In 2013, Coventry city council decided to become a self-described “Marmot city”, which meant working in partnership with the Institute of Health Equity at University College London to improve wellbeing and reduce disparities in health outcomes within the local population. Between 2010 and 2012, there was an 11-year gap between life expectancy at birth between men with the highest and lowest incomes, while the inequality between women in those income brackets stood at eight years.
“Coventry is quite a small and compact city, and there is widespread deprivation but there are also pockets of severe deprivation, and it’s a very diverse community,” says Angela Baker, a public health consultant for health inequalities and life chances at the council. “We felt that the Marmot tools, particularly the Marmot review, gave us a good framework.”
Published in 2010, the Marmot review: Fair Society, Healthy Lives, was a comprehensive report that examined health inequalities across England, and what could be done to reduce them. The key findings were that people living in the poorest neighbourhoods would on average die seven years earlier than those living in the wealthiest areas. The report also found that the lower a person’s socioeconomic status, the more likely they were to live in poor health.
By being a Marmot city, all policies and services commissioned across Coventry, such as housing and transport, will take into account the impact they will have on health equity before they are implemented.
Dr Sarah Raistrick, a GP in Willenhall in Coventry, and co-chair of the Coventry Marmot Partnership, said considering how policymaking would affect the health outcomes of the population had been “embraced as a default way of working across the whole city regardless of what sector people are in”.
She added: “There’s a real understanding that the Marmot principles are things that underpin the way that we want to commission services, deliver services, and work with people to reduce health inequalities and improve outcomes.”
One key strategy from Marmot’s review that Coventry has adopted into its policymaking is proportionate universalism, meaning that in order for health inequalities to be reduced, policies must be considered in regards to everyone but that the scale of intervention is proportionate to the most disadvantaged. “It means that any policy that we make, we think about what different groups need and how different groups will access the service so the outcomes are the same. So the more affluent people need less service to get the same outcome as someone who is more deprived,” Baker says.
Since becoming a Marmot city, Coventry’s outcomes regarding health and inequalities have improved. The number of young people not in employment, education or training has reduced from 6.84% to 3.5%, compared with a national drop of less than one percentage point.
In 2015, Coventry was ranked the 60th most deprived local authority, and this dropped to 81st in 2019. The proportion of people considered the most deprived in the local authority reduced from 18.46% in 2015 to 14.36% in 2019, with this drop in percentage points being higher than the trend seen elsewhere across the country.
Although there are areas that still need improving, the work and progress within Coventry has been heralded by its community. “Coventry should be really proud of what it has achieved, both in the improvements that we can point to, but also that we don’t underestimate the power of having a strong united partnership that is really striving for improvement of the population,” Raistrick said.
“I think other local authorities would be wise to look at the benefits that could be gained in this way of working, and to learn from both the successes and at times the slow progress we’ve seen in Coventry. So please learn from us.”
