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Fair Society, Healthy Lives

The Marmot Review

Reducing health inequalities is a matter of fairness and social justice. In England, the many people who are currently dying prematurely each year as a result of health inequalities would otherwise have enjoyed, in total, between 1.3 and 2.5 million extra years of life.

There is a social gradient in health – the lower a person’s social position, the worse his or her health. Action should focus on reducing the gradient in health.

Health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health.

Focusing solely on the most disadvantaged will not reduce health inequalities sufficiently. To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. We call this proportionate universalism.

Action taken to reduce health inequalities will benefit society in many ways. It will have economic benefits in reducing losses from illness associated with health inequalities. These currently account for productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs.

Economic growth is not the most important measure of our country’s success. The fair distribution of health, well-being and sustainability are important social goals. Tackling social inequalities in health and tackling climate change must go together.

Reducing health inequalities will require action on six policy objectives:

—— Give every child the best start in life

—— Enable all children young people and adults to maximise their capabilities and have control over their lives

—— Create fair employment and good work for all

—— Ensure healthy standard of living for all

—— Create and develop healthy and sustainable places and communities

—— Strengthen the role and impact of ill health prevention

Delivering these policy objectives will require action by central and local government, the NHS, the third and private sectors and community groups. National policies will not work without effective local delivery systems focused on health equity in all policies.

Effective local delivery requires effective participatory decision-making at local level. This can only happen by empowering individuals and local communities.