Health equity in England: the Marmot review 10 years onBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m693 (Published 25 February 2020) Cite this as: BMJ 2020;368:m693
- Michael Marmot, director
- Institute of Health Equity, Department of Epidemiology and Public Health, UCL, London
Britain has lost a decade. And it shows. Health, as measured by life expectancy, has stopped improving, and health inequalities are growing wider. Improvement in life expectancy, from the end of the 19th century on, started slowing dramatically in 2011. Now in parts of England, particularly among women in deprived communities and the north, life expectancy has fallen, and the years people spend in poor health might even be increasing—a shocking development. In the UK, as in other countries, we are used to health improving year on year. Bad as health is in England, the damage to the health of people in Scotland, Wales, and Northern Ireland has been worse.
Put simply, if health has stopped improving, then society has stopped improving. Evidence, assembled globally, shows that health is a good measure of social and economic progress. When a society is flourishing, health tends to flourish. When a society has large social and economic inequalities, it also has large inequalities in health.1 The health of the population is not just a matter of how well the health service is funded and functions, important as that is, but also the conditions in which people are born, grow, live, work, and age, and inequities in power, money, and resources. Taken together, these are the social determinants of health.2
This damage to the nation’s health need not have happened. In 2010, both the Labour government and the Conservative-led coalition government that followed it were concerned that health inequalities in England were too wide and that action was needed to reduce them. To inform that action the government in 2008 commissioned me to review what it and wider society could do to …