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|The Marmot Review: Fair Society, Healthy Lives|
With few exceptions, the lower an individual’s socioeconomic position, the worse their health. Tackling inequality in health requires addressing disparities in income, education and well-being across society, finds a report by the Marmot Review.
16th February 2010
11th February 2010 - The Marmot Review
1. Reducing health inequalities is a matter of fairness and social justice. In England, the many people who are currently dying prematurely each year as a result of health inequalities would otherwise have enjoyed, in total, between 1.3 and 2.5 million extra years of life.
2. 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.
3. Health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health.
4. Focusing solely on the most disadvantaged will not reduce health inequalities sufficiently. To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. We call this proportionate universalism.
5. Action taken to reduce health inequalities will benefit society in many ways. It will have economic benefits in reducing losses from illness associated with health inequalities. These currently account for productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs.
6. Economic growth is not the most important measure of our country’s success. The fair distribution of health, well-being and sustainability are important social goals. Tackling social inequalities in health and tackling climate change must go together.
7. Reducing health inequalities will require action on six policy objectives:
—— 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 healthy standard of living for all
—— Create and develop healthy and sustainable places and communities
—— Strengthen the role and impact of ill health prevention
8. Delivering these policy objectives will require action by central and local government, the NHS, the third and private sectors and community groups. National policies will not work without effective local delivery systems focused on health equity in all policies.
9. Effective local delivery requires effective participatory decision-making at local level. This can only happen by empowering individuals and local communities.
12th February 2010 - Eilís Lawlor, The Guardian
Successive reviews and reports have consistently told us two things: that we live in an increasingly polarised society and that this is damaging to our social wellbeing. The latest – yesterday's Marmot review – supports a widely held view that inequalities of health, education, income and opportunity are all inter-related, and that better education leads to longer, healthier lives, and educational attainment itself is affected by income inequality.
Sir Michael Marmot was commissioned to review health inequalities but his recommendations range from investments in early years to an increase in the minimum wage. This comes hot on the heels of the National Equality Panel report on income inequality and the launch of policy positions by all three political parties on the issue. Inequality is no longer an embarrassing legacy of old Labour; instead, all three parties are now falling over themselves to profess their concern. This raises an intriguing question: after decades of tolerating the rise and maintenance of high inequalities, do we now face the prospect of an election fought around the issue?
Social problems are often economic in their origin, and reforming the system itself is the most powerful policy tool that we have at our disposal. A truly preventative approach starts with the structures and institutions that shape our lives: the destabilising income inequalities, the spatial concentrations of unemployment and poverty, the focus on growth as a proxy for social welfare to the neglect of other outcomes.
Late last year we at the new economics foundation produced a report that looked at the economic case for investing in early years. We calculated that by 2030 savings of about £400bn could be made in return for big investments now in universal childcare, extended parental leave and a holistic suite of preventative services. The response from policy-makers and commentators was that it was "too ambitious". It is a sobering thought that it is too ambitious for one of the world's biggest economies to aim for outcomes for children similar to its less well off European neighbours.
Inequality is not inevitable. But in the absence of countervailing forces trends such as globalisation, changing demographics and family structure will increase it. Yet, other countries manage to counteract these forces, whether it's childcare in Sweden, education in the Netherlands, or land redistribution in South Korea. Labour has of course tried (a bit), and it has identified many of the right points of intervention. The problem is that it either didn't go far enough (not indexing the minimum wage to incomes) or it left key drivers untouched (industrial policy).
Tackling inequality, at least in the public imagination, is overly synonymous with redistribution through the tax and benefit system. Discussion of the forces that influence different wages is notably absent, which might suggest that people think that the pre-tax distribution of incomes is broadly speaking "fair". But the fact that a senior banker can earn 4,400 times what a nursery worker earns is not fair and is not an accident. It is in opening up this debate and in helping to highlight the determinants of inequality that the Marmot report is so welcome. The research is in, the arguments have been won, now it is time to act on them.
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