Unfair society, unhealthy lives? Inequality and health in 2020

Dan Robotham

A few days ago, I woke up and saw that Professor Michael Marmot had updated his review on Health Equity in England. The new review assesses the effect of the last ten years on the nation’s health, drawing on evidence from over 500 documents.

About a decade ago, I sat in the audience at a conference listening to Professor Marmot talk about his then latest report “Fair Society, Healthy Lives” (colloquially called “the Marmot Review”). He showed us lots of graphs with coloured lines going up and down and talked about the impact of social inequalities on health. He mentioned that he enjoyed speaking at mental health conferences because the audiences understood him instinctively. People who work in mental health are (or should be) aware of the importance of factors like poverty, homelessness, abuse, trauma, a pressurised education system, physical health problems and welfare reform. They will likely know many people who experience the brunt of these things daily, and a good proportion will also experience them personally.

This is certainly true at McPin. We work with lots of people affected by poor housing, severe mental health problems, isolation, discrimination, physical health problems, trauma, to name but a few. The influence of poverty and inequality on mental health is obvious. It’s a given. We talked about this recently in our project about mental health, debt and money. These things come up every time we speak to people about welfare benefits, such as people fighting to apply for and keep Personal Independence Payments and the like. Inequality is a thread that runs through our work, every day.

Who is listening?

This is not a new message. Activist groups such as Disabled People Against Cuts and Psychologists for Social Change have been raising awareness of the social determinants that affect mental health and the devastating impact that austerity policies have had. Marmot keeps repeating himself. He’s right to do this. The politicians know that he is one of the few people with enough clout to warrant a public response on this issue. Does anyone in power really listen in the long-term though? What happens after the headlines die down in a week or two?

Nothing in the new review is a surprise. It is simply depressing. In a society which has become increasingly unequal, we see declines in health and life expectancy. Perhaps most concerning of all is the sentence in his foreword, where he highlights that many of these problems were a result of conscious political decisions, in his words: “the damage to the nation’s health need not have happened”.

Like all organisations in this space, McPin must do our bit. One of our goals is to create sustainable employment for peer researchers, and to help people recognise the relevance of their skills and experiences. We must strive to be part of the solution rather than part of the problem, aware of our position in a world where everything can have unintended consequences.  

So, in 2030, what will the next Marmot review say? How much further will we have fallen? How much further backward can we go? We’ve got ten years to reclaim some hope.