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Marmot Principles Driving Our Approach

The 'Marmot Review 10 years' on was published in 2020, ten years since the original report examined key health inequalities in England1.

It outlines that the conditions in which people are born, grow, live, work and age are key determinants of health, and differences in these conditions can result in inequalities in health. This a fundamental principle underpinning our work on health and wellbeing in Bexley.

Marmot recommends action across the social determinants of health and beyond the reach of the NHS which places renewed emphasis on the role of local government who along with national government departments, the voluntary and private sector have a key role to play, and our local partnerships reflect this broad approach to health and wellbeing.

Environmental sustainability is a new area of focus in the review and is compatible with action to reduce health inequalities through promoting sustainable local communities, active transport, sustainable food production, and zero carbon houses, all of which have health benefits. Bexley’s new Climate Change Statement and Action Plan (2022-26) outlines our key commitments to environmental sustainability locally.2

Evidence shows that disadvantage starts before birth and accumulates throughout life and is part of the reason why we have chosen children and young people as one of our four key priority areas for Bexley.

There are eight policy objectives in the Marmot review, with the highest priority being given to the first objective:

  • Give every child the best start in life
  • Enable all children, young people and adults to maximize their capabilities and have control over their lives
  • Create fair employment and good work for all
  • Ensure a healthy standard of living for all
  • Create and develop sustainable places and communities
  • Strengthen the role and impact of ill-health prevention
  • Tackle racism, discrimination, and their outcomes
  • Pursue environmental sustainability and health together

Central to our work on reducing inequalities is a prevention approach across the life-course, as described in Bexley’s Prevention Strategy:

Start Well

Giving children and young people the best start in life and throughout their lives, including preconception and in transition to adulthood.

Live Well

Improving outcomes for adults supporting them to be healthy and well, make decisions about their future, and engage in meaningful life roles in the community at all stages.

Age Well

Supporting older people to be active, independent, and thriving.

Bexley’s Prevention approach

  • Primary prevention is about minimising the risk of people developing needs
  • Secondary prevention is about targeting people at high risk of developing needs and intervening early
  • Tertiary prevention is about minimising deterioration and the loss of independence for people with established needs or preventing the reoccurrence of a health and social care crisis

The latest Marmot review is a reminder that a whole systems approach to improving health and wellbeing and prevention needs to be delivered in partnership, recognising that local organisations have the expertise, experience, and opportunities to find the solutions.

The Bexley Joint Local Health and Wellbeing Strategy, alongside the Bexley Prevention Strategy, the Bexley Wellbeing Partnership Vision for Health and Care and the SEL ICS Strategy provide the platforms for this work. Our local Bexley Wellbeing Partnership alongside the Health and Wellbeing Board are uniquely placed to drive forward actions to support local priorities.

What do we mean when we talk about health inequalities?

Health inequalities are about differences in people’s health as well as the care they receive and opportunities to live a healthy life.3

Health inequalities can involve differences in:

  • health status, for example, life expectancy
  • access to care, for example, availability of given services
  • quality and experience of care, for example, levels of patient satisfaction
  • behavioural risks to health, for example, smoking rates
  • wider determinants of health, for example, quality of housing

Inequalities between who?

Health inequalities4 can be experienced by people from different groups, and are often described by:

  • socio-economic factors, for example, income
  • geography, for example, region or whether urban or rural
  • specific characteristics including those protected in law, such as sex, ethnicity or disability
  • socially excluded groups, for example, people experiencing homelessness
  1. Marmot Review 10 Years On - Institute of Health Equity
  2. Bexley's Climate Change Statement and Action Plan
  3. Adapted from The King’s Fund What are health inequalities?
  4. Ibid