The Consequences Of Stepping Off The Road To Health Equity

three paths diverging from one
Public policy decisions set the path for a country's population.

Sir Michael Marmot doesn’t mince words. As head of the Institute of Health Equity, he is critical of the United Kingdom government’s COVID 19 response. His objections are based on a detailed analysis of pandemic measures that have widened inequalities in income and regional disparities in the country, while doing little to help the people with the highest mortality rates.

And although he’s critical, he also sees the pandemic as an opportunity to rejig government programs during recovery to undo the income inequalities and regional disparities that have been growing in the country for the last decade. He offers short, medium and long term changes to put everyone in England on a better health footing in the coming years.

The Institute is responsible for monitoring and advising on the social determinants of health1 and the progress the country is making to ensure that all residents enjoy the same prospects for good health. Sadly, over the last ten years, much of the “progress” to report is in the negative direction. These findings were available in February 2020 and could have been used in planning the COVID-19 response. In the latest report, Marmot and his team demonstrate that their earlier advice has fallen on deaf ears.

His comments and recommendations about housing focus on condition, cost and homelessness:

  • Housing condition This includes damp and mould, which contribute to ill health. These effects were exacerbated by the lockdown, which required people to stay home. The report calls for improvements to housing conditions, with special attention paid to people in temporary housing and housing in disadvantaged areas of the country.
  • Housing cost This means a disproportionate amount of money is spent on housing, leaving little to purchase healthy food and medicine. The emergency measures to close businesses meant loss of income, which has hit low income families particularly hard. The report also identifies that many more families have had to apply for emergency social assistance, which falls far short of the levels needed to continue to pay for housing. The report forecasts a much larger number of people becoming homeless and recommends changes to help prevent this from happening.
  • Homelessness This contributes to shortened life expectancy and higher rates of severe and chronic illness. The report discusses the “Everyone In” program, which swept people who were living rough off the streets and into temporary accommodation. It also calls for more comprehensive supports to ensure that people do not remain homeless for extended periods of time.

Although this work is based in the United Kingdom, the social determinants of health are widely acknowledged as a health planning framework in other countries. For this reason, the report will be of interest to readers who deliver health and housing programs in other countries. It will also be helpful to local decision makers who are thinking about recovery measures and how they will affect specific groups within a larger population.

You can dip into the report by the Institute of Health Equity here: Build Back Fairer: The COVID-19 Marmot Review


  1. For more about social determinants of health, see: Connecting The Housing And Health Dots