Less well off people die earlier than more well off people (Marmot)
Those that need our help are least able to access it. (Tudor-Hart)
I'm summarising #Marmot2020 with key graphs. Apologies if I've lost nuance here @MichaelMarmot. #FOAMed
What drives these causes, i.e. indirect causes such as social/economic factors? #Marmot2020 #FOAMed
➡️ Spending on social protection, education, housing and environment has GONE DOWN as % GDP 📉
![% of GDP on social spending has gone down over the last decade](https://pbs.twimg.com/media/ESA_WBFXYAE5_JY.jpg)
➡️Council spending for people in the most deprived areas has been cut the most 📉
#Marmot2020 #FOAMed
![Council spending per person by quintile of Index of Multiple Deprivation average score, 2009/10 to 2017/18 has decreased the most for most deprived areas.](https://pbs.twimg.com/media/ESBA2YeW4AA6XG4.jpg)
The woman who smokes because she is lonely and stressed because she is on zero hours contracts, 2 children to bring up as a single parent and can’t keep up rent repayments. #Marmot2020
➡️ Your money does not go far if you are poor.
![Increasing percentage of families spending more than a one-third of their income on housing costs in the UK in 1996/97 compared to 2016/17 worse for the most deprived.](https://pbs.twimg.com/media/ESBDKvfXkAAPFb9.jpg)
➡️ Life expectancy has slowed down for both men and women but affecting women in the most deprived areas the most.
#Marmot2020 #FOAMed
![Life expectancy has slowed down for both men and women since 2010](https://pbs.twimg.com/media/ESBExxUW4AEunPw.jpg)
![Life expectancy has actually decreased for women in the most deprived decile comparing 2010-12 to 2016-18](https://pbs.twimg.com/media/ESBEzF4XkAE6RF9.jpg)
➡️ Death rates are plateauing most notably for the 55-74 age group. Is this due to ‘deaths of despair’ (suicide, drugs and alcohol abuse) as seen in the USA?
#Marmot2020 #FOAMed
![Net decrease in death rate for those < 55 years of age but increase in last 2 years](https://pbs.twimg.com/media/ESBJEwBWoAA82rh.jpg)
![Death rates are plateauing most notably for the over 55 age group](https://pbs.twimg.com/media/ESBJHprXUAI3Y6_.jpg)
➡️ Big gradients continue to persist between the least deprived and most deprived populations in both men and women
The most deprived populations spend 12-15 years less health years compared to the least deprived populations. #Marmot2020 #FOAMed
![The most deprived populations spend 12-15 years less health years compared to the least deprived populations.](https://pbs.twimg.com/media/ESBGdHJWAAEKXjh.jpg)
➡️ Worse quality of life for older people from ethnic minorities compared to those who are white British. #Marmot2020 #FOAMed
![Worse quality of life for older people from ethnic minorities compared to those who are white British.](https://pbs.twimg.com/media/ESBHXqkWoAAy0r4.jpg)
➡️ Child poverty is on the rise whether you control for household income or not.
➡️ Good development for children with free school meals has stalled for a decade. Remember these children didn't choose this.
#Marmot2020 #FOAMed
![](https://pbs.twimg.com/media/ESBKzdYW4AASVp0.jpg)
![](https://pbs.twimg.com/media/ESBK02yWoAEQ0UC.jpg)
➡️ When you have less money, eating well is not possible. For the most deprived, eating well would cost 75% of the household income.
Then you have little choice but to buy cheaper unhealthy food: think Whitechapel, London: theguardian.com/society/2016/j…
#Marmot2020 #FOAMed
![](https://pbs.twimg.com/media/ESBZeFMXUAAAC4j.jpg)
Is poverty relative or absolute? Some say that poverty is relative as it is defined as compared to the population, e.g. having a TV now vs 50 yrs ago: iea.org.uk/sites/default/…
But we are talking about not having enough food or somewhere to sleep. #Marmot2020 #FOAMed
➡️ People from most deprived backgrounds face more adverse childhood experiences (ACEs).
"ACEs elevate risk children... will experience damage to health/social outcomes, across the life course."
➡️ Marked decrease on spending for the most deprived.
#Marmot2020 #FOAMed
![](https://pbs.twimg.com/media/ESBNbAgXYAA3j2r.jpg)
![](https://pbs.twimg.com/media/ESBNcfbXsAANRHo.jpg)
➡️ Decreasing school attainment as measured by GCSE for children from the most deprived backgrounds.
AND
➡️ Increasing permanent secondary school exclusion rate for children from the most deprived backgrounds.
#Marmot2020 #FOAMed
![](https://pbs.twimg.com/media/ESBPSE_XYAAA49f.jpg)
![](https://pbs.twimg.com/media/ESBPToTXkAAOMw9.jpg)
➡️ Increasing people in employment - that's great really as people in jobs are generally happier
BUT this is crude as it doesn't measure the type and quality of work. #Marmot2020 #FOAMed
![](https://pbs.twimg.com/media/ESBQa0IWkAA90MV.jpg)
➡️ Average wages have fallen - albeit by a little bit
AND
➡️ Increasing numbers of zero hours contracts (do not guarantee a minimum number of paid hours and associated with poor health)
AND
➡️ Increasing work related stress/mental health problems
#Marmot2020 #FOAMed
![](https://pbs.twimg.com/media/ESBRsq-W4AEGGrH.jpg)
![](https://pbs.twimg.com/media/ESBRwjeXkAANO0_.jpg)
![](https://pbs.twimg.com/media/ESBSWoJWkAA2Snb.jpg)
Could be availability bias from me as I currently see more patients now. #Marmot2020 #FOAMed
➡️ Increasing workers in poverty especially for those in full time employment and after correcting for housing costs.
➡️ No real increase in household incomes for the poorest in society which is difficult given rising living costs
#Marmot2020 #FOAMed
![](https://pbs.twimg.com/media/ESBT6UuX0AEW9Op.jpg)
![](https://pbs.twimg.com/media/ESBT7mDXsAAB3il.jpg)
![](https://pbs.twimg.com/media/ESBUu09XUAApngj.jpg)
➡️ The rich have got richer at a rate far higher than the poorest in society
➡️ The richest 1% of the UK have increased their share of the wealth held
➡️ The rich are comparatively taxed less compared to the poorest in society
#Marmot2020 #FOAMed
![](https://pbs.twimg.com/media/ESBYLvWXsAEzx_i.jpg)
![](https://pbs.twimg.com/media/ESBYOdSXYAANmKB.jpg)
![](https://pbs.twimg.com/media/ESBYQJTW4AMipSF.jpg)
➡️ Local authority spending has gone down.
➡️ Why does it matter? It affects people physical and mental health - think air pollution, crime, road collisions (see table)
#Marmot2020 #FOAMed
![](https://pbs.twimg.com/media/ESBatPgWAAAE9A-.jpg)
![](https://pbs.twimg.com/media/ESBbOl0WAAAAOM2.jpg)
![](https://pbs.twimg.com/media/ESBbPt2W4AAdRWl.jpg)
➡️ Increasing violent crimes over the last decade but higher rates in the most deprived populations
#FOAMed #Marmot2020
![](https://pbs.twimg.com/media/ESBb83vX0AIycFR.jpg)
➡️ Worsening housing conditions over the last decade - think mould affecting asthma, cold houses due to poor insulation, mice carrying disease. @mhclg
➡️ No clear North-South divide when it comes to worse housing conditions
#FOAMed #Marmot2020
![](https://pbs.twimg.com/media/ESBcvI3WkAA7q-0.jpg)
![](https://pbs.twimg.com/media/ESBcwYQXkAA-G5n.jpg)
➡️ Over the last decade, homelessness have been rising: increasing households in temporary accommodation and increasing numbers of rough sleepers
➡️ Increasing spending on crisis housing and decreasing spending on preventive housing
#FOAMed #Marmot2020
![](https://pbs.twimg.com/media/ESBd69JWAAAKRRm.jpg)
![](https://pbs.twimg.com/media/ESBd8TlX0AY5MJ8.jpg)
![](https://pbs.twimg.com/media/ESBd9pXXsAAoSJD.jpg)
Health spending is much higher for the most deprived populations looking at age and gender. #Marmot2020 #FOAMed
![](https://pbs.twimg.com/media/ESBfeIgXYAA4Nrf.jpg)
![](https://pbs.twimg.com/media/ESBffT7WsAA_vHB.jpg)
Is all this data right? Is this correlation not causation? #Marmot2020 #FOAMed
Inequality is linked to rising GDP but defenders of the free market have unsuccessfully debunked this:
BUT Inequality IS inevitable but over the last decade but...
![](https://pbs.twimg.com/media/ESBg3DKWsAAU47I.jpg)
As @MichaelMarmot said in "The Health Gap"
🗣️It's not poor choices that result in poverty BUT poverty that result in lack of or NO choice.
#Marmot2020 #FOAMed
![](https://pbs.twimg.com/media/ESBhfU6WAAE2cXh.jpg)
There are dozens of recommendations and case studies in the report. I've shown the macro and some relevant to primary care.
#Marmot2020 #FOAMed
![](https://pbs.twimg.com/media/ESBi8arWsAAVQJx.jpg)
![](https://pbs.twimg.com/media/ESBi9rjWAAAaXyW.jpg)
📺 Do you learn by watching?
2 min @TheMarmotReview @HealthFdn video:
#Marmot2020 #FOAMed
📚 Do you learn by reading? #Marmot2020 #FOAMed
@TheLancet editorial: thelancet.com/journals/lance…
@bmj_latest: bmj.com/content/365/bm…
🔊 Do you learn by listening? #Marmot2020 #FOAMed
Listen to the @fairhealthuk podcast: shows.acast.com/findingfairhea…
This is bigger than access to healthcare and health tech. It's about our social and economic values.
We must do better. We need change and we need it now for a better fairer society.
#Marmot2020 #FOAMed
![](https://pbs.twimg.com/media/ESBlo81WkAE8IQu.png)