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Marmot offers vision to cut health inequality

Moves to address health inequalities must take priority over politics

OnMedica staff

Thursday, 11 February 2010

Health professionals have called for health promotion to take priority over politics following the publication today of Fair Society, Healthy Lives. The ‘Marmot Review’ is an independent review outlining the most effective strategies for reducing health inequalities for the next 10 years and beyond.

Professor Sir Michael Marmot, of University College London, was commissioned by the Government to provide a clear set of short-, medium-, and long-term objectives to inform how health inequalities can be dramatically reduced.

His review is critical of the poor record of policy success in tackling health inequalities and advocates two aims: to improve health and wellbeing for all and to reduce health inequalities. To achieve these he says social justice, health, and sustainability should be at the heart of all policies.

But David Hunter, professor of health policy and management at Durham University, and his colleagues question on bmj.com whether “there is sufficient genuine and sustainable political will to tackle health inequalities”. Reducing health inequalities is not a vote-winning policy, they warn, and “although the report is at pains to point out, as others have, that we are all adversely affected and our lives diminished by the growing health gap, this message could easily get lost.”

They outline three reasons for the lack of progress. The first is a focus on individual lifestyle interventions rather than government action.

The second – an ingrained inability to coordinate policy and delivery across government – is, they argue “evidence of how fossilised our institutional structures have become and how incapable they are of providing effective solutions to the complex problems we face.”

The third reason for policy failure, they say, is politics. “With the economic outlook bleak and an election looming, the temptation will be for politicians to say that we can’t afford to deal with health inequalities just yet. The imperative is to show that we can't afford not to.”

The policy changes needed for Marmot’s recommendations to succeed can occur only if these three obstacles to progress are confronted, they conclude. Underpinning these must be a real political commitment at all levels.

Authors of an Editorial in The Lancet concur with David Hunter and colleagues. They argue that health equity must become a fundamental principle underlying national and local policies for health delivery and that “actions must be proportionate to the degree of disadvantage, and hence applied in some degree to all people, rather than applied solely to the most disadvantaged.”

They point out that inequalities in health are directly related to inequalities in society and “the conditions in which people are born, grow, live, work, and age”. Those who live in the poorest areas of England die, on average, 7 years earlier than people in the most wealthy areas and the average difference in disability-free life expectancy between the poorest and richest areas is 17 years.

The Lancet reviewers conclude: “The question for political parties in the UK is to what extent they adopt the objectives outlined by Marmot as their blueprint for social, and therefore health, policy. The Marmot Review is a pivotal document for future policy on health equity. The question for voters later this year in the UK’s general election is what sort of society do they want?”

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