UCL News


Framework to reduce inequities for future generations launched by Professor Sir Michael Marmot

30 June 2021

The UCL Institute of Health Equity (IHE) – the leading global institute on health inequalities – has published a new framework led by Professor Sir Michael Marmot, which includes new recommendations on how to reduce health inequities and build back fairer following the pandemic.


The Framework is part of a new Marmot Review and comes as life expectancy falls for everyone across the UK, and health inequities widen at a cost of £39 billion every year.

The new Review, published today (30  June), was commissioned by the Greater Manchester Health and Social Care Partnership. The City Region had a 25% higher COVID-19 death rate than England as a whole in the 13 months to March 2021. This high death rate contributed to a decline in life expectancy in the North West region, which was larger than the average in England. Life expectancy fell in 2020 by 1.6 years for men and 1.2 years for women in the North West compared 1.3 years and 0.9 years, respectively, across England.

Professor Marmot (UCL Institute of Health Equity), said if the government is serious about levelling up health inequities, equity of health and wellbeing must be at the heart of government and business strategy rather narrow economic goals: “Greater Manchester has high levels of avoidable health inequalities as a result of longstanding economic and social inequities, and as across the country, ethnic disadvantage.”

The City Region has also experienced high rates of mortality from COVID-19 and particularly damaging long-term economic and social effects during the pandemic as a result of prolonged lockdowns.  These multiple negative impacts will damage health and widen health inequalities unless action to build back fairer is introduced across the City Region. 

The Institute of Health Equity has previously called for a national inequalities strategy to provide the backbone of the government’s levelling up agenda. ‘Build Back Fairer in Greater Manchester: Health Equity and Dignified Lives’ now lays out a clear framework to reduce health inequities for future generations. The Region’s devolved powers, leadership and strong existing programmes make it well positioned to take a lead, provided central government commits to long-term additional investment.”

Build Back Fairer Framework 

Key recommendations include:

The Problem

The Solution

  1. Build back fairer for future generations – prioritise children & young people

While children and young people have been at far less risk from the disease than older adults, they have been disproportionately, and inequitably, harmed by the impacts of restrictions and lockdowns and are experiencing the most rapid increases in unemployment alongside poor mental health, already at concerning levels pre-pandemic.

Additional support for early years settings; extend interventions to support young people’s mental health & wellbeing at school & work; and offer all 18-25-year-olds in-work training, employment or post-18 education – Greater Manchester’s strong record on reducing inequities in early years & educational attainment needs scaling up, strengthening & tailoring to need

  1. Build back fairer resources – rebalance spending towards prevention

Cuts to public funding in the decade to 2020 damaged health and contributed to the country’s high and unequal toll from COVID-19. The cuts were regressive (larger cuts to poorer areas) resulting in local authorities with greater deprivation being affected from the Pandemic the worst.

Double the budget for prevention in the total health care budget in Greater Manchester within five years and a system-wide prevention/health spending target for all of Greater Manchester to be developed by end of 2021, with incremental targeted increases over five years.

  1. Build back fairer standards – for healthy living

Guaranteeing equitable access to a range of quality services such as health care, education, police and fire, alongside a baseline minimum income for healthy living, improves living and working conditions that drive health equity.

Develop minimum standards for healthy living so communities can challenge employers, businesses, service providers & local authorities on the quality of employment, environment & housing, transport & clean air.

  1. Build back fairer institutions – extend anchor institution approaches to VCSE & businesses

Anchor institutions (large public & private sector organisations e.g., universities, hospitals & businesses) are rooted in places and connected to their communities – they have significant assets & spending power, and the ability to scale social value contracting.

Encourage anchor institutions to extend approach to VCSE* sector and businesses – their significant resources benefit the communities in which they are based by hiring local populations and direct supply chains to support local economies (see Box 1, Businesses in Executive Summary)

  1. Build back fairer monitoring & accountability – develop equity targets

The Greater Manchester Marmot Beacon Indicators were proposed specifically for monitoring equity in areas that are highly relevant to health equity as set out in the Framework diagram.

Marmot Beacon Indicators to develop publicly accessible targets to monitor progress towards Building Back Fairer from COVID-19 through an equity lens to inform action and maintain a focus on wider determinants of health.

  1. Build back fairer through greater local power & control – devolution

While Greater Manchester, as a devolved region, has more powers and flexibilities than other regions in England, there are still significant limitations in how far the Combined Authority can make decisions that affect health and equity – national changes are needed to the City’s ability to improve health equity.

National support needs to be strengthened to allow devolved regions, such as Greater Manchester, to leverage more power and flexibility to address local health inequities through increased control of employment services, labour market, social housing and early years policies.



Media contact 

Rowan Walker

Tel: +44 (0)20 3108 8515

Email: rowan.walker@ucl.ac.uk