Funding must target health inequalities

In a report on health inequalities in Greater Manchester, which was commissioned by the Greater Manchester Health and Social Care Partnership, Professor Sir Michael (pictured) set out an ambitious framework to reduce inequities. He was the driving force behind the pivotal Marmot report in 2010, which proposed an evidence-based strategy to address the social determinants of health.

The new report, Build back fairer in Greater Manchester: heath equity and dignified lives, said the Covid-19 death rate in the Greater Manchester city region was 25% higher than England as a whole in the 13 months to March 2021. This high death rate contributed to a decline in life expectancy in the North West region that was larger than the average for England. Life expectancy fell in 2020 by 1.6 years for men and 1.2 years for women compared with 1.3 years and 0.9 years, respectively, across England.

The framework highlights the need for extra resources for more deprived areas and communities. While these could be generated partly through redistributions of existing resources and assets within the region, the reports added it would also require greater investment from business and central government.

It said the austerity cuts in public spending prior to the pandemic were regressive (affecting poorer areas the most), and this had led to the greater impact of Covid in areas of greater deprivation. The particularly damaging health, social and economic impacts during the pandemic in Greater Manchester provided strong justification for additional national investments in the city region.

Funding balance

Sir Michael called for spending to be rebalanced in favour of prevention of ill health. The prevention budget should be doubled, within five years, he said. And a system-wide prevention/health spending target for all of Greater Manchester should be developed by end of 2021, with incremental targeted increases over five years.

Wider measures on funding and support were also recommended, including proportionate funding for deprived communities and particular public services, and the identification of a minimum income for healthy living in Greater Manchester. The latter would be accompanied by lobbying for additional national resources to increase public sector pay and support businesses to pay for this minimum healthy wage.

Professor Sir Michael said: ‘Greater Manchester has high levels of avoidable health inequalities as a result of longstanding economic and social inequities, and as across the country, ethnic disadvantage. The city region has also experienced high rates of mortality from Covid-19 and particularly damaging long-term economic and social effects during the pandemic as a result of prolonged lockdowns. These multiple negative impacts will damage health and widen health inequalities unless action to build back fairer is introduced across the city region.’

Covid had highlighted the fact that many local residents had lives, jobs and homes that adversely affected their health, according to Andy Burnham, the mayor of Greater Manchester.

‘People in low-paid, insecure work have often had little choice in their level of exposure to Covid, and the risk of getting it and bringing it back home to those they live with. Levelling up needs to start in the communities that have been hit hardest by the pandemic.

‘To improve the nation’s physical and mental health, we need to start by giving all of fellow citizens a good job and good home. We are grateful to Michael Marmot for showing how Greater Manchester can improve the health of our residents and we hope the government will back us with the resources and powers to put better health at the heart of our recovery.'