Late last year Professor Sir Michael Marmot, a leading expert on health inequalities, delivered a keynote speech at the Drugs, Alcohol and Justice All Party Parliamentary Group (APPG), which is co-sponsored by Waythrough alongside Via and WithYou.
Professor Marmot has spent decades examining the root causes of health disparities, which are outlined in his landmark 2010 review Fair society, healthy lives alongside evidence-based strategies to address them. A decade later his Health equity in England: the Marmot review 10 years on report found that health inequalities in England had in fact worsened, with drug and alcohol use remaining a key driver.
Professor Marmot framed health inequality as a profound issue of social justice and stated simply that ‘social injustice is killing on a grand scale’. Addressing health disparities requires more than investments in healthcare systems, he said – it demands systemic change to tackle the underlying social determinants of health, such as education, housing, and employment opportunities.
Professor Marmot’s core message was that deprivation directly correlates with poor health. Wealth acts as a protective factor, regardless of location, but for those in deprived areas – especially in the North West and North East of England – health disparities are particularly stark. A lack of social mobility and rising rates of child poverty also create intergenerational cycles of ill health that are difficult to break.
Professor Marmot didn’t hold back in criticising how political decision-making drives inequalities, and singled out the reduction in public sector expenditure during the austerity years as a key cause. Between 2010-11 and 2020-21 the total spending power for local authorities fell by 26 per cent, and government-funded spending power fell by more than 50 per cent in real terms. His research also found that, perversely, areas with shorter life expectancy experienced the most severe funding cuts during austerity. ‘The sicker the community, the more money the government takes away from it,’ he said.
‘Deaths of despair’ is a phrase popularised by economists Professor Angus Deaton and Anne Case, referring to deaths caused by drugs, alcohol and suicide. Each often has a link to inequality and deprivation.
Professor Marmot noted that while public discourse often blames individual people for substance use or poor mental health, environments and systems perpetuate these issues. We have all seen evidence of this only too clearly – in 2023, there were 5,448 drug-related deaths, with the North East being disproportionately impacted with 441 deaths. This was the eleventh consecutive year the area had the highest rate of drug-related deaths.
Despite the scale of the challenge, Professor Marmot expressed cautious optimism. The new government has said it will focus on prevention and is committed to tackling the social determinants of health to reduce inequalities, with public health minister Andrew Gwynne publicly stating the aim of making England a ‘Marmot country’.
While these steps alone won’t reverse the devastating impacts of hollowed-out public services and falling life expectancy, Professor Marmot emphasised the need to take action and called for others to do the same. We at Waythrough will continue to work with the parliamentarians in our APPG to urge the government to act on its commitments to reduce deprivation and inequalities and ultimately save lives.
Elsa Corry-Roake is external affairs manager at Waythrough
