Happy new year – and what a year 2024 has started out to be, as global, national and local events unfold and impact us all in different ways.
What these differences look like and how they play out was at the forefront of my mind as I took in a series of news stories on health, housing and places over the last two weeks.
The first was a Guardian piece on research led by Sir Michael Marmot at the Institute of Health Equity showing that between 2011 and 2019, 1,062,334 people died earlier than they would have done if they lived in areas where the richest 10% of the population reside.
This finding was based on analysis of ONS data measuring excess deaths over a ten year period, and coupled with further evidence that most of our health is determined by social circumstances and NHS care only accounts for 20% of population health, these findings spotlight the inequality in health and life expectancy across the country based on the places where people live. More importantly, they show how our political and institutional leaders have consistently failed to address these inequalities.
“If you needed a case study example of what not to do to reduce health inequalities, the UK provides it. The only other developed country doing worse is the USA, where life expectancy is falling” said Sir Michael.
The IHE report is particularly shocking at a time when our knowledge of how to prolong lifespan is advancing at a rapid pace. So-called Longevity Science is a billion-dollar industry focusing on finding ways to slow ageing and increase “healthspan” (years of life in good health) – but its benefits are seen as accessible by a small number of people – and a highly exclusive group at that..
Next, a series of reports on housing and places:
First, a report from the Financial Times on the UK housing crisis, revealing shocking evidence that the majority of 18-34 year olds in the UK live with their parents. So what, you might ask, and I have strongly argued the benefits of intergenerational living. But this evidence-based trend is not so beneficial to our communities, as the report’s author states:
“The breakdown of the housing conveyor belt has huge and diverse impacts. Studies show that the inability to afford a home causes people to postpone starting a family or simply not have children at all. High housing costs also divert individuals away from productive places and activities, and dramatically increase inequality in wealth and between regions”
As if I needed further proof that the housing crisis is alive and well, I came across a story from the west country where a housing developer in Cornwall states that its proposed developments of 58 homes would include no affordable ones, as these would make the project “unviable”. And another story tells us that what is being built affordably is under review for quality and impact on residents’ health, as the Royal College of Physicians warned the government in its recent report that unless landlords are required to fix mouldy homes, many more people will die from the effects. You couldn’t get much stronger than that.
Finally, a few stories about places.
The Guardian reported that children living near green spaces have stronger bones, citing a study that showed howbone strength is set in childhood, and better park access could prevent fractures in older people. Interestingly this was corroborated by another recent report on the positive impact that green spaces have on frailty amongst older people. And of course, this is all supported by the places across the world known as “Blue Zones” where residents enjoy exceptionally long lifespans, and where research reported last week shows the positive links between regular walking and mental health.
Indeed. As I suggested last year, we all deserve to live in a Blue Zone.
If these early stories of 2024 don’t convince you that homes, places and health are interconnected, and that this interconnection is a contributory factor in health inequality, I don’t know what will. How we as a nation choose to use this evidence and take action to build our homes and places so that they support our health equitably and sustainably is a major challenge of our time.
One approach to meeting this challenge is the Marmot City.
What is a Marmot city?
It’s a place whose leaders have adopted the principles of the Marmot Review, and is working in partnership with the IHE to develop and implement ways to improve wellbeing and reduce disparities in health outcomes within the local population.
Coventry is an example of a local authority that has adopted these principles. All policies and services commissioned across the council, including housing, transport and planning, take into account the impact they will have on health equity before they are implemented.
Since becoming a Marmot city, Coventry’s outcomes regarding health and inequalities have improved. According to a local GP involved in the programme,
“There’s a real understanding that the Marmot principles are things that underpin the way that we want to commission services, deliver services, and work with people to reduce health inequalities and improve outcomes.”
In addition to Coventry, five English local authorities have taken on the Marmot approach: Stoke, Newcastle, Gateshead, Bristol and Somerset.
By adopting the Marmot principles, these local authorities are increasing awareness of the social determinants of health, and exploring ways to measure impact and outcomes from their actions.
How the principles and practices associated with Marmot cities extend beyond local authorities to investors and developers of the built environment has yet to be tested. An initiative is underway, led by the IHE and funded by Legal & General, to encourage and support private sector organisations in building health equity into the homes and places they develop.
Health, lifespan, longevity, homes, places – they all converge in a Marmot city. Now, more than ever, we must take action to ensure their critical role in the development of our cities, towns and communities.
Clare Delmar
Listen to Locals
17 January 2024
