The Committee will hear from Professor Sir Michael Marmot, author of ‘Fair Society Healthy Lives’ (The Marmot Review) published in February 2010 and ‘Health Equity in England: The Marmot Review 10 Years On’, published February 2020.

Professor Marmot will discuss the key issues relating to health inequalities and what he believes are the measures to be taken to address these in Manchester.

The Committee heard from Professor Sir Michael Marmot, University College London and author of ‘Fair Society Healthy Lives’ (The Marmot Review) published in February 2010 and ‘Health Equity in England: The Marmot Review 10 Years On’, published February 2020. Professor Marmot had been invited to discuss with Members the key issues relating to health inequalities and what he believed were the measures to be taken to address these in Manchester.

Professor Marmot spoke of the positive measures taken following the publication of his review, stating that cities such as Coventry and Gateshead had declared themselves as Marmot Cities and sought to implement the Marmot recommendations to address health inequalities. He stated that he had welcomed the decision taken by Greater Manchester to also become a Marmot City region.

The Professor described that the onset of COVID-19 had drastically revealed and amplified the existence of health inequalities, and he further highlighted the stark figures in relation to life expectancy in Manchester and across the North West. He stated that the understanding of inequalities and deprivation, across a range of metrics was essential to tackle and address adverse health outcomes for residents of the city.

The Committee noted that recently published data on life expectancy at birth over time in Manchester compared with England showed that life expectancy had fallen (i.e. got worse) for both males and females in Manchester in the 3-year period 2018-20 compared with the previous period of 2017-19. However, data for the 3-year period 2018-20 combined did not fully reflect the impact of the pandemic on life expectancy. Local calculations showed that life expectancy at birth for Manchester residents had fallen by 3.1 years for men and 1.9 years for women in 2020 compared with 2019. In absolute terms, 568 more men and 295 more women died in 2020 compared with 2019.

In response to questions from Members, the Professor advised that it was undeniable that the Government’s policy of austerity and continued reductions in public sector budgets had an adverse effect on health outcomes and exacerbated inequalities, adding that austerity had not ended and the Government needed to address the regressive funding cuts that had been imposed. He stated that if the Government was committed to Building Back Fairer for regions such as the North West, they needed to provide adequate funding settlements to support activities across a person’s life course. He further commented that it was important that Government investment should be prioritised in social infrastructure, not physical infrastructure projects.

In response to a specific question regarding the decision to abolish Public Health England to be replaced by the UK Health Security Agency and Office for Health Improvement and Disparities, Professor Marmot stated that whilst he always remained optimistic the use of the term Disparities was not adequate and a more appropriate title would have been Office for Health Improvement and Inequalities.

In reply to a question regarding his opinion of the Health and Social Care Bill, published 6 July 2021 that set out key legislative proposals to reform the delivery and organisation of health services in England, Professor Marmot commented that the lessons from the roll out of the COVID-19 vaccination programme indicated that local knowledge and expertise were best placed to plan and deliver services, rather than increased centralised control.  He further called for adequate funding to deliver social care and supported the continued design and delivery of integrated care models. 

In reply to a specific question regarding the impact of the Pupil Premium, a fund to improve education outcomes for disadvantaged pupils in schools in England, he stated that due to the real term cuts of education budgets of 8% per pupil he doubted that the Pupil Premium compensated for the overall budget cuts. He did state that he recognised the improvements made in Manchester in relation to education outcomes for those children in poverty.

In reply to a discussion regarding the Inequalities in health: report of a research working group (also known as the 'Black report') that was published in August 1980 that had reported the findings of a working group on inequalities in health, chaired by Sir Douglas Black, that had been commissioned in 1977 by the Labour government to investigate the variation in health outcomes across social classes and consider the causes and policy implications. Professor Marmot stated that, unlike that report, that had been ignored by the subsequent administration he remained optimistic and urged that if the Government was serious in their stated commitment to Level Up the country, he had provided them with a blue print to deliver on.

In response to a question regarding where the Scrutiny Committee should direct their focus and attention to, again he advised that regular scrutiny across the relevant scrutiny committees should be given to monitoring and reporting progress against the Marmot Beacon Indicators. He reiterated the importance of addressing inequalities as a central consideration in all decision making taken by Local Authorities.

The Chair commented that the Economy Scrutiny Committee would be considering a report entitled ‘Build Back Fairer – COVID-19 Marmot Review: Housing, Unemployment and Transport’ at their meeting of 14 October 2021 and she would discuss this issue further with all the scrutiny Chairs to ensure appropriate attention was given to this within their relevant Work Programmes.

Professor Marmot encouraged Manchester and the wider Greater Manchester city region to drive and deliver on the Marmot Beacon Indicators and he commented that he would use Greater Manchester as an example and model of good practice, both nationally and internationally.   

The Executive Member for Health and Care addressed the Committee and said that addressing health inequities was a priority for the city and would continue to be central to all considerations and decision making. She further called upon the Government to deliver a fair funding settlement for the city to enable the continued delivery of this important work.

The Chair, on behalf of the Committee, concluded this item of business by thanking Professor Marmot for attending the meeting and contributing to the discussion.

Decision   

The Committee;

1. Endorse the implementation of the recommendations from the review: ‘Build Back Fairer in Greater Manchester: Health Equity and Dignified Lives’;

2. Recommend that update reports that describe the activities and progress against the agreed Marmot Beacon Indicators are submitted for consideration at regular intervals; and

3. Recommend that all Scrutiny Committees regularly consider the Marmot Beacon Indicators, once agreed, that are relevant to the remit of the respective Committee.