Analysis by DrNaeem Aziz, RCP London SAS Lead & Council member.
The Marmot Review, titled Fair Society, Healthy Lives, was published in 2010 and comprehensively analysed health inequalities in England. It emphasised that social determinants—conditions in which people are born, grow, live, work, and age—significantly influence health outcomes. The review proposed six policy objectives to reduce health disparities:
- **Give every child the best start in life.
- **Enable all children, young people, and adults to maximise their capabilities and control 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.
In 2020, a decade after the original publication, the Marmot Review 10 Years On assessed progress toward these objectives. The findings indicated that health inequalities had not only persisted but, in many cases, worsened. Key observations included:
- Stagnation in Life Expectancy: For the first time in over a century, life expectancy had plateaued, with a decline observed among the most deprived communities, particularly for women. Health.org.uk
- Widening Health Inequalities: The gap in health outcomes between affluent and deprived areas has increased, with people in poorer regions experiencing more years of ill health. Health.org.uk
- Impact of Austerity: Public spending cuts, especially in local government services, were linked to deteriorating social determinants of health, such as housing, education, and community resources. BMJ
Policy Changes Since the Marmot Review
Since the 2010 review, successive UK governments have implemented various policies impacting health inequalities:
- Health and Social Care Act 2012: This legislation restructured the NHS, emphasising competition and greater autonomy for healthcare providers. Critics argue that it led to fragmentation and diverted focus from addressing social determinants of health. Wikipedia
- Austerity Measures: Post-2010, significant reductions in public spending affected services crucial for health equity, including social care, education, and housing. These cuts have been associated with widening health disparities. BMJ
- Recent Initiatives: In 2024, the government announced plans to reform social care, aiming to establish a “National Care Service” integrated with the NHS by 2028. While this indicates a commitment to addressing systemic issues, the extended timeline has drawn criticism amid immediate needs. Reuters
Impact on Devolved Nations: Wales, Scotland, and Northern Ireland
Health policy is a devolved matter in the UK, allowing Wales, Scotland, and Northern Ireland to develop tailored approaches:
- Scotland: The Scottish Government has prioritised reducing health inequalities through policies focusing on early childhood, fair work, and community empowerment. Despite these efforts, challenges persist, and health disparities remain significant. JSTOR
- Wales: Wales has implemented the Well-being of Future Generations (Wales) Act 2015, aiming to improve social, economic, environmental, and cultural well-being. While the act provides a framework for addressing health determinants, tangible reductions in health inequalities have been limited. JSTOR
- Northern Ireland: Facing unique challenges, Northern Ireland has seen debates over welfare reforms and their implications for health equity. The region’s political landscape has influenced the implementation and impact of policies addressing social determinants of health. The Times
Conclusion
Despite the Marmot Review’s comprehensive recommendations, progress in reducing health inequalities over the past decade has been insufficient. Austerity measures and systemic changes have often exacerbated disparities. While recent policy initiatives signal a recognition of these issues, their effectiveness will depend on timely and sustained implementation, focusing on the social determinants of health across all UK nations.
