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Marmot warns government not to bury health inequalities


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Marmot warns government not to bury health inequalities

In the most engaging of the plenary addresses on the opening day of the Confederation annual event, Sir Michael Marmot made a plea to the new government to put “fairness at the centre of all policies and programmes”.

The author of the report on health inequalities that bears his name, Sir Michael described the need to address the variation in the system as “a matter of social justice”.

Putting the issue in its global context, Sir Michael said: “Life expectancy for women in Zimbabwe is about 34. Life expectancy for women in Japan is 86. There’s no good biological reason why there should be a spread of 50 years in life expectancy across the world.”

In the UK the gap is much smaller, at “only” seven years between the most deprived and the most affluent areas, but Sir Michael also had another, less often quoted statistic: the gap between those who spend their lives free of disability is 17 years.
He emphasised that the tendency to regard health inequalities in terms of the polarisation of rich and poor was a mistake. There is not a step from one to the other, but a gradient and anyone at any point below the best off is in the health inequalities gap.

Responding to the criticism that his work was “ideology with evidence”, Sir Michael was unapologetic. “I actually took that as praise...We do have an ideology and that is that avoidable health inequalities that could be put right and are not are quite wrong.”
Although he had resisted making economic arguments in the belief that the moral case was strong enough, the meticulous Sir Michael had covered this ground too. “Each year in England if had the mortality of those with university education there would be 202,000 people aged 30 plus who did not die prematurely. That’s 40 per cent of all deaths,” he said.
“Health inequalities are not a footnote to the concern with health. They are the concern with health.”

Though he clearly found something distasteful in the economic expression of the issue, Sir Michael nevertheless produced some number to show that the sterling cost of life years lost by health inequalities is enormous. He mentioned productivity losses of £30bn, welfare payments of £22bn and other sums big enough to solve the financial problems of the NHS at a stroke.

“The cost of doing nothing is insupportable. It is simply not an option.”
Although many of the causes of health inequalities are social and economic, the health sector had a role to play in ensuring access to services, health promotion and disease prevention, but Sir Michael noted that despite the P in QIPP, we still invest only 4% of the health budget in prevention.

Asked about the disappearance of the Black report and other reviews of health inequalities, Sir Michael said he remained hopeful that the coalition government would put take the issue seriously. He also noted that the local action was already underway with around 30 implementation plans in development across the country.
And while the statistics showing the variation in health are depressing, “variation also gives us optimism that health inequality is not inevitable.”