The Marmot Review 10 Years On report has made for shocking reading.
Professor Sir Michael Marmot has revealed the extent to which health has deteriorated and inequalities widened in England over the last decade, driven by significant social and economic changes.
His findings have particular bearing for us in the north of England. People and communities here have been particularly impacted by these changes and the deep public spending cuts that have contributed to them.
In Greater Manchester, over one million people live in areas among the 20% most deprived in England.
These are exactly the areas that Sir Michael found had seen highest decreases in Government spending.
And the more deprived an area, the shorter the life expectancy.
So in Greater Manchester men in our most deprived areas can expect to die 12.6 years younger than those in our least deprived, and women seven years earlier.
Life expectancy – which is already lower in the north than the south – is falling fastest in these most deprived areas.
And inequalities in life expectancy have increased in particular for women.
This is unfair, unjust and unacceptable.
But the report does offer some grounds for optimism, with Sir Michael showing how local authorities and communities can take positive actions to overcome these significant challenges.
The good news for Greater Manchester – as highlighted in a detailed evaluation case study published alongside the report – is that, thanks to our series of devolution agreements with central government and our strong tradition of collaboration, we have been able to start taking effective action to reduce health inequalities.
As our Mayor, and previous Health Secretary, Andy Burnham has explained: “As Secretary of State for Health, you can have a vision for health services. As Mayor of Greater Manchester, you can have a vision for people’s health. There is a world of difference between the two. Devolution holds the key to breaking down the silos between public services and moving from a picking-up-the-pieces to a preventative approach.”
Becoming the UK’s first Marmot city region is central to our approach to make the most of this opportunity available to us.
We will put into practice the report’s recommendations by working across all public services in our city region to ensure that policies, approaches and resources are geared towards creating a fairer, more equal society.
This means placing improved health and reduced inequalities at the centre of how we develop our approaches to early years, education and skills, transport, housing, places and spaces, and jobs and businesses.
The actions we have already taken since our 2016 devolution have provided the bedrock for this new way of working. Our Taking Charge plan, our population health plan and the wider Greater Manchester strategy brought together multiple partners to address some of the key factors for our people’s health, breaking down barriers between services and drawing on local strengths and assets.
We are now seeing some early signs of progress, from reductions in the number of stillbirths, to increases in the numbers of children from more deprived backgrounds starting school ready to learn, improvements in the quality of our social care and our lowest ever rates of people who are smokers or inactive.
But while we are pleased with progress so far, we have a need and a responsibility to go further, faster.
For, as Greater Manchester’s independent prosperity review highlighted last year, poor health and inequalities in some communities are impacting not only on the lives of thousands of residents, but the development of our city region as a whole.
As the UK’s first Marmot city region, increasing the scale and pace of change is what we will do.
We are now developing a programme of actions to create a true population health system, where everything we do is shaped to ensure it maximises the opportunities to improve health and reduce inequalities.
Our overall plan, developed alongside Sir Michael Marmot and the Institute of Health Equity as well as the Kings Fund and Health Foundation charities, has recently been agreed with our local and regional partners.
Over the next year and beyond, we will:
- Make reduced health inequalities a core goal of everybody’s work in Greater Manchester
- Ensure health and wellbeing and health inequalities for today’s residents and future generations are key considerations of policy and decision making across our city region
- Empower all organisations – not just the NHS – to play their role in creating good health for everyone who lives and works here
- Invest in prevention and health creation across our city region, prioritising areas such as children’s services, housing, employment and inclusive growth
- Increase our focus on the physical, economic, digital, social and commercial environments in which people live, and the opportunities and impacts these have for population health
- Build on our strong and collaborative system and political leadership across our city region, our ten local areas, and our many neighbourhoods
With our broad, prevention-focused approach set out in the Greater Manchester Health and Care Prospectus and the Greater Manchester Model of public services as the basis, over the coming months we will further develop what this looks like with and for our residents and our communities.
We are under no illusions that this will be easy or the rewards quick to materialise. Indeed, we believe that this change in thinking about our health is as radical as the creation of the welfare state and the NHS itself.
But for the sake of all our residents, and our city region as a whole, we simply must answer the question Sir Michael posed in his report:
“If health has stopped improving, it is a sign that society has stopped improving. What is government for if not to act on that?”