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

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

2. 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.

3. 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.

4. 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)

5. 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.

6. 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.