By Imogen Richmond-Bishop
“Health inequalities are not inevitable and can be significantly reduced… avoidable health inequalities are unfair and putting them right is a matter of social justice” Marmot Review 2020
The Marmot review: Ten Years On confirms what many civil society colleagues as well as ourselves have been saying: Inequality damages communities, negatively affects life outcomes, and is a violation of a number of our human rights.
Crucially though inequality is not inevitable
Life expectancy in England has stalled, and in fact for many women and men living in some of the most deprived communities life expectancy is falling.
This review highlights some of the clear structural barriers that are preventing people from having access to their rights. These include the closure of vital public services, an increase in poor quality work, as well as the troubled roll out of universal credit.
As these barriers are created by political and policy choices we now need our Government to listen to the recommendations in the report and reverse the damage caused by austerity.
“Poverty has a grip on our nation’s health – it limits the options families have available to live a healthy life.” Marmot Review 2020
Whilst unemployment has decreased, there has been a clear increase in poorer quality work, including part time and insecure employment. This means that for far too many people across the UK, work is no longer a protection from poverty.
At the same time our own research as well as the review has found that for those who are not in work social security payments are not keeping in line with the cost of living and this is pushing many people into poverty.
We have found that tax and social security cuts since 2010 do not meet the requirements of non-retrogression, and therefore breach our socio-economic rights. These rights provide the essential conditions needed to live a life of equality, dignity and freedom, and include the right to work, to social security and social protection, as well as to the highest attainable standard of health, education, food, water, and housing.
Decisions have been made by policy makers with regards to which groups feel the brunt of the changes to the tax and welfare system. According to the Marmot review overall these changes have had negative impacts for the poorest 50% ,with the poorest 20% seeing the most negative impacts. At the same time the benefit changes were positive for the top 40%, and when the changes are combined with tax reforms they have been most beneficial to the top 30%.
Austerity measures that the Marmot review has linked to decreases and stagnation in health and life outcomes have disproportionately impacted certain groups, including women, disabled people, and minority ethnic populations.
There are higher rates of unemployment and zero hours contacts, and over double rate of child poverty for minority ethnic groups when compared to white people.
Women face higher rates of unemployment across all categories when compared to men. Women have seen little or no improvement in life expectancy overall since 2010. In fact life expectancy declined in the most deprived 10% of neighbourhoods between 2010-12 and 2016-18 with only negligible changes for men.
Nearly half of all people in poverty have at least one member of their household who has a disability. This can be due to a number of factors including the extra costs faced by people with a disability as well as the fact that disabled people, at every level of qualification, are more likely than non disabled people to receive lower pay.
Following his official visit to the UK in 2018, the UN Special Rapporteur on Extreme Poverty and Human Rights found that “Government reforms have often denied benefits to people with severe disabilities and pushed them into unsuitable work”. The Marmot review also found that disability assessments for benefits were “superficial, dismissive” and that they appeared to “contradict the advice of doctors”.
Children with a disability or with some types of special educational needs were two of the groups that were most likely to be excluded from school. Exclusion from school has a negative impact upon lifelong outcomes.
“Austerity will cast a long shadow over the lives of the children born and growing up under its effects” Marmot Review 2020
Child poverty is on the rise and austerity measures introduced over the past decade have been found to be majorly impacting upon children’s ability to achieve their full potential.
The review identified not only a key link between high levels of deprivation at birth and low healthy life expectancy, but also that clear socioeconomic inequalities persist with a graded relationship between the level of early years development and the level of deprivation.
The areas with the highest rates of deprivation, and therefore containing the children who are most in need of children and youth services, have seen the funding for these projects cut back more significantly than less deprived areas.
Evidence also shows that positive early life experiences have a significant impact upon a child’s outcomes including better social and emotional development, improved work outcomes, higher income, better lifelong health as well as longer life expectancy.
“If health has stopped improving it is a sign that society has stopped improving. When a society is flourishing health tends to flourish” Marmot Review 2020
The question we should ask, and that the Marmot review rightly posits, is not whether we can afford to make society better but whether we can afford to live in such an unequal society.
By investing in communities our Government would reap the rewards of better population health, increased social mobility, and improved educational outcomes.
Our Government has made clear commitments on an international stage with regards to respecting, protecting, and fulfilling our basic human rights including our right to the highest attainable standard of health, to food, and to education. They have also made specific commitments to protecting the rights of people with disabilities, children, women as well as to ensuring non-discrimination. What we need now is for these commitments to be translated into policy making that will reduce inequalities and improve life outcomes.
A key tool that could be used to reduce socio-economic inequality is the enactment of Section 1 of the Equality Act 2010. Find out more about our #1ForEquality campaign with the Equality Trust online.