On Monday 12th November, our Programme Manager for Communities, Isabel Young, attended the ‘Poverty in a Marmot City’ summit in Coventry. Here, she reflects on the key findings from the conference, and how Coventry, as an example of a Marmot city, can inspire us all.
Working on the Tower Hamlets Communities Driving Change project here in Bethnal Green, we are reminded about the realities of health inequalities on a daily basis. We regularly hear from local people about how their biggest health and wellbeing concerns are down to poor or inadequate housing, feeling unsafe where they live, and the lack of opportunities for local people and families. These issues relate to what we call the ‘wider determinants of health’ – i.e. your environment, income, safety are inseparable from your health and wellbeing. In fact, I’d argue there are few aspects of life which do not benefit from being viewed through a public health lens. For instance, we’ve seen the success in Scotland of tackling knife crime as a public health issue, using an approach which focuses on education and prevention.
I attended the summit to learn about how health inequalities are being tackled in Coventry and how we might be able to replicate their successes here in Tower Hamlets. The day provided an opportunity to hear from Professor Sir Michael Marmot, David Buck from The King’s Fund, representatives from Coventry City Council and people working across the city’s not for profit and social innovation sector. Both the presenters and those in attendance spoke about how the impact of poverty on health is experienced in the city, and how people are working together to put Marmot’s 6 recommendations into practice (as 1 of 7 pilot ‘Marmot cities’):
- Giving every child the best start in life
- Enabling all children, young people and adults to maximize 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.
Sir Marmot’s passion and ability to convey robust evidence clearly and meaningfully was inspiring, I made notes throughout the entire event and recorded some of the things which really jumped out at me:
- From 1918 to 2010, life expectancy was on the rise (quite steeply in fact). Since 2010, it has stalled.
- There are over 9,000 unnecessary deaths a year in the UK, because people cannot afford to heat their homes.
- If people on lower incomes followed Public Health England’s guide to eating healthily, it would cost them 74% of their income. In other words, people have to choose to heat their homes, eat well, or pay their rent.
The event reminded me that it’s important to revisit evidence surrounding health inequalities, not only to recognise the weight of the structural inequalities we’re up against, but to understand just how Government Local Authorities (GLAs) like in Coventry, like in Tower Hamlets, are trying different approaches to improve health and wellbeing locally.
This is important to our work at The Young Foundation because much like Marmot’s 5th recommendation (creating and developing sustainable places and communities), our approach is founded upon place-based work which draws from the expertise and lived experience of local people to make lasting change.
Since becoming a ‘Marmot City’ in 2013, the Marmot principle of a fair society with healthy citizens has been embedded across the core functions of Coventry City Council and its local partners. And what’s more, it appears to be working. 1,700 young people, recognised as NEET (Not in Education, Employment or Training) have now moved into work through initiatives such as the Routes to Ambition programme. 35,000 people have found jobs through the ‘Job Shop’ project (reducing the cities’ unemployment ranking nationally), crime has reduced, and greater life satisfaction has been reported.
However, more work is needed and more evidence needs to be collected to fully understand the impact over time. In Coventry, there is still a ten-year life expectancy gap depending on which area of the city you live in. This is part of a poverty cycle which continues, and is, for Marmot, a national crisis which can begin to be broken at a city level.
To revisit the issue of knife crime, the words of one of the presenters, Rashid Bhayat who leads Positive Youth Foundation (a charity engaging and developing young people across the City of Coventry) really struck a chord with me;
“We talk about the importance of the social determinants of health…but we have a problem. We are now saving young people’s lives through public health.” He talked about how knife crime and gang violence follows young people into adult life; “you’re still paying off that bag of chips someone bought you in to your twenties!” – referencing how difficult it is to work against the grooming tactics used to coerce young people into gang culture. This is not far removed from the lives of young people in Tower Hamlets, or across the UK at large. For me, this shows how crucial it is to strike a balance between place-based local responses and understanding issues as part of the bigger picture of wider structural inequalities.
Coming away from the event, I am left with more questions to ponder. What I hope, is that by continuing to work alongside likeminded agencies, whether in Coventry, Tower Hamlets or elsewhere, we can continue to gather information, robust evidence and share learning which can feed into healthier, more equal communities.
For now, I think we must begin from a place of inspiration. For Coventry and for Tower Hamlets, they have made the decision that inequalities are not inevitable. They have made the decision to make these places better and more equal for all. They have done so by taking a holistic approach to health, which is not divorced from housing, education, employment or all of the other factors which determine the quality of our lives.
I will end on Marmot’s call to action “why treat people and send them back to the conditions that made them sick?”
What happens next? Dedication to doing things differently, working together, and time, will tell.