Report 7/2023
Building a Fairer Gwent: improving health equity and the social determinants by Michael Marmot, Jessica Allen, Tammy Boyce, Peter Goldblatt, Owen Callaghan

Building a Fairer Gwent: improving health equity and the social determinants

.pdfMain Report .pdfExecutive Summary .pdfExecutive Summary (Welsh)

The Marmot Review in Gwent highlighted the many challenges around inequalities and the large gaps in life expectancy across its 5 regions. Senior leaders are building on relationships in the Gwent Public Services Board to focus of building fairer, safer and stronger communities. We are taking a Public Health approach across our partnerships to deliver a fairer, safer, stronger and healthier Gwent.


Torfaen County Borough Council

Tackling health inequalities that exist in the borough and improving the quality of life for residents is a priority for the council. By focusing on the wider determinants of health such as employment, housing, education and the physical environment, the council have a tremendous opportunity to make a lasting impact on health inequalities and wider deprivation.

Torfaen Council was successful in securing £5 million in research investment to tackle health inequalities and improve health outcomes for residents in Torfaen.  The Department of Health and Social Care, through the National Institute for Health and Care Research (NIHR) is investing funding into a new local Health Determinants Research Collaboration (HDRC) for Torfaen over the next 6 years.

The council commenced its development phase in January 2024 before the ‘full’ HDRC is expected to go live during January 2025.

Torfaen’s HDRC funding will enable the council to embed a culture of research and evidence through:

  • Eliminating organisational practices that mitigate against evidence-based practice and research.
  • Strengthening collaboration and capacity to focus a research culture on the wider determinants of health. 
  • Creating an environment where professional curiosity can flourish with the aim of reducing health inequity
  • Strengthening the council’s approach to equality and diversity, with the voice of the communities and specific groups a significant force in informing the research priorities and chosen outcome measures.

As part of the first Marmot region in Wales, Torfaen have developed a set of Marmot indicators to measure progress in addressing the wider determinants of health.  Torfaen’s County Plan Future Torfaen measures well-being and tracks the impact of the Council on population health and reducing inequality.  The establishment of the HDRC will support evidence-based decision-making on the activities needed to most benefit the wellbeing objectives in the County Plan. The council will tackle inequality by focusing on early identification and prevention activities that support people to live independent and fulfilling lives and support and promote healthier lifestyles in Torfaen to improve mental and physical well-being

The HDRC will build on the work of Torfaen being a Marmot Place by:

  • enhancing relationships between stakeholders;
  • building the infrastructure needed to support the creation of robust evaluations of pragmatic, feasible interventions.


This work was commissioned by the public health team at Aneurin Bevan University Health Board (ABUHB) in Gwent, Wales. Based on analysis of data and workshops and interviews with stakeholders across the five local authorities in the region: Blaenau Gwent, Caerphilly, Monmouthshire, Newport and Torfaen.

The report outlines health inequalities in Gwent, and identifies ways to improve the social determinants of health, the drivers of health inequalities. The current context for health and health equity is bleak, with worsening health, widening inequalities and extensive pressures on the NHS and public services, The report shows it is still possible for local areas such as Gwent to take actions to make a difference to their residents, in an era when they most need this support.



The accompanying datapacks (available in PDF format) present figures not included in the main report showing the drivers and impacts of health inequalities and should be read in conjunction with the main report and recommendations.

Links to:

Blaenau Gwent IHE datapack

Caerphilly IHE datapack

Monmouthshire IHE datapack

Newport IHE datapack

Torfaen IHE datapack

Further reading