Luton to become a ‘Marmot Town’ as new review confirms Lutonians are living shorter lives than they should
People living in Luton are dying around eight years before they should from preventable illnesses according to the latest Marmot Review from the UCL Institute of Health Equity (IHE).
Reducing Health Inequalities in Luton: A Marmot Town, is published today (Wednesday 7th September, 2022) and emphasises how ill health starts in childhood and tracks throughout life, placing tens of thousands of people in preventable ill health and poverty.
While Luton has many strategies for reducing inequalities and improving health for poorer children in schools, it is anticipated that the severe situation this winter will damage health and widen health inequalities.
In the years 2017-19, before the COVID-19 pandemic, life expectancy at birth in Luton was, on average, more than one year less than the England average for men (79), and about eight months less for women (83). Latest ONS data shows there’s also wide differences in life expectancy within the town itself*. Those who live in the more deprived areas like Challney, central Luton & Park Town are predicted to die around eight years before those in affluent areas such as Bramingham, Barnfield and Stopsley North.
The IHE’s Deputy Director, Dr Jessica Allen explained: “These stark differences in health and life expectancy begin in the early years of life. Luton lags behind the national average in some important areas, with higher infant mortality rates and more child poverty. Without a good start in life these children are more likely to have unstable work, live in poor quality housing and not have enough money to lead a healthy life.
“But Luton is well-placed to become a Marmot town – it has a thriving and vibrant voluntary, community, faith and social enterprise (VCFSE) sector, a resilient economy and no shortage of the ambition and leadership needed to put health equity at the top of the agenda. It has some important plans for change including the Luton 2020-40 plan, the Fairness Taskforce and becoming a Child Friendly Town.”
Luton Borough Council is partnering with IHE to make Luton a Marmot Town to reduce these avoidable health inequalities. The town is joining a growing number of ‘Marmot Places’, which includes cities and regions across the country, such as Manchester, Coventry, and Cheshire & Merseyside. These Marmot Places work towards implementing the eight ‘Marmot Principles’ to create communities where everybody has an opportunity to thrive.
Dr Allen added: “Across England, between 2010 and 2020 life expectancy slowed and actually fell for people living in deprived areas. It’s likely as a result of the policies of austerity, which led to significant financial cuts. While Luton does well on some measures, such as education for more deprived children, unfortunately health will get significantly worse in Luton, as across the country, as a result of the cost-of-living crisis. Our partnership with Luton will help orientate Luton in the right direction to be a healthy town - and build on the strong leadership and appetite to do this. But it has to be accompanied by significant national government intervention if we are to prevent the humanitarian crisis of poverty.”
Marmot Principles and Recommendations
- Give every child the best start in life and improve educational and development outcomes e.g., expand provision of Flying Start in Luton, reduce child poverty and improve school readiness.
- Enable all children, young people and adults to maximise their capabilities and have control over their lives by improving educational attainment e.g., increase free school meals, commission programmes to support young people’s mental health in schools and improve funding for youth services
- Create fair employment and good work for all e.g., implement a local good work charter for public and private sector employers, building on the national Good Business Charter
- Ensure a healthy standard of living for all e.g., implement partnerships to reduce levels of debt, fuel poverty and provide social welfare services
- Create and develop healthy and sustainable places and communities to support good mental and physical health e.g., introduce a Clean Air Zone, strengthen housing/health care services partnerships, prioritise reducing social isolation
- Strengthen the role and impact of ill-health prevention both within the NHS and by extending social prescribing so patients are referred for food and fuel security support as well as financial, legal, housing and debt advice
- Tackle discrimination, racism and their outcomes – Luton is very ethnically diverse, with more people of Black and Asian decent than average e.g., all services (NHS, local authorities, public sector and businesses) should work in partnership with local minority communities
- Pursue environmental sustainability and health equity together to ensure health and climate goals are achieved symbiotically e.g., transition away from carbon while building resilient communities, monitor net-zero policies for equity impacts and encourage local employers to promote active travel (cycling/walking)
Case Study Examples of Good Practice
- Local government may have received funding cuts since 2010 but much can be achieved by partnership working with the NHS, businesses and VCFSE sector to avoid a future where social care consumes the entire budget
- Build on the approach developed by the East London Foundation Trust to strengthen action on the social determinants, including creating a senior role to take responsibility for housing and health
- Ensure health equity is the central concern across local public services including police, fire services and education to set up as anchor institutions of good practice in the community
- Invest in the vibrant VCFSE sector across Luton to harness their energy, knowledge and skills in partnership working long-term and ensure their work is evaluated and rolled out
- Businesses should commit to a local good employment charter to promote a healthy workforce as well as health equity in local community and across their procurement and supply networks
*Office for National Statistics (2021) Life expectancy at birth and age 65 years by sex for Middle Layer super Output Areas (MSOAs), England: 2016 to 2020. Available from: https://www.ons.gov.uk/peoplepopulationand community/birthsdeathsandmarriages/lifeexpectancies/adhocs/13926lifeexpectancyatbirthandage65 yearsbysexformiddlelayersuperoutputareasmsoasengland2016to2020.
All media enquiries: Felicity Porritt, UCL Institute of Health Equity
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The UCL Institute of Health Equityis confident enough to conclude that we have the evidence on what needs to be done to advance health equity, as laid out in our 2010 Marmot Review. The recommendations in Reducing Health Inequalities in Luton: A Marmot Town are tructured according to the ‘Marmot Principles’.
The first Marmot Review, published in 2010, introduced six of these principles, which are broad policy objectives aimed at reducing health inequalities by improving the conditions of everyday life and reducing socioeconomic inequalities. Two further principles have since been added to make more explicit and add focus to the key considerations of discrimination and sustainability, which are essential to equity.
The UCL Institute of Health Equity works in local partnerships nationally and globally to influence the delivery of interventions to ensure they incorporate action on health, social and economic inequalities. Organisations with which the IHE works include business, city authorities, voluntary sector, local government and healthcare services.
In the UK the evidence on what needs to be done to advance health equity has been overlooked by central government. From 2010, the rate of increase in life expectancy slowed markedly; health inequalities increased, linked to deprivation and region; and life expectancy for the poorest people outside London declined.
This worsening health picture is related to policies of austerity and regressive cuts to spending during that period. The IHE produced Build Back Fairer: The COVID-19 Marmot Review in December 2020, which includes national for government, business, the health and care system, and the voluntary and community sector. Build Back Fairer in Greater Manchesterpublished June 2021, builds on the 2020 review.
In April this year IHE published its first review for the role of business in reducing health inequalities: The Marmot Review for Industry. Building on this review the IHE, in partnership with Legal and General, will launch the Health Equity Network this autumn. The aim of the network is to support action on health equity through partnerships across the UK by sharing experience between the partnerships and building momentum on health equity as the primary goal of place-based working.
IHE continues to work closely with other cities and regions, including Coventry, for which a city evaluation was produced in 2020. We have begun programmes of work with Cheshire and Merseyside, Cumbria and Lancashire and other local authorities in England. In May 2021 IHE published a commentary report on UK ethnicity and mortality statistics in relation to the COVID-19 pandemic.
Internationally IHE has responded to COVID-19 with:
- Build Back Fairer: Achieving Health Equity in the Eastern Mediterranean Region - The WHO EMRO Commission on the Social Determinants of Health, published on 31 March 2021
- Hong Kong, with the first report in a series from our collaboration with the Chinese University of Hong Kong's Institute of health Equity: Build Back Fairer: Reducing Socioeconomic Inequalities in Health in Hong Kong published 16 November 2021
- Evidence Brief: COVID-19, the social determinants of health and health equity, which discusses the disproportionate impacts that the COVID-19 pandemic is having on more disadvantaged population groups, with a focus on how it is widening health inequities.
The IHE’s Director, Sir Michael Marmot, is Professor of Epidemiology at University College London and Past President of the British and World Medical Association. He is the author of The Health Gap: the challenge of an unequal world (Bloomsbury: 2015) and Status Syndrome: how your place on the social gradient directly affects your health (Bloomsbury: 2004). Professor Marmot holds the Harvard Lown Professorship for 2014-2017 and is the recipient of the Prince Mahidol Award for Public Health 2015. He has been awarded honorary doctorates from 18 universities. In 2021 Professor Marmot received BMJ's Outstanding Contribution to Health award. Professor Marmot has led research groups on health inequalities for over 40 years.