Health Inequalities haven’t changed. They have increased. Thoughts from the Marmot report.


Before all this (the big C word) kicked off I found myself sitting in London listening to a man I had long admired. In fact, I was sat in a rather grand hall in Westminster with Michael Marmot delivering his summary of the nation’s progress to addressing health inequalities over the last 10 years. Marmot’s report about fairer societies published 10 years ago had been the background and constant for the last decade, almost like the bass note in a piece of music. Marmot had set the tone and progression for action.

10 years ago I was hearing from his own mouth the reality that he and his team had found during their review. 10 years is a long time. 10 years ago my eldest child, who now towers over me, was looking for tooth fairy money. 10 years ago he and his brother had discussed whether they would be friends with children with black teeth (an observation on the poverty born out where they live). Spring 2010 was before “Bake Off” had hit our screens and Gordon Brown was still (just about) Prime Minister. Marmot took to the stage to pronounce his take on progress for the last 10 years.

The answer came as a mixture of relief, shock and anger.

Health inequalities had gotten worse in the past decade. Life expectancy for women in the poorest area had actually dropped, something that should be unheard of in modern societies and the number of children living in poverty had risen. Matrix after matrix flashed up. Increases in street homelessness, increases in family homelessness and families living in B&B accommodation and increase in the number of people living in housing unfit for human habitation. The day passed in a blur of charts, pictures and chat. Discussion that prison is the worst place for young people who mostly come out more deprived, dejected and hardened. I heard lived stories of attending school and being hungry all day and testimonies from teachers despairing of the circumstances of the children sitting in front of them. The link between disability and poverty. That one almost predicts the other. The link between universal credit and real hardship.

The day was slightly surreal. Grand building, vegan food, fancy tea and coffee and the ever present drum beat of the research findings.

To be honest it was with relief that I heard the overall message that things had gotten worse. Relief because on the ground in the hard pressed places of Greater Manchester where we work it has felt like it has got worse. The decade has seen universal credit rip through the area. Zero hour contracts have increased where previously good solid jobs like working for parks and gardens at the council has become a zero hour life.

On the ground it has felt like there are no consequences to being a rubbish landlord or employer. On the ground the decade has seen those suffering from childhood grooming emerge into complex adult survivors. On the ground it has felt forgotten.

And so it was a relief that the learned, wise, diligent man of Marmot and his team had found it, counted it and were now saying it. Speaking truth to power.

The benefits system has been designed to make poor people poorer. We have to break that being disabled means you must be poor. It is unacceptable for mortality rates to climb and life expectancy to fall. There is nothing just in a society that can not see its own people.

I can’t state causation but it does not require any imagination to know that austerity has really, really hurt.

Marmot spoke like we had been seen, he was making the invisible visible.

The anger that boiled up in me was restrained to the social niceties of the event. And yet you wanted to scream.




I got on a train and let my head be.

Months later back in Manchester, even during lockdown, the work carries on.

The Shared Health Foundation started because it is not good enough and we will carry on.

  • Our work with homeless families to get the system changed, to make the system better, to stop so many people finding themselves in this place, to ensure children in temporary accommodation get education and support and keep their health still goes on.
  • Our work with parents and carers of under fives in areas of deprivation to help them look after their children and give them health, still goes on. (Lockdown has proven this difficult but we are pursuing). Families who if they followed the healthy eating advice Marmot says they would have to spend 70% of their income on food.
  • Our work with children and young people struggling with mental health often caused by, made worse by and continued by poverty and the life events that come with poverty, still goes on.
  • Our work in training health staff to be able to really excel in these hard pressed areas through our GP training scheme, GP support and nurse events, still goes on.
  • Our work in Focused Care bringing real solutions to patients in general practice who are the least and the lost, who are complex and beautiful, who’s clinical staff really want to help but are not sure how, still goes on. In the last 3 years 5,000 households in Greater Manchester in the most hard pressed areas have had Focused Care alongside them.

Our work in continuing to speak and write and talk about poverty and its impact, still goes on.

Marmot is a stark call out of the current reality. A call to action so that the next 10 years will be different. He has given us the how.

Now we must do.

Dr Laura Neilson

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