Government policies will make health equality harder to achieve, conference hears

BMJ 2013; 346 doi: (Published 03 May 2013) Cite this as: BMJ 2013;346:f2873
  1. Matthew Limb
  1. 1London

Doctors should press for every citizen to have a “minimum income for healthy living,” a leading expert on health inequalities has said.

Michael Marmot, who has made health inequalities his life’s work, urged health professionals to make the argument, citing evidence of the dire effect on people’s health of having too little money to live on.

Many people found that their work did not pay enough, and for those living on benefits life was “appalling,” he said.

“We should be advocates—from the health point of view—of a living wage,” he said.

He also urged the government to do more to create jobs and “not blame the workless for their worklessness.”

Marmot, who is director of the Institute of Health Equity at University College London, maintains that reducing health inequalities is a matter of fairness and social justice.

He led a review into health inequalities—Fair Society, Healthy Lives—which was commissioned under the previous Labour government and published in February 2010.1

He spoke in London on 30 April at Westminster for a social policy forum seminar on health inequalities, in which he reflected on developments in the three years since the review’s publication.

Marmot said he was pleased that the current Conservative-led coalition government had made reducing health inequalities part of its strategy.

Now that public health was berthed in local government, there were fresh opportunities to tackle the wider social and economic determinants of ill health, he said.

He reported that three quarters of English local authorities had developed “Marmot implementation” plans to reduce inequalities in their areas, adopting his review recommendations.

But he said that councils were facing severe budget cuts, and the “really bad news” was that child poverty levels would rise “more sharply” as a result of government policies.

This threatened to harm early child development, which was a crucial factor in dealing with health inequalities, he said.

Marmot said that insufficient income clearly had adverse effects on outcomes such as long term health and life expectancy, but his recommendation on minimum incomes had not been picked up by government.

He described the lack of jobs or training for young people leaving school as a public health “disaster.”

Marmot called for the “political prioritisation of health equity” with policies being based on evidence and judged by their effect on health inequalities.

The seminar heard what local councils and clinical commissioning groups in particular could do to reduce health inequalities, and how better approaches could help disadvantaged groups.

Patrick Hutt, a general practitioner and member of the health inequalities standing group on the Royal College of General Practitioners, said: “We’re very concerned [about] the impact of austerity on the most vulnerable.”

John Middleton, a public health director and vice president of the United Kingdom’s Faculty of Public Health, said that the new public health system had a role in economic development to create more jobs.

Shadow public health minister Diane Abbott, who co-chaired the seminar, said that directors of public health in financially squeezed local authorities would have to fight hard to protect core budgets.

There was a risk of health and wellbeing boards being steered on to the “fluffier” aspects of public health, such as “tea dances for old ladies,” rather than tackling big inequality issues, she said.

She added, “My concern is the less likely you are to vote, the less likely you are to be the focus of the new groups’ attention.”

Charles Fraser, chief executive of the homelessness charity St Mungo’s, called for health and wellbeing boards to form “inclusion health” subcommittees to plan and deliver services for homeless people and other excluded groups.


Cite this as: BMJ 2013;346:f2873