Thirteen years ago, Michael Marmot, Professor of Epidemiology and Director of the UCL Institute of Health Equity, published a report on health inequalities in the UK.
Professor Marmot outlined gaps in life expectancy in certain parts of the country. Ten years later, he reported that the Greater Manchester City region had not done enough to reduce these health inequalities.
Based on the study’s results, the ten localities of Manchester, including the city of Manchester, have been tasked with producing their own ‘Marmot health inequality plan’ to tackle these health issues over the next five to eight years.
“But we decided we weren’t just going to create our own plan,” explains Councillor Thomas Robinson, Executive Member for Healthy Manchester and Social Care, at Manchester City Council. “We were going to put that plan at the heart of our strategic and political priorities as a City Council. Now, what you see is the Making Manchester Fairer Plan.”
Poverty as a trigger of health inequalities
Professor Marmot analysed how the conditions in which people are born, grow, live, work and age can lead to health inequalities. Results show, for example, that men in the most disadvantaged areas of Manchester die nearly eight years younger than those in the most privileged areas. Women in the same situation die six years younger.
“It goes beyond tackling health inequalities – it’s about tackling poverty,” continues Councillor Robinson. “Because you can’t tackle health inequalities without tackling poverty, you must start with the source, when people are still young.”
The plan reads: “Poverty is associated with worse long-term physical and mental health and lower than average life expectancy. If you don’t have enough money to meet your basic needs, such as sufficient and healthy food, a warm and safe house and a sense of control over your life, your health will suffer over time.”
…and discrimination triggers poverty
Poverty combines various elements that affect minorities and obstruct access to good quality public services. This includes, among others, systematic racism, housing, transportation, employment, or representation in society.
Communities that experience racial inequalities are more likely to live in poverty since they experience higher unemployment rates. “We recognise that for some members of our community, life is hard because of issues such as long-term unemployment, poverty, discrimination and serious health conditions,” reads the introduction of the plan, signed by Joanne Roney, Chief Executive at Manchester City Council and Councillor Bev Craig, Leader of Manchester City Council.
In Manchester, people’s health has generally been worse than the English average. Like many other cities, pre-existing inequalities paved the way for this situation to worsen after the pandemic. The plan reports that “Black, Asian and Minority Ethnic communities, as well as disabled people, were disproportionately affected by Covid-19.”
Given this data, Manchester plans to address the need to tackle poverty and the additional barriers of racism and discrimination for some communities through four schemes called the Kickstarters, which will involve diverse local communities.
Children, youth and mental health
The plan also states that poverty is the leading cause of inequalities for children and young people. Over 40% of children under 16 in Manchester live in poverty. Due to the importance of economic difficulties on early childhood foundations, three Kickstarters are focusing on children, young people, and adults and mental health.
“The children’s Kickstarter,” explains Robinson, “ensures that we have intensive support in schools where we need to help those children who may have fallen behind during the pandemic, with learning to write, for example.”
Older people are also a targeted group. Isolation increases as we age; loneliness entails worse mental health and decreased physical activity. The council has just started the ‘Walking Football Scheme’ to improve the lives of people over 65. First, encouraging physical activity means working on the prevention of illnesses and premature death. Secondly, by tackling isolation, the participants’ mental health improves. “Physical and mental illness are symbiotic,” states Robinson. “They affect one another and the best way to combat them is usually bringing people together.”
For the councillor, the determination is visible. “If you want to boil this down into one line, this plan goes above and beyond. We are determined to tackle health inequalities in every part of life,” he says.
So, how can the plan be implemented?
The plan’s strategy runs from 2022 to 2027. It provides an overview of the inequalities in Manchester, what groups are more vulnerable, and why building a fairer city is essential. The plan goes into more detail, explaining how the city will implement this work.
Representatives from the public sector, academia, and voluntary and community organisations gathered to create the Health Inequality Task Group and represent Manchester’s health system in one way or another. In response to Professor Marmot’s review, the group developed an action plan, identifying gaps in the system by listening to the residents and organisations and including those who face discrimination.
“We especially want to involve those with first-hand experience of discrimination, or who have struggled to live in conditions that create good health and wellbeing,” reads the plan.
Some of the group’s leaders belong to what Manchester has named ‘anchor institutions’, major local organisations with long-established social, cultural or economic roots that can benefit communities through the plan. The institutions can also be private companies that contribute through their activities or investments.
Teamwork is the answer
The Making Manchester Fairer programme challenges how the different departments of the city council work together to produce solutions that place the person at the heart of everything they do.
The programme board, co-chaired by Councillor Robinson and Joanna Midgley, the deputy leader of the Council, monitors the plan. “We hope it keeps changing to meet the complexities and challenges our most vulnerable residents face,” says Robinson.
Councillor Robinson also hopes this plan and its assessment will trigger a culture change that will end up embedded within the council. “As we go into the next financial year, we will aim to secure more funding to build on what we’ve learned,” he adds.
Making Manchester Fairer is generating cross-cutting work across the Council. Multiple directors work together, such as the children’s director, the adults’ director, the anti-poverty and the work and skills team.
A work in progress with a clear vision
Councillor Robinson explains that the plan is about being reactive, listening and considering people by encouraging them to contribute. “We will ensure that communities and community leaders are all constantly part of this conversation of making Manchester fairer”, the councillor says, “not only by including them but also by providing them with responses”.
Tackling health inequalities is not new in Manchester, but the scale of the divide is growing through many external factors. “As a city, we must dig deep, be courageous and address those equity gaps,” Roney and Craig add.
“This is a very exciting time for Manchester,” concludes Robinson, “because this strategy demonstrates that health and tackling inequality is right at the top of everything we want to do.”
