A leading international voice on health inequalities says the Scottish government should follow the example of their counterparts in Wales and commit to putting equity of health and wellbeing at the heart of all government policy.

Professor Sir Michael Marmot will tell today’s ALLIANCE conference that, given the right funding, the voluntary sector will be vital in addressing Scotland’s failure to improve life expectancy, particularly for those living in the least affluent communities.

In 2008, on the back of work for the World Health Organisation on social determinants of health, London-based Professor of Epidemiology Sir Michael Marmot was asked by Prime Minister Gordon Brown to conduct a Strategic Review of Health Inequalities in England.

His findings, published in his findings, published in his 2010 report ‘Fair Society, Healthy Lives’, set out six policy objectives to reduce health inequalities: giving every child the best start in life, giving young people control over their lives, fair employment, ensuring healthy standards of living, developing healthy communities and delivering more impactful health prevention.

To these, he later added two more principles: tackling racism, discrimination and their outcomes; and pursuing environmental sustainability and health equity together.

To these were, he later added two more principles: to address health inequalities, racism and discrimination in all its forms must be tackled and environmental sustainability should be considered alongside health equity.

Since then, Sir Michael will tell the ALLIANCE Conference in Glasgow today, inequalities have grown and life expectancy across the UK has not improved:

“My general assumption is that health is a good measure of how well we're doing as a society,” Sir Michael told healthandcare.scot ahead of his keynote address. “And if health has stopped improving, it means society has stopped improving.”

Sir Michael lays the blame at the door of the Conservative-led coalition government that took over from Mr Brown’s Labour in 2010, and introduced a policy of austerity.

“If you do that, you can't do it with impunity. There will be costs, and it's showing up in worse health, failure of life expectancy to improve, increased inequalities and worse health, particularly in deprived areas.”

After the UK government declined to act on his recommendations, a growing number of cities and regions across the UK chose instead to follow the principles locally and to become ‘Marmot Places’.

“So my message is, we've got a problem. We know what to do to fix it, and we need to take the action to do it. And we've got good examples, including the three areas in Scotland, of what you can do to make a difference.”

Aberdeen City, South Lanarkshire and North Ayrshire are on their way to becoming Scottish Marmot Places – in partnerships led by local government.

The Collaboration for Health Equity programme now underway in these three areas will look to improve long-term health outcomes for local residents by uniting the NHS, local government, businesses and voluntary sectors.

And it is this last pillar that Sir Michael says is “absolutely vital”:

“Not as I might have once thought: “if you can't get government to do it, we need somebody else to do it”, but because the voluntary community sector has something very positive to offer that isn't being done by others.

“It's a complement to what else we need. Locally, we need city government, we need health and care, the voluntary community sector, education and public organisations such as police and fire and rescue services.”

Earlier this month, Sir Michael says the health secretary in Wales announced that Wales is to become a ‘Marmot Nation’.

“Why not Scotland?” he asks, adding that such a move will need ministers to put equity of health and wellbeing at the heart of all government policy, not just health policy.

Scotland’s gems

Sir Michael says Scotland is already adopting Marmot principles with policies committed to giving children the best start:

“I'd been to several meetings in Scotland before we started this collaboration on health equity in Scotland, which were about early childhood. And I was delighted that this was a real priority for Scotland.

“One of them was called Polishing Our Gems. Wow. Polishing Our Gems. Our children are our gems, and we need to make them shine. That was pretty inspiring. I know we need to be dispassionate, but I got a bit teary-eyed at the idea of making our children shine.

“However, there are no laurels on which to sit back, to rest on, because their problems are huge.

“We can be pleased that priority is being given to early childhood, but there are significant headwinds: deindustrialisation and the fact that across the UK as a whole, the economy is not in good shape.

“So, yes, be proud of what you're doing well, and rise to the challenge of doing better.”

 

healthandcare.scot is pleased to be a conference media partner for the ALLIANCE Annual Conference 2025, Our Voices Matter

 

Read more: ALLIANCE: Action needed from Scotland’s leaders; Analysis: abolishing non-residential care charges; Concern as human rights absent from government plan; New collaboration to tackle health inequalities

 

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