The Marmot Review – love it or hate it, but you cannot ignore it!

The Marmot Review of Health Inequalities post 2010 was published today and many will hope it will influence public policy in the years following the General Election.

The key messages are here and the detailed objectives are set out here. These are all very worthwhile, however the more interesting question one could have asked of the public is how likely are these objectives going to happen in the foreseeable future?

I suspect there are likely to be relatively high levels of public pessimism and that means the political will to achieve the objectives is likely to remain quite low. We also know from observing many public health campaigns that when there is investment in improvements, take-up varies, with some areas responding  to the advertised messages over positive health much quicker. A simplistic view might be to see these as the affluent areas, but from our own value based research we have identified segments of the population that may be more easily motivated by some campaigns than others. This means we now know which groups are more vulnerable and much harder to reach with much greater accuracy than in the past. We also, from the training and development work that we conduct, understand far more the ways in which public services staff can be helped to more effectively use their time to engage with and support the motivations of those groups.

As Marmot shows, clearly additional resources need to be targeted, but are they likely to be radical enough? Often for upstream public policy changes the level of extrinsic personal incentive required over a significant period to make change is likely to fall foul of fairness perceptions from those who have different motivations and as a result public anger reinforced by the news media may make politicians naturally cautious in taking forward these objectives.

Does this mean that one de-prioritises inequalities and places it under the heading of “too-difficult” in the policy agenda? Are there instead a wider range of approaches that can be developed that enable us to move forward even within the constraints I have outlined?

The work we are now doing is increasingly focusing in the field of how emotions, intrinsic motivations, resilience, character and other forms of targeted behavioural support can also add to the “bricks and mortar” of formal service provision through forms of engagement and co-production in vulnerable and hard to reach communities. This is important at a time when there is no guarantee that further resources will be available and indeed current resources will need to be used more efficiently.

We also now have the tools to more effectively assess outcomes. The development of values based segmentation to identify and target demotivated groups as well as quantitative mapping software to more effectively measure and test the actual real time impact of programmes, means that we believe that organisations will be more able to target limited resources using better trained key staff to help those hard to reach and vulnerable communities that most need it.

In other words, Marmot has set out the challenges, but we need more than exhortation. To make a real difference we also need modern strategies and modern tools that assist with the practical delivery of these laudable objectives.

Charlie Mansell is the Research and Development Officer of the Campaign Company

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