In April 2018, the APPG on A Fit and Healthy Childhood published ‘The Impact Of Social And Economic Inequalities On Children’s Health’.
The report maintained that ‘ A child born into circumstances of social and economic inequality in the 21st century United Kingdom will start life with one hand tied behind its back.’
We said that the inflexible direction of policy meant that existing inequalities were ever more entrenched for some families in every community and that if, as a nation, we were serious about children’s health, we should invest now to rectify the ills that were holding them back; thus saving later on the lasting prosperity that would thereby be secured for the benefit of all.
Earlier this year, Michael Marmot and colleagues revisited his seminal 2010 study by publishing 2020 Health equity in England: the Marmot review 10 years on (Marmot M. et al, 2020)
Marmot concluded that:
‘There were two distinguishing features of UK Government strategies pursued since 2010: rolling back of the state – public expenditure went from 42% of gross domestic product (GDP) in 2010 to 35% in 2018 – and being sharply regressive – the poorer you were, the more likely you were to be disadvantaged by the changes government made….. whatever the reason for such clearly regressive policies – whether driven by some economic ideology, or rather, grisly political calculations – their effect was to make the poor poorer and to deprive those in need of services. It is highly likely that these policies had an important role in the health picture in England.’
In an article published by ‘The Lancet’ on May 2nd 2020 (‘Society and the slow burn of inequality’) Marmot argued that epidemics (and pandemics) serve to expose fundamental truths about societies and ‘If we have the capacity to learn,’ show us that there are other ways in which to live and other policy options not only become possible but essential.
Far from being, in the words of many commentators, a great ‘’equalizer’, COVID-19 has shone an unrelenting beam upon the injustices and disparities in our society:
‘Those who could work from home and those who could not; those who could retreat to holiday homes and those in crowded flats; those with income reserves and those who could not afford to buy food; those in a position to offer home education to their children and those not so fortunate or well equipped.’
Marmot believes that the aim of policy after the pandemic should not be circumscribed by the narrow aim of restoring economic growth, but to create societies that are truly better than what has gone before, characterised by better health and a narrowing of health inequalities.
Above all, Marmot believes (as he did in 2010) that in a post-COVID world, the principle of equality should embrace children. The findings of Marmot 2020 show what the building blocks of those better societies should be:
- reductions of child poverty and funding of services to improve outcomes for children
- proper funding for education
- improvement of working conditions
- ensuring that everyone has at least the minimum income to lead a healthy life
- creating healthy and sustainable environments in which to live and work
- creating the conditions for people to pursue healthy behaviours.
Helen Clark, Lead Author for the APPG on A Fit and Healthy Childhood welcomed the positivity and added:
The arguments made by Marmot in 2010 and 2020, by the APPG On A Fit and Healthy Childhood and others are relevant as never before now that they have been thrown into stark relief by COVID-19.
As Marmot says, the public health crisis of a pandemic has become an economic and social crisis. The new society that will emerge tentatively from the wreckage must be one in which the needs of children whoever they are and however they live – must come first.’