As political parties prepare their manifestos, the Marmot review into tackling health inequality is timely. They should all "rise up" against inequalities.
As political parties prepare their election manifestos – and the Conservatives attempt a form of cross-dressing by claiming they are now concerned by inequality – Professor Michael Marmot’s evidence-based review into tackling health inequality is timely.
The World Health Organisation expert begins his government-commissioned review with a quotation from Chilean Nobel Prize for Literature winner and politician, Pablo Neruda:
“Rise up with me against the organisation of misery”
The review’s premise is that reducing health inequalities is a matter of fairness and social justice:
“There is a social gradient in health – the lower a person’s social position, the worse his or her health. Action should focus on reducing the gradient in health.”
It highlights six themes relevant to all government departments, including prioritising high quality early child development through public funding, and the need for adequate incomes to secure better health
The review finds that people living in the poorest neighbourhoods in England will, on average, die seven years earlier than people in the richest neighbourhoods, with the average difference in disability-free life expectancy between the richest and poorest areas at 17 years. Marmot has described as “absolutely dramatic” that life expectancy in England has improved 2.9 years in the past decade in the quarter of the population with the worst health.
Campaigners have welcomed the report but highlighted its challenges. Malcolm Clark of One Society said:
“your position relative to others matters as well as your absolute position. It is not good enough to simply focus attention on those at the bottom; improvements can only happen once there are fewer gaps between all sections of society.”
Yet the case for addressing inequality is not only about health. With the rate of growth necessary to reduce the national deficit while minimising cuts, an OECD study this week highlights that limited social mobility undermines both equal opportunities and economic growth. The UK is in a group lagging behind the Nordic countries, Australia and Canada, says the study.
We have had major reports – by Black and Acheson – on health inequalities before. The new development, however, is the Equality Bill, current going through Parliament. This will create a unified public sector requirement to promote equality in public policy, and a new public sector duty related to socio-economic inequalities.
Perhaps not quite what Pablo had in mind, but one to watch.
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