Build Back Fairer: the new mantra for now

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This title is about health equity issues, however, not building better houses. Professor Sir Michael Marmot, author of the Marmot Review – Health Equity in England Ten Years On which was published in February this year, has led a follow-up study called Build Back Fairer: The Covid-19 Marmot Review.

The new report highlights how inequalities in social-economic conditions before the pandemic contributed to the high and unequal death toll from Covid-19.

The enduring social and economic inequalities in society mean that the health of the public was threatened before and during the pandemic and will be after. Just as we needed better management of the nation’s health during the pandemic, so we need national attention to the causes of health inequalities.

Professor Marmot is as unflattering here about the present state of affairs as he was in his ten-year report. He writes, “Poor management of the pandemic was of a piece with England’s health improvement falling behind that with other rich countries in the decade since 2010”. That, he recalled, was for several reasons including that “the quality of governance and political culture did not give priority to the conditions for good health”, that there was increasing inequality in economic and social conditions, a rise in poverty among families with children, plus a policy of austerity and consequent cuts to funding of public services.

“Addressing all of these needs to be at the heart of what needs to change if we are to build a fairer, healthier society as we emerge from the pandemic,” he writes. As the previous report had shown, life expectancy had stalled in more deprived areas, with life expectancy at birth differing by 12 years between the most and least deprived local authorities in England in 2018. It had pointed out the harmful effects of poverty on health, and showed that some ethnic groups, particularly of Black and Bangladeshi and Pakistan origin, had much higher rates of poverty than others. Now the new report shows that Covid-19 has demonstrated and amplified such inequalities.

Analysis of risk factors for Covid-19 mortality clearly shows that risks are much higher for those living in more deprived areas, in overcrowded housing, in key worker roles with close proximity to others, being from BAME groups, having underlying health conditions, as well as being older and male.


Overcrowded living conditions and poor-quality housing are associated with higher risks of mortality from Covid-19 and these are more likely to be located in deprived areas and inhabited by people with lower incomes.

This is a dense review, 221 pages long, which can only be touched on here. So, finally, what does Professor Marmot recommend should be done to Build Back Better?

He writes, “Public Health needs to develop capacity and expand focus on social determinants of health. The pandemic highlights how poverty, deprivation, employment and housing are closely related to health.” The recommendations do not much change the past imperatives, but urgently reinforce the need for them, and for a wide-ranging approach to reducing health inequality with its accompanying social ills.

“The pandemic must be taken as an opportunity to build a fairer society”, he concludes. “In Building Back Fairer we must accept the growing recognition worldwide, that economic growth is a limited measure of societal success.” He states that there must be first of all “commitment to social justice and putting equity of health and wellbeing at the heart of all policy-making, nationally, regionally and locally.”


* Katharine Pindar is a long-standing member of the Lib Dems and an activist in the West Cumbrian constituency of Copeland and Workington.