Marmot review – reducing health inequalities

Health inequalities result from social inequalities, including the built environment. Action on health inequalities requires work across all the wider determinants of health. Local government has a pivotal role to play in addressing the wider determinants of health and heath inequalities.

There is a “social gradient in health” and related to this there is a social gradient in environmental disadvantage. Universal action is needed to reduce the steepness of the social gradient, but with a scale and intensity that is proportionate to the level of disadvantage.

Reducing health inequalities is a matter of fairness and social justice. It is also an economic matter – is estimated that the annual cost of health inequalities is between £36 billion to £40 billion through productivity losses, lost taxes, higher welfare payments and increased costs to the NHS.

Reducing health inequalities requires action on six policy objectives (the fifth is most directly relevant to planning):

1. Give every child the best start in life
2. Enable all children, young people and adults to maximise their capabilities and have control over their lives
3. Create fair employment and good work for all
4. Ensure healthy standard of living for all
5. Create and develop healthy and sustainable places and communities – elements identified as having a significant impact on health under this objective were:
   • Air pollution
   • Green/ open space
   • Transport
   • Food
   • Housing
   • Community participation and social isolation
6. Strengthen the role and impact of ill-health prevention.

How to address each of the elements highlighted under objective 5 through planning is addressed in the Joint Working Section (see specific topic links above).

1. Prioritise policies and interventions that reduce both health inequalities and mitigate climate change, by:
   • Improving active travel across the social gradient
   • Improving the availability of good quality open and green spaces across the social gradient
   • Improving the food environment in local areas across the social gradient
   • Improving energy efficiency of housing across the social gradient.
2. Fully integrate the planning, transport, housing, environmental and health systems to address the social determinants of health in each locality.
3. Support locally developed and evidence based community regeneration programmes that:
   • Remove barriers to community participation and action
   • Reduce social isolation.

• Fair Society Healthy Lives (The Marmot Review) – A range of outputs from the Marmot Review, including the full report.
• The Marmot Review: Implications for Spatial Planning – This paper highlights the evidence on the relationships between health and spatial design, and the socio-economic gradient in environmental disadvantage; outlines policy recommendations for the built environment; proposes “good design principles” for promoting physical and mental health and well-being; and gives examples of best practice in addressing health inequalities through spatial planning.