A European Review

We said the Marmot Review for England, Fair Society, Healthy Lives, was the beginning, not the end goal. Our conference on 12th February in London provided us with the fantastic starting block from which we can champion a social determinants approach to reducing health inequalities.

Over the next year there are already a number of planned implementation projects and many events exploring the way forward at regional and local level. This is great news: the more action, the better. With your help, we need to mobilise all stakeholders, including all the political parties, to adopt the objectives laid out in the Review. As the Lancet editor Richard Horton wrote, "the question for voters later this year in the UK's general election is 'what sort of society do they want?'" It has to be a fair and just one - we can't afford the alternatives.

I am delighted to confirm, as announced at the conference, that the World Health Organization European Region is commissioning me to conduct a European review. WHO Europe has a new Regional Director, Zsuzsanna Jakab, who started work on 1 February. She wants to emphasise public health, and exercise leadership in this area, as was done in the Regional Office's 'Health for All' strategy.

Zsuzsanna also plans to launch Health 2020 - a new health strategy - and wants to make the social determinants of health and health equity a cornerstone of that new strategy.

It's planned that there will be two clear purposes to the European Marmot Review:

• To review the situation of health inequalities in Europe, and its social determinants, and conduct a detailed study with a view to developing policies and practical steps to address the social determinants of health
• To inform the developing health strategy for Europe, Health 2020

The Review will work on the model of the WHO Commission on the Social Determinants of Health and the English Review. Zsuzsanna proposed two stages of the Review:

• Inform an updated health strategy - Health 2020
• This will be based on the CSDH, the English Review, and evidence from European countries
• Strengthen capacity within WHO
• Identify issues that need further study
• Produce a final report of the Inequalities Review that will cover:
• What we know, new issues and tools
• Proceed with issues that won't get into Health 2020
• Produce policies and practical programmes for countries

This will translate into four stages of the Review:

1. Present a report on the health inequalities situation in Europe, and a statement of intent, at the Regional Committee in Moscow in 2010.
2. Inform the developing Health 2020 strategy - this will be based on CSDH, English Marmot Review, evidence from Europe, and what other countries are doing; it will also include
3. Reports of the Task Groups and reference groups. 2) and 3) should be ready by Spring 2011, and an interim report will be presented to the Regional Committee in 2011
4. Final Report published April 2012

It is hoped we would have the first meeting of around 10 commissioners, yet to be appointed, before the summer. Zsuzsanna emphasised the importance that the Review be independent, with a mechanism to establish a close working relationship with WHO to ensure staff own the process and the outcome.

The future looks exciting. We must keep the momentum rolling. With your help I'm sure we will. Many thanks to all of you who continue to work tirelessly - let's keep it going!

Fair Society, Healthy Lives

It’s an exciting time as we are in the final stages of completing our year long independent review which proposes a new strategy for tackling health inequalities in England.

In November 2008, just after we published the Report of the WHO Commission on Social Determinants of Health Closing the gap in a generation, the Secretary of State for Health in England asked us to review health inequalities policies post 2010. The stimulus for doing this was two fold. First, the then Secretary of State, Alan Johnson, asked how the recommendations of the WHO report could be applied to England. Second, although health had improved for everyone in England over the last decade, health inequalities have not narrowed.

At the end of 2008, I assembled a team of commissioners, with expertise in a range of areas and commissioned academics to report back on the latest research in nine areas which shape health.  All of these task group reports are available on our website. 

Our report, Fair Society, Healthy Lives, will be launched to the media on 11 February, with a conference held in London the following day.  The report will be available on this website on 11 February.  The report presents a strategy, based on the most recent evidence, to reduce health inequalities through a series of policy and delivery system recommendations.

Our research seeks to move health inequalities’ policy in a new direction. To date, policy tends to have focussed on improving health for the worst off. We describe, however, how everyone has worse health than those at the top of the social economic scale –  this produces a social gradient in health.. Policy has to address the whole gradient to reduce inequalities, not just those at the bottom.  We also describe how health inequalities relate to wider social inequalities – in education, income, the built environment, communities, working conditions – these are the social determinants of health.    We also make clear that reducing health inequalities is not only a job for the health sector. health inequalities should also be addressed in the early years, at primary and secondary schools, at work, in our communities and at home.

Commonly, I am asked: what is the one thing that I can recommend. Our report demonstrates that there is not one solution to reducing health inequalities.  Recommendations are made that are relevant for local authorities, nursery staff, teachers, employers, planning, housing and transportation departments, as well as the NHS. Our report also sees the Department of Health as one of many government departments who can influence health inequalities.  Many government departments have important roles and we have held meetings over the past year to discuss them.

Our work will continue after we publish the final report.  Over the next year we will continue to work with the Review’s two regional partners: the Northwest of England and London, to help them implement our recommendations.  We are also working with the NHS Institute for Innovation and Improvement and the Department of Health on the Healthy Places & Healthy Lives programme.

Fair Society, Healthy Lives is a starting point not the end goal. Reducing health inequalities requires a social determinants approach to be championed and increasingly adopted as the way forward. The long-term success of reducing health inequalities depends on all of society working together – we provide answers, just a new direction in which to go.