Professor Sir Michael Marmot, Director of the University College London Institute of Health Equity and a leading voice on health inequalities, has published a landmark report on how public, private and third sector organisations in Cheshire and Merseyside can work together to tackle health inequalities.

The report – All Together Fairer – was written by Sir Michael and his team of researchers in partnership with Cheshire and Merseyside’s local authorities, and sets out measurable actions for each area, as well as the subregion as a whole, to create a fairer, equitable society.

The work has been welcomed by the Director of Liverpool Health Partners’ Starting Well programme, Prof Michael Beresford.

Prof Beresford said: “This work, along with other key reports such as Child of the North, published in December 2021, paints a stark picture of inequality for children growing up in Cheshire and Merseyside post-pandemic.

“Sadly, we know that COVID 19 has further exacerbated health inequalities particularly for children and young people.”

The University of Liverpool Starting Well, Living Well and Ageing Well theme, along with the Starting Well programme, Liverpool Health Partners and supported by Capacity, are developing a number of programmes of work to facilitate collaborative engagement and action to support whole system implementation of appropriate policies and initiatives.

The programmes are all in line with eight Marmot goals:

1. Give every child the best start in life.

2. Enable all children, young people, and adults to maximise their capabilities and have control over their lives.

3. Create fair employment and good work for all.

4. Ensure healthy standard of living for all.

5. Create and develop healthy and sustainable places and communities.

6. Strengthen the role and impact of ill health. 

7. Tackle racism, discrimination and their outcomes.

8. Pursue environmental sustainability and health equity together.

These initiatives will support, where necessary, the development and delivery of a strategic approach to improve population health and address inequalities in health and the social determinants of health across Cheshire and Merseyside and beyond.

All Together Fairer was presented this week at an event by Sir Michael, who delivered a keynote address to partners made up of local authorities, the NHS, private and third sector organisations, and interested members of the public.

A subregion, made up of Cheshire East, Cheshire West and Chester, Halton, Knowsley, Liverpool, Sefton, St Helens, Warrington and Wirral, has been working as a Marmot Community since 2019 and has undergone a period of intense research from Sir Michael’s team to create a set of recommendations to deliver real, tangible changes for local communities.

Some of the recommendations, which have been broken down into one-year and five-year goals, along with related indicators to measure outcomes, include action on young peoples’ services, wages, housing, racism, poverty and much more. They are influenced heavily by the Marmot Principles, eight policy areas defined by Sir Michael, which include early years development, employment, living standards, communities, ill-health prevention, discrimination, and environmental sustainability.

Commenting on the launch of this report, Sir Michael Marmot, Professor of Epidemiology at University College London, and Director of the UCL Institute of Health Equity, said:

“The COVID-19 pandemic exacerbated existing inequalities. Life was harder for those living in deprivation. The rising cost-of-living is a social crisis which will have further damaging impact on peoples’ physical and mental health. We need central government action. But much can happen at local level, as shown by the eagerness of colleagues in Cheshire and Merseyside to grasp this issue with both hands and do everything in their power to change lives for the better.

“It is shocking that a third of residents in Cheshire and Merseyside live in the most deprived 20 per cent neighbourhoods in England. It is vital that local leaders and partners do not accept this as destiny. The kind of large-scale change needed cannot be delivered by just one organisation or group of people, which is why I’m delighted to see how closely the public, private and third sectors work together in the subregion, which will prove most helpful when delivering the schemes and initiatives set out in our report.”

Like other parts of England, Cheshire and Merseyside faces numerous challenges, and many people in the subregion’s nine local authority areas are living in poverty and deprivation, which impacts health. Life expectancy is lower for men and women, many areas are below average levels of healthy life expectancy, the COVID-19 mortality rate is higher than average, levels of fuel poverty have been higher than average since 2016 and areas also struggle with increasing levels of alcohol and drug misuse.

Raj Jain, Designate Chair of NHS Cheshire and Merseyside, said:

“The launch of this ground-breaking report and the imminent integration of health and care services across Cheshire and Merseyside mean we are now in a position to make a real difference for the people who live and work in our area.

“It was very encouraging to see 500 people join the launch of this much awaited report yesterday. It will help guide us through the journey of positioning, creating, and improving services for our people while tackling some of the current inequality in health and care across our Places.”

Councillor Louise Gittins, Leader of Cheshire West and Chester Council, and Cabinet Member of Poverty and Wellbeing, said:

“I am confident that we will see a real change for our local people because of this work. Put simply, we cannot afford to fail. Continuing and worsening health inequalities are not inevitable and we want to make a difference, so that all local people in Cheshire and Merseyside live healthy and happy lives. No one organisation has all the answers or resources, which is why we can only really improve the health of our population by working together. I’d like to thank Sir Michael and his team for their support and expertise in producing this report, and as we continue to work together over the coming years.”

Councillor Ian Moncur, Cabinet Member for Health and Wellbeing at Sefton Council, said:

“All Together Fairer supports transformation across our system in line with the eight Marmot priorities. It’s particularly exciting as Cheshire and Merseyside is the first report where the two new Marmot priorities, tackling racism and pursuing environmental sustainability, have been included. I know for a fact that there are committed public servants and leaders in our councils and across our public sector partners who want to tackle the causes of poor health, who will do everything they can to make these recommendations a reality. Too many people do not have access to the opportunities, or the resources, that they need to fully thrive and that’s what must change.”

Steve Rotheram, Mayor of the Liverpool City Region, said:

“The true measure of levelling up isn’t in the shiny buildings that shape our skyline -it’s in the health, wellbeing, and prosperity we create for the people. It’s an absolute injustice that still now – in 2022 – where you are born often determines your life chances – a post code lottery determining your bank balance, the food you can afford, the diseases you’re likely to develop, and how long you will live.

“In our region, life expectancy is worse than the national average for both men and women – this has got to change. While we know that health inequalities aren’t isolated to our area, I know that we have the capabilities to lead the way in addressing them.

“It’s fantastic to have the support and expertise of Sir Michael Marmot and his team with us as we begin our journey to building a healthier, fairer city region – where no one is left behind. This isn’t a journey for an easy life, but for a better future for the 1.6 million people who call the Liverpool City Region their home.”

The All Together Fairer report was commissioned by the Cheshire and Merseyside Population Health Board and can be downloaded here. To be kept up to date with the latest news from this programme of work, please sign up to the mailing list for the Champs Public Health Collaborative, here.

Examples of the work already taking place across Cheshire and Merseyside that embody the approach defined by Sir Michael and his team have been captured as video case studies. These videos can be viewed here.