Why health inequalities have not changed since 2010

Over the next weeks, the publication of Health Equity in England: The Marmot Review 10 Years On will be an unwelcome reminder of persistent and widening health inequalities in the UK.

There will be an important and necessary public debate about stalling life expectancy and the desperately poor health outcomes that track to social circumstance, race and class.

For those of us who work in tackling these inequalities, there may be a temptation to celebrate this exposure. Perhaps, though, it should be a moment of stark reflection: why, a decade on, are we in much the same place as before?

Much will be made of government policy (or its failings), of the impact of austerity, of the rising complexity of everyday living, of structural inequalities and so on. These are undoubtedly all part of the picture.

But might another reason be that we, as a community, are insufficiently clear about how to address health inequalities in a way that others can get behind? Put bluntly, do we spend too long polishing the challenge with those who agree with us?

Patterns

Despite inspiring pockets of practice all across the country, in our work at Guy’s and St Thomas’ Charity we spot three consistent patterns.

First, it’s easy to assume that everybody understands how much of our health is determined by our social realities. This is almost certainly not the case.

A surprising number of policy makers, journalists, employers, investors, housing associations, teachers — those people who control the environments that shape our health — are unaware of the fact.

Second, the cupboard is barer than we think. In a lot of areas that impact our health, such as financial resilience, good quality employment, decent accommodation and so on, the evidence base is only emerging and the practical asks at best patchy.

It’s easier to discuss “complexity” and “systems” than to advise people what to do about them.

In a lot of areas that impact our health, such as financial resilience, good quality employment, decent accommodation and so on, the evidence base is only emerging and the practical asks at best patchy

Third, there seems to be limited prioritisation on what issues to address. Perhaps this is inevitable: all inequities matter.

But we know from our work — which takes a hyper focused approach to health inequality through data, ethnography and a cross-section of people, place and partners — that it’s difficult to arrive at meaningful observations without very specific investigation.

Indeed, the more targeted we go, the more generalisable the insights.

One reading of Marmot’s findings is that the country simply doesn’t care about health inequalities. That would be a sad view.

Perhaps it’s as simple as the fact that, at scale, the answers are still unclear, and we all need to do much more work to find them.

That, to me, is a positive and addressable challenge for the next 10 years.