
But we’ve been here before. The first Marmot Review was published in 2010, coinciding with the end of the New Labour government, the launch of the Con-Dem coalition and the austerity which followed made matters far worse.
Will we, in 10 more years, look back on ‘Marmot 2020’ and ruefully conclude government has, yet again, done nothing to stop things becoming even worse? Marmot did not hesitate, during the launch conference of the Review, to lay his cards on the table:
“We have to make sure that we change the agenda, we take the action, that we don’t sit back and say “how will it come out?” We convince politicians, the policy makers, as well as our communities, that we are serving in the cause of social justice and health equity. And what greater cause could there be than that?”
This is a far and I would say welcome cry from the ‘detached’ academic stance of taking no political action. Marmot is saying, as he more than anyone is surely entitled to say and able to judge, ‘We must change this’.
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