The 2010 Marmot Review was a landmark in the study of health inequalities in England. Tasked with finding the most effective evidence-based strategies for reducing health inequalities in England, the review put forward six key policy objectives for addressing the causes of health inequalities, including giving every child the best start in life, and enabling all children, young people and adults to maximise their capabilities and have control over their lives.
Ten years on, the Institute of Health Equity today published a new report, Health Equity in England: The Marmot Review 10 years on. The report is a damning indictment of the effects of a decade of austerity, with the implications for public health and wellbeing summed up in the opening line of Michael Marmot’s foreword: “England is faltering.”
The report highlights how ten years of government cuts – especially to local authority budgets – have resulted in a diminished public realm with devastating impacts on physical and mental health. Children and young people’s mental health is singled out as a particular cause for concern, with the authors pointing to “worrying indications of deteriorations and widening socioeconomic inequalities in mental wellbeing.”
The report combines its scathing commentary on the current situation with practical steps for addressing health inequalities. It was good to see mention of the roll-out of social prescribing – a promising initiative to utilise the capacity of community-based services to address healthcare needs – illustrated with a case study highlighting the exciting work three of our members (Youth Advice Centre in Brighton & Hove, Door 43 in Sheffield and No Limits in Southampton) are undertaking as part of a project led by the charity StreetGames to pilot young person-centred social prescribing models.
But such initiatives will need to be accompanied by the regeneration of key services that have been lost if they are going to do more than simply put more pressure on residual services that are already stretched to breaking point. Importantly, the report identifies the key role of advice services in addressing the social determinants of health. As our own research has shown, advice on housing, benefits, employment and debt can be highly effective in improving the health of marginalised and vulnerable young people.
What’s needed is huge local investment in services like this, and on the same day the report was published there was a ray of hope in the government’s announcement of a £49.2 billion spending increase for local authorities – the largest such increase in a decade. The Secretary of State for Housing, Communities and Local Government, Robert Jenrick, confirmed that this would include a £500 million investment in youth clubs and youth services.
Any investment in local services for young people is welcome, and this is a start towards reversing the damaging cuts that the Marmot review exposes. But it’s only a start. With recent research from YMCA showing an overall real terms drop of £959 million in local authority funding for youth services in England since 2010, it’s clear that the government’s latest offer won’t come close to putting back everything that has been taken out of local funding in the past decade. The voluntary sector must continue to push for recognition of the importance of local services to public wellbeing – and the need for significant and sustained investment from national government.