Devolution: how health equity in Manchester is providing a sense of hope

24/07/26

Devolution: how health equity in Manchester is providing a sense of hope Michael Marmot, Jessica Allen, Felicity Porritt, April Whitworth

With Andy Burnham now Prime Minister, devolution is high on the national agenda. His record in Greater Manchester — where he championed a place-based approach to tackling the social determinants of health — offers both a model and a mandate. But translating local success into national change will require commitment from Whitehall to every UK postcode.

Greater Manchester became the first Marmot Region. Making Manchester Fairer, which is specific to the City of Manchester, applied principles of health equity (similar to the 8 Marmot Principles) across the full life course, including early childhood, education, work, housing, cost of living, and community. The results are beginning to show:

School readiness among five-year-olds eligible for free school meals in Manchester City has improved so markedly between 2021-2025 that it now exceeds the English average.
Secondary school attainment among pupils eligible for free school meals has risen in eight of Greater Manchester's 10 local authorities — at a time when it flatlined nationally (between 2018-2025).
Full-time employment rates in Greater Manchester are above the English average.

The national picture makes this local progress all the more striking. The UK's life expectancy has flatlined for 14 years — a longer stall than almost any other rich country. Where you live determines how long you live: the most deprived areas fare worst, and deprivation hits harder in the north than in the south. Within the UK, the geographic inequalities are extreme — strip out London, and the UK has roughly the same income per person as Mississippi, the poorest US state.

There are now nearly 70 health equity ‘Marmot’ places across England, Scotland and Wales that are paving the way for what's possible. Scotland and Wales have gone further — embedding health equity into their national strategies. England is sadly lacking.

Local places shouldn’t have to do it alone; they need national direction to match their ambition. Manchester has shown that real change is possible even against a bleak national backdrop. Scaling this approach isn't just the right thing to do — it's how you help give people across the country a genuine sense of hope.

This is a summary of a BMJ article, authored by Michael Marmot and Jessica Allen, available here.