Tackling health inequality means tackling its root causes
A YouGov survey shows that health is one of the biggest issues the country is facing, second only to the economy. Seventy-five per cent of those surveyed believe that the government should spend more money on the NHS.
The main political parties understand that the public will vote with their feet to get better health and social care services. One of Labour’s five missions to drive change, should it form the next government, is to get the NHS back on its feet.
Last week Labour leader, Sir Keir Starmer, and Shadow Health Secretary, Wes Streeting, elaborated on their plans, with a focus on tackling the huge waiting list backlog. While these proposals will garner the immediate headlines, there is also a pressing need to tackle the far wider issue of health inequality and the underlying causes that are its heart, particularly in the most deprived communities.
The Labour Party has already pledged to make England ‘a Marmot country’, acknowledging that real change will only come from addressing the systemic weaknesses that undermine the nation’s health, especially that of the poorest.
It will build on the approach of the nine existing ‘Marmot places’, named after Professor Sir Michael Marmot and covering more than 40 local authorities - Coventry, Manchester, Leeds, Cheshire and Merseyside, Lancashire and Cumbria, South West of England, Waltham Forest, Luton and Gwent - where action is being taken to improve health and reduce health inequalities by tackling the social inequalities that influence them.
Professor Marmot has expressed the hope that the next government will make tackling the problem a priority but has warned that it will require action on all the social determinants of health, including improving housing, education and employment opportunities.
Marmot has long advocated that health inequality can only be effectively addressed by understanding its root causes and that where you live matters much more if you are poor, as it is hugely impacted by geographic region as much as by socio-economic status. His seminal report, Fair Society, Health Lives, in 2010 highlighted that people in England dying prematurely every year as a result of health inequalities would have enjoyed up to 2.5 million extra days of life if they had not experienced those inequalities.
His follow up review ten years later found that health inequalities had widened even further. He recently launched a £3m equity fund with the Institute of Health Equity and investment group, Legal & General, to tackle the link between economic deprivation and poor health.
The pandemic was a stark reminder that our health is largely shaped by our environment. People living in the poorest communities were hit the hardest, with higher mortality rates and more negative economic and social outcomes.
The cost-of-living crisis impacted these same communities, exacerbating the health inequalities that already existed. A new government will need to deliver a joined-up, long-term strategy if it is to see effective results although, inevitably, there will be no quick fix to these endemic problems. A shared sense of purpose from local authority and NHS leaders can help them develop local solutions tailored to their own communities, often using tried and tested local partnerships.
Many are already responding with innovation and ambition, with the nine Marmot areas good examples of a place-based approach. The Purpose Coalition is collaborating with organisations from the public and independent healthcare sector, local authorities and businesses to shape a constructive way forward that is not just focused on health but seeks to break down all the barriers that stand in the way of health equality and equality of opportunity more widely.
