The Marmot Review 10 Years On (Marmot et al, 2020) report makes for grim reading. For the first time in over 100 years, life expectancy in England has failed to increase, and for the poorest 10% of women it has declined. The report found that health inequalities have widened, and the amount of time people spend in poor health has increased in the last decade. Although the report was based on findings in England, this is a UK-wide problem—it is believed that similar results can be seen in Scotland, Wales and Northern Ireland.
Previous theories had suggested that the slowdown in life expectancy increases had occurred due to severe winters or particularly bad flu. This report dispels that idea: more than 80% of the slowdown results from influences other than winter-associated mortality. Part of this is that mortality rates have increased for people aged 45-49. So-called ‘deaths of despair’ caused by alcohol and drug misuse and suicide have been observed in the US and it is thought England may be experiencing a similar phenomenon in this age group.
Now more than ever, where you live and, perhaps most importantly, where you were born, have a huge impact on your health. The more deprived the area, the shorter the life expectancy. The North/South divide is real. Life expectancy is lower in the North and higher in the South.
Back in 2010, Fair Society Healthy Lives, the Marmot Review (Marmot et al, 2010), analysed the causes of health inequalities and what needed to be done to tackle them. These points have largely not been addressed in the 10 years since. Commentary around the report has focused on government policy and austerity being the root causes of widening inequality. It is easy to feel dispirited by all of this. Practice nurses may not be able to change government policy by themselves, although it is certainly possible to try—by lobbying MPs and signing petitions, we can all do our bit. However, what nurses can do is make a difference at a local level.
Working with your primary care networks, identifying groups in your practice that are likely to be at risk of suffering health inequalities and finding ways to engage with them, and starting social prescribing schemes can all help to make a real difference to communities.
As report co-author Michael Marmot said: ‘Put simply, if health has stopped improving, then society has stopped improving’. I am hopeful that by working together health can get better for everyone, regardless of their social circumstances.
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