Sir Michael Marmot was commissioned by the secretary of state in November 2008 to propose cost effective strategies to reduce health inequalities. The Fair society, healthy lives report found that:
- there were wide variations in life expectancy between areas
- people in poorer neighbourhoods died earlier and tended to live with disabilities for most of their lives
- there was a distinct ‘social gradient’ of health inequalities – where the economic and social status of an individual determined their health status
- health status and inequalities could be determined by factors such as the environment, income, housing, education, disability and others.
Sir Michael Marmot argued that health inequalities were largely preventable, but to tackle them would require action across all the social determinants of health. There was not only a moral necessity to ensure good health and wellbeing was spread evenly across the population, but also an economic argument for tackling inequalities.
To achieve better health and wellbeing for all, the report set out two policy goals – to create a society that enabled individuals to maximise individual and community potential and that social justice, sustainability and health must be at the centre of all policies.
The review grouped its recommendations under six policy objectives, which were as follows:
- giving every child the best start in life
- enabling all children, young people and adults to maximise their capabilities and have control over their lives
- creating fair employment and good work for all
- ensuring a healthy standard of living for all
- creating and developing sustainable places and communities
- strengthening the role and impact of ill health prevention.
The report recognised that individuals experience different life stages and that at every life stage they will require different types of support. To realise these objectives, the NHS, central and local government would need to work together.
The government response was embodied in the Healthy lives, healthy people white paper.