Rising health inequalities in England

26 February 2020

Tuesday 25 February saw the launch of Sir Michael Marmot’s second report on inequalities, ten years on from his 2010 review, Fair Society Healthy Lives.

The Marmot Review 10 Years On contains powerful and unsettling messages about the health of the population in England. Health is getting worse for people living in more deprived districts and regions, health inequalities are increasing and, for the population of England as a whole, health is declining. "If health has stopped improving it is a sign that society has stopped improving. When a society is flourishing, health tends to flourish."

The review sets out how growth in life expectancy has slowed dramatically since 2010. The last decade has seen the weakest growth in life expectancy since 1900. For the most deprived communities outside London it has actually gone into reverse, with the gap between those living in rich and poor areas widening. On average people are spending longer in poor health, particularly those in the most deprived areas.

Marmot sets out how life expectancy follows the social gradient. The more deprived the area, the shorter the life expectancy. Among women in the most deprived 10% of areas, life expectancy fell between 2010-12 and 2016-18. The largest increases in life expectancy occurred in the least deprived 10% of neighbourhoods in London – creating a widening of the inequalities gap overall.

The health of the population is not just a matter of how well the health service is funded and how well it functions, important though that is. Health is closely linked to the conditions in which people are born, grow, live, work and age, and to inequities in power, money and resources – the social determinants of health. The Marmot Review makes a compelling case for the importance of action on the social determinants of health to reduce avoidable health inequalities.

Marmot contrasts England with other countries, and says that the slowdown in life expectancy cannot be attributed to severe winters, nor solely to problems with the NHS or social care, although declining funding relative to need has undoubtedly played a part. Broader funding cuts have created worsening social and economic conditions right across England, but with the most severe effect in the most deprived regions. Failure by governments to address the social determinants of health gives rise to these profound and alarming changes in the nation’s health.

The Marmot Review sets out recommendations for government to address six priority areas which cover stages of life, healthy standards of living, communities and places, and prevention of ill-health. The government is urged to prioritise action through an ambitious, high-visibility health inequalities strategy, which brings the level of health of deprived areas in the north of England up to the level of good health enjoyed by people living affluent areas in London and the South.

The BGS will follow developments as the Marmot findings are publicly debated and will provide further information to BGS members over the coming months. BGS members encounter the differential effect of health inequalities on the health of the older people they see every day in primary, community and acute care. The BGS will add its policy voice to the call for government action to level up the health and wellbeing of the population. We will also contribute to the Inequalities in Health Alliance, being established by the RCP.