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The Government is being urged to introduce a national health inequalities strategy to tackle England’s widening health inequality gap, in a new report by the Local Government Association.

The report Building Fairer Towns, Cities, and Regions: Insights from Marmot Places, is being launched at the LGA’s Smith Square Debate Health inequalities – can councils close the gap?

It comes as councils across the country continue to lead the way in tackling health inequalities at a local level, with significant progress made in addressing the social determinants of health through the ‘Marmot Eight’ principles.

The report features innovative case studies from Marmot Places and underlines the need for national leadership to mirror and support local efforts. The debate will bring together leading voices in public health, government, and community advocacy to discuss how to bridge the health inequality gap and ensure everyone can lead a healthy life, regardless of their circumstances.

Grounded in addressing the social determinants of health such as housing, employment, and education, the Marmot approach has proven transformative. 

With more than 50 local areas across England, Wales, and Scotland designated as Marmot Places, councils are already demonstrating how collaborative, community-focused initiatives can deliver meaningful change. 

However, as this report highlights, the scale of health inequalities demands a concerted national effort.

It follows a number of previous studies which have warned of the widening health inequality gap:-

• Figures from the King’s Fund showed that in 2020-22, healthy life expectancy in the North East was almost seven years shorter for males and six years shorter for females compared with the South East. People living in northern regions also spend higher proportions of their shorter lives in poor health. 
   
• Meanwhile a study published by the Health Foundation found that based on current trends, inequalities in health will persist over the next two decades, with people in the 10 per cent most deprived areas expected to be diagnosed with major illness a decade earlier than people in the 10 per cent least deprived areas.
   
• A report by the UCL Institute of Health Equity confirmed widening inequalities of life expectancy between regions in England and within local authorities since 2010. It warned widening inequalities were associated with an average reduction in local authority spending power of 34 per cent.

Cllr Louise Gittins, Chair of the LGA, said:

“The Marmot Places report is a powerful reminder of what local government and its partners can achieve when they commit to tackling health inequalities. Across the country, councils are working tirelessly to incorporate fairness into housing, employment, and public health initiatives, often in the face of significant challenges.

“But local action alone cannot close the widening health inequality gap. We urgently need a national health inequalities strategy that builds on the excellent progress councils have made. With national and local leadership working together, we can create a society where everyone, regardless of their background or postcode, has the opportunity to thrive.”

Professor Sir Michael Marmot, Director, UCL Institute of Health Equity said: 

“Our review of health inequalities in 2010 laid out what needs to be done to promote health equity where people are born, grow, live, work and age. IHE analysis has shown that cuts to local authorities led to stalling of life expectancy, stopped health improving and widened inequalities across the UK. 

“We are now working with more than 50 places across the country who are doing what they can, with diminished funding, to improve the lives for local people. We desperately need national action to accompany these truly inspirational local initiatives on the social determinants of health.”

Katherine Merrifield, Assistant Director of Healthy Lives at the Health Foundation, said: 

“Good health is an asset to society. The health inequality described in our Health in Equalities 2040 report should not exist. The LGA's report is a vital reminder of the key role local authorities can play in tackling health inequalities in their local areas. 

“However, councils need to be supported in this activity, including through a sustainable finance system that better links funding with need and more joined-up support from central government. 

“Like the LGA, we believe that the Government’s health mission must focus on delivering health and health equity by addressing broader factors beyond just health care and social care that influence our health.”

Paul McDonald, Chief Campaigns Officer of campaigning coalition Health Equals, said: 

“It is deeply unfair that across the UK today, health inequalities are cutting lives short by up to 16 years. Our health is shaped by the world around us – from the money in our pockets, to quality homes that are warm and safe, stable jobs and neighbourhoods with green space and clean air. 

“The insights from the Marmot Places Report show us that by working to improve access to these essential building blocks of health in our towns and cities, change is possible. 

“But the incredible work of local government and its communities cannot solve the issues alone. If we really want to make health equal across the UK, we urgently need a national health inequalities strategy, so everyone can have the best chance of good health, no matter who they are or where they are born, work and live.”

Case studies

Coventry: Pioneering health equity as the first Marmot City

Coventry became the first Marmot City in 2013, partnering with the UCL Institute of Health Equity to tackle health inequalities. 

Over the past 11 years, despite challenges such as reduced local government funding and the pandemic, Coventry has maintained its commitment to health equity. The city has embedded Marmot principles across council policies, ensuring that initiatives in transport, housing, and employment support consider their impact on health inequalities. 

A cornerstone of Coventry’s Marmot approach is its “Job Shop,” a high-street hub offering employment advice and training, which supports around 170 residents daily. This inclusive service caters to diverse needs, from basic job searches to tailored support for ex-offenders.

Post-pandemic, the city reinvigorated its Marmot work. Successes include reducing the proportion of neighbourhoods in England’s most deprived 10 per cent from 18.5 per cent to 14.4 per cent (2015–2019), whilst inequality in life expectancy for both men and women in the city has remained relatively stable, even as these widened nationally.

In 2023, Coventry launched a Marmot Monitoring Tool to measure efforts by the council and its partners to tackle health inequalities. The tool provides an updated framework, considering challenges such as the cost of living crisis, and monitors the potential widening of health inequalities for residents. 

Oxfordshire: Addressing Hidden Inequalities in a Mixed Landscape

Oxfordshire is one of the most recent Marmot Places, joining the Marmot network in 2023, targeting unique health challenges within its mix of urban and rural areas. Despite its affluence, pockets of deprivation and rural isolation create significant health disparities. Partners in the county have prioritised three Marmot principles: giving every child the best start in life, fair employment for all and ensuring a healthy standard of living for all.

A key focus is housing quality. Backed by £1.5 million from the Integrated Care Board, Oxfordshire is retrofitting homes to address damp and mould, reducing childhood respiratory illnesses. The council is also expanding its community connector work, piloting a strengths-based Local Area Co-ordination programme, and developing GP-led intensive care models.

Collaboration underpins Oxfordshire’s approach. The council has formed the Policy Lab with Oxford’s universities to bridge research and policy working with anchor institutions’ resources for local benefit. Marmot’s framework provides cohesion by aligning various programs to systematically tackle health inequities. Public health leaders emphasise the framework’s value as an “umbrella,” bringing structure and credibility to Oxfordshire’s public health work to ensure lasting impact.