Introduction
European Review
English Review
Global Review
About Prof Sir Michael Marmot

 

Introduction

The ‘Marmot Reviews’ refer to the work that is carried out by Professor Sir Michael Marmot and his team at University College London (UCL).

Below you can find an overview of the Reviews he has finalized or is currently involved in, and examples of other Reviews that are based on his work.

European Review (2010 – 2012)

The WHO Regional Office for Europe commissioned a regional review of the health divide and inequalities in health from July 2010 to 2012, which was conducted by a Consortium of experts and institutions, and chaired by Professor Sir Michael Marmot. The purpose of the review was to identify the relevance of the findings of the WHO Commission on the Social Determinants of Health (CSDH), the Strategic Review of Health Inequalities in England post 2010 (see below), and other new evidence to the European context. These will be translated into policy proposals. The European Review will also feed into the development of a renewed European health policy: Health 2020.

The European Review draws on best practices, examples and experience of addressing social determinants of health and health inequities in the Region and how to take this to scale. One of the key goals of the review is to identify what works and how to implement it across the diverse context of the European Region.

A first interim report was published in September 2010, and describes the subsequent stages and content of the rest of the review. A second interim report was published in August 2011, and already outlines some of the areas emerging as key. These include a focus on health assets, addressing processes that increase people’s vulnerability and the whole-of-government approach. Both interim reports are available in our publications database.

The European review is being informed by 13 task groups that are undertaking work building on existing knowledge and proposing effective strategies for action in key areas relating to health. Eight topic groups (TG) are each covering one or more of the key social determinants of health in the European Region and/or key stages of the life cycle:

  1. TG1: early years, education and the family
  2. TG2: employment and working conditions, including occupation, unemployment and migrant workers
  3. TG3: disadvantage, social exclusion and vulnerability
  4. TG4: GDP, taxes, income and welfare
  5. TG5: sustainability and community
  6. TG6: preventing and treating ill health
  7. TG7: gender
  8. TG8: older people

A further five cross-cutting groups (TC) are each focusing on issues that span across two or more of the topic groups:

  1. TC1: economics
  2. TC2: governance and delivery systems
  3. TC3: global factors
  4. TC4: equity, equality and human rights
  5. TC5: measurement and targets

More information about the European Review can be found on UCL’s website.

English Review (2008 – 2010)

In November 2008, Professor Sir Michael Marmot was asked by the Secretary of State for Health to chair an independent review to propose the most effective evidence-based strategies for reducing health inequalities in England from 2010. The strategy includes policies and interventions that address the social determinants of health inequalities. The Review had four tasks:

  1. Identify, for the health inequalities challenge facing England, the evidence most relevant to underpinning future policy and action;
  2. Show how this evidence could be translated into practice;
  3. Advise on possible objectives and measures, building on the experience of the current PSA targets on infant mortality and life expectancy;
  4. Publish a report of the review’s work that will contribute to the development of a post-2010 health inequalities strategy.

As a result, in February 2010 the report “Fair Society, Healthy Lives: A Strategic Review of Health Inequalities in England Post-2010” was published. This publication is available in our publications database.

The report included 9 key messages:

  1. Reducing health inequalities is a matter of fairness and social justice. In England, the many people who are currently dying prematurely each year as a result of health inequalities would otherwise have enjoyed, in total, between 1.3 and 2.5 million extra years of life.
  2. There is a social gradient in health – the lower a person’s social position, the worse his or her health. Action should focus on reducing the gradient in health.
  3. Health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health.
  4. Focusing solely on the most disadvantaged will not reduce health inequalities sufficiently. To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. We call this proportionate universalism.
  5. Action taken to reduce health inequalities will benefit society in many ways. It will have economic benefits in reducing losses from illness associated with health inequalities. These currently account for productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs.
  6. Economic growth is not the most important measure of our country’s success. The fair distribution of health, well-being and sustainability are important social goals. Tackling social inequalities in health and tackling climate change must go together.
  7. Reducing health inequalities will require action on six policy objectives: (1) Give every child the best start in life; (2) Enable all children, young people and adults to maximise their capabilities and have control over their lives; (3) Create fair employment and good work for all; (4) Ensure healthy standard of living for all; (5) Create and develop healthy and sustainable places and communities; (6) Strengthen the role and impact of ill-health prevention.
  8. Delivering these policy objectives will require action by central and local government, the NHS, the third and private sectors and community groups. National policies will not work without effective local delivery systems focused on health equity in all policies.
  9. Effective local delivery requires effective participatory decision-making at local level. This can only happen by empowering individuals and local communities.

For more information about the English Review, please visit the website of UCL.

Global Review (2005 – 2008)

In 2005 the World Health Organisation established the Commission on Social Determinants of Health (CSDH) to support countries and global health partners to address the social factors leading to ill health and inequities. It drew the attention of society to the social determinants of health that are known to be among the worst causes of poor health and inequalities between and within countries. The CSDH was chaired by Sir Michael Marmot.

In order to achieve its goals, the Commission on Social Determinants of Health focused on the following:

  • Country action

The CSDH supported countries to develop policies that address the social causes of poor health and inequities.

  • Civil society

Civil society organizations from all regions provided vital inputs to the Commission’s work.

  • Knowledge networks

The networks collated knowledge and evidence to support policy design and action.

In 2008 the CSDH published its final report called ‘Closing the gap in a generation: Health equity through action on the social determinants of health“. This report is available in our publications database.

More information about this Global review and the outcomes of the work can be found on this section of the website: “Health inequalities outside the EU“, or on the WHO website of the CSDH.

About Professor Sir Michael Marmot

Professor Sir Michael Marmot has led research groups on health inequalities for the past 30 years, and is currently Director at the International Institute for Society and Health and MRC Research Professor in Epidemiology at University College London (UCL). In 2000 he was knighted by Her Majesty The Queen for services to Epidemiology and understanding health inequalities.

A detailed CV of Professor Sir Michael Marmot can be found on the website of UCL.

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