Building a fairer future

In planning for our post-Covid future, we've repeatedly heard the phrase 'build back better'. But Professor Sir Michael Marmot wants us to build back fairer. Speaking at the Anna Freud Centre's Transformation Seminar on the day his review of the pandemic's impact on health inequality in England was published, Marmot presented his key findings and recommendations.

Health follows the social gradient – the most deprived have the worst health and the highest mortality rate. And pre-pandemic, health inequalities in England were increasing. The gradient was getting steeper. Overall life expectancy stalled after 2010, and for the poorest, life expectancy was going down. The social gradient is almost identical for Covid-19 mortality, indicating a common set of causes. 'If we want to understand why Covid-19 is so unequally distributed in the population', Marmot said, 'we have to understand why health is so unequally distributed in the population'.

During the pandemic, relative excess mortality has been higher in England than Scotland, Wales, Northern Ireland, and even the US, where most agree the pandemic has been handled badly. 'I think the governance of the last 10 years paid very little heed to health and wellbeing of the population, and very little heed to social determinants of health… There was a dramatic reduction in spending on public services, we were ill prepared for anything let alone a pandemic.'

Those on a lower income are more likely to be in a workforce that closed down due to the pandemic – and if furloughed, they received a wage cut of 20 per cent. The picture will be much worse when the job retention scheme ends in March 2021, and even more people lose their jobs. 'This will have a catastrophic effect on mental health,' Marmot said. 'We know unemployment is correlated with suicide, and short of suicide it relates to depression.' Meanwhile, the rich stay at home, continuing to work, and saving money they no longer spend going out. The poor are getting poorer and the rich are getting richer. There are important intersections – BAME groups, younger people, women and disabled people are disproportionately affected.

Marmot's report contains short, medium, and long term recommendations to improve population health, including mental health. Child poverty in the UK is at a staggering 24 per cent, but it doesn't have to be. 'We know what to do – adjust the tax and benefit system and you've done it.' The report recommends ending the five-week wait for Universal Credit, raising minimum wage for apprentices, prioritising funding for youth services, providing additional support for pupils with SEND, and much more. Marmot's key message is that the fair distribution of health and wellbeing should be at the heart of government policy.

Marmot is hopeful for the future. 'I didn't call my report Everything's Gone to Hell, I called it Build Back Fairer.' While some of us are wondering when things are going back to normal, Marmot hopes we're never going back to normal. He said he takes heart from the Black Lives Matter movement, which shattered the delusion that there is no structural racism in Britain. Marmot thinks that a real difference can be made. The more people who are committed to social justice and taking practical action, the more likely government are to listen. Marmot urged mental health professionals to be part of social movements for change. Social change isn't achieved by individuals, he said, 'we get it by building social movements'. 

-       Find more on Marmot in our archives
-       Information on the Transformation Seminar Series can be found on the Anna Freud website
-       The BPS welcomed the findings of the Marmot Review, in line with the society's From Poverty to Flourishing campaign