Poverty kills: my reflection on 10 years of the Marmot review

“England has lost a decade.”

That was the conclusion of Sir Michael Marmot on this week’s publication of his review of the government’s attempts to tackle inequalities in health over the last 10 years. In particular, his review is scathing of the government’s lack of action on the recommendations of his landmark report, Fair Society Healthy Lives. The longevity and intensity of austerity imposed by the government over the last decade has meant they have utterly failed to address the link between deprivation and health inequalities.

Some of the key findings of the review should make for deeply uncomfortable reading for national policymakers:

  • For the first time since 1900, increases in life expectancy have stalled.
  • Life expectancy is strongly linked to your social and economic circumstances – the more deprived the area, the shorter the life expectancy.
  • In the 10% most deprived areas in England, life expectancy for women has fallen.
  • The difference in healthy life expectancy is even sharper – people in more deprived areas live shorter lives, and spend more of that time in ill-health than those living in more affluent areas.

This is a huge social injustice. It makes a mockery of the Prime Minister’s Brexit-driven boasts about Britain being the sixth largest economy in the world. How can a country that fails to lift its population out of poverty, take on the world?

The report sets out clearly how poverty and deprivation affect people’s health:

“Living in poor quality housing, being exposed to poor quality environmental conditions, poor quality work and unemployment, not being able to afford nutritious food and sufficient heating for example all impact on health. Poverty is also stressful. Coping with day-today shortages, facing inconveniences and adversity and perceptions of loss of status all affect physical and mental health in negative ways.”

To put it bluntly, when we plot differences in life expectancy and health outcomes against deprivation, one trend becomes clear:

Poverty kills.

This is not just an issue of social justice: an unequal, fragmented and unwell population means an unequal, fragmented and unwell workforce. It’s bad for the economy. It’s bad for democracy.

The original Marmot review challenged public services, community groups, and local and national leaders to reduce health inequalities by focusing work on six areas:

  • 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 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

Where leadership from national government has been found wanting on these six themes, Bristol has stepped up. As Marmot says, “some local authorities are leasing the way in demonstrating how to make local and regional approaches to reducing health inequalities both practical and effective and there is much for national government to learn.”

Marmot’s praise for local authorities like Bristol is all the more remarkable given we have delivered this under a government that has imposed austerity policies that have generated the conditions that have driven demand. In the face of crippling budget cuts, political instability which constantly undermine our ability to plan for the long-term, Bristol has put the principles for a healthier population at the heart of what we do.

Delivering affordable, high-quality and sustainable homes in balanced communities across the city; investing in the dramatic transformation of our transport network to connect people to people, people to jobs and people to opportunity; keeping all of our children’s centres open and safeguarding the future for our library service; supporting Feeding Bristol to provide nutritious meals so families don’t go hungry in the school holidays; preserving green space, and developing opportunities to take up sport and physical exercise; bringing city partners together to harness the whole city’s energy to agree and achieve the vision of a One City Plan.

These are all steps we have taken to unlock inclusive economic growth, empower people and communities to shake off entrenched poverty, and improve health outcomes so people can enjoy longer, healthier and more independent lives.

Yet they are all steps that need to be taken on a bigger journey. National government needs to face up to the reality that we in local government have been grappling with for the past decade – that austerity, and the poverty it engenders, is bad for all our health.

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