The UK government urgently needs to seize the opportunity presented by the pandemic to try to reset the health and social care agenda, a public expert will tell nursing staff today.
Sir Michael Marmot will tell the Royal College of Nursing’s annual Congress that the pandemic has exposed and magnified health inequalities and the social and economic inequalities that lead to health inequalities.
He will add that these damaging, widening health inequalities must be addressed by focussing the health and social care agenda more on prevention and by building back fairer from COVID-19.
He will say he has seen impressive levels of engagement from politicians at local level and in some of the devolved nations, in particular Wales, but that the UK government has yet to follow suit.
Like the RCN, Sir Michael has passionately spoken out against the cuts to the UK’s public health and social care budgets in the last decade as health inequalities have widened.
The RCN is calling for the UK Government to introduce a fully-funded health inequalities strategy to address the social determinants of health, and to deliver a long-term, increased, sustainable funding settlement for public health which includes investment in public health nursing.
Sir Michael, who is Director of University College London’s Institute of Health Equity, is expected to say:
“The Prime Minister spoke in July about how we didn’t know why people’s life expectancies in Glasgow and Blackpool were much lower than in Hertfordshire and Rutland. We do. It’s down to the fundamental, societal issues like poverty, poor housing and children not having enough food to eat.
“We need to adopt a health and social care system which prioritises not just the treatment of illness but how it can be prevented in the first place. The pandemic has made it crystal clear over the last 18 months why public health and, more broadly, the social determinants of health, are so important.
“The health and social care agenda must be re-balanced more towards prevention.”
Pat Cullen, RCN general secretary and chief executive, said:
“Cuts to public health budgets must be reversed urgently. The impact on patient care has been appalling in areas such as smoking cessation, obesity services and sexual health clinics.
“We are calling for the Government to come up with a fully-funded health inequalities strategy to address the social determinants of health, and to deliver a long-term, increased, sustainable funding settlement for public health which includes investment in public health nursing.
“That the UK government has failed to grasp what is clear as day to the rest of the country is deeply disappointing.”
Sir Michael will tell delegates the underlying problem is “not that central Government is telling local authorities not to act, it is that they have taken the funding away”. There has not been a national health inequalities strategy since the publication of his landmark report ‘Fair Society, Healthy Lives’ in 2010.
He will say that only by tackling the root causes of those health inequalities, which are socially determined – such as poverty, poor-quality housing and hunger – can huge discrepancies in the life expectancies and health of people living in wealthy and poorer parts of the country be addressed.
On what needs to be done to implement his public health agenda, he will say those things include:
- Education and training of health care staff to focus on prevention and the social determinants of health as well as treatment.
- Seeing the patient in a broader perspective – for example, you can give a homeless person good healthcare but without a decent quality home to return to the outcome is likely to be poor
- “Anchor institutions”: the wider impact of the healthcare institution, such as employment conditions for doctors, nurses and lab technicians, etc., but also the impact of healthcare jobs and spending on the local community.
- Partnership working: people working in paediatrics or geriatrics do this, for example.
Notes to Editors
Last year, Sir Michael published ‘Health Equity in England: The Marmot Review 10 Years On’.
Its findings included that the more deprived the area the greater the fall in spending per person by local authority during that time, with the most deprived areas seeing that amount fall by 32 per cent.
The 10 Years On Review reinforced the six priority objectives and areas of recommendations set out in the 2010 Marmot Review, Fair Society Healthy Lives:
- Give every child the best start in life.
- Enable all children, young people and adults to maximise their capabilities and have control over their lives.
- Create fair employment and good work for all.
- Ensure a healthy standard of living for all.
- Create and develop healthy and sustainable places and communities.
- Strengthen the role and impact of ill health prevention.
In June, Sir Michael published a report called Build Back Fairer in Greater Manchester: Health Equality and Dignified Lives.
It revealed “jaw-dropping” falls in life expectancy in Greater Manchester during the pandemic which were higher in the more deprived areas. They were also likely to have been replicated across the country, the report found.
In July, Prime Minister Boris Johnson gave a speech on his vision to level up the country which referred to differences in life expectancy nationally.