Gwent Public Services Board
Response
Analysis Template
On 10 March 2022, Gwent Public Services Board (PSB)
made the decision to become a ‘Marmot Region’, and to use the social
determinants of health approach as the basis for the response to well-being and
health inequalities in Gwent. A copy of
the Marmot proposal paper is available at:
https://www.gwentpsb.org/wp-content/uploads/2022/03/03-Proposal-Gwent-Becoming-a-Marmot-Region.pdf
The ABUHB Director of Public Health Annual
Report 2019, ‘Building a Healthier Gwent’1, described the scale of
the strategic challenge to reduce health inequalities. For people in all communities in Gwent to
live healthy, fulfilled, dignified lives, means going further to reduce the
inequality gap in the number of years lived in good health between the most and
least deprived communities.
The
Gwent Well-being Assessment (2022)2 highlights the significant
inequalities across communities in Gwent, whether measured by health, education,
employment, or home ownership. It also demonstrates the impact of poor housing
quality, which drives fuel poverty, and exacerbates health inequalities. The Gwent
Well-being Assessment highlights the breadth of action necessary to narrow
health inequalities between communities across Gwent. The eight Marmot Principles
provide a framework for a programme of action:
1.
Give
every child the best start in life
2.
Enable
all children, young people and adults to maximise their capabilities and have
control of their lives
3.
Create
fair employment and good work for all
4.
Ensure
a 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 prevention
7.
Tackle
racism, discrimination and their outcomes
8.
Pursue
environmental sustainability and health equity together
Gwent’s assets are a diverse economy,
rich culture and heritage, iconic natural environment and strong communities.
However, there are significant inequalities in health, education, housing,
income and employment which collectively result in socio-economic deprivation. The
Gwent Well-being Assessment (2022) shows that the highest levels of socio-economic
deprivation are located in the valleys and Newport city centre communities.
Gwent has a high proportion of residents
with limiting long-term illness, and high premature death rates in the parts of
the region with high levels of socio-economic deprivation. Over the period 2011-13 to 2018-20, for both
men and women, the inequality gap in life expectancy (between the most and
least deprived communities) has remained unchanged, and there continues to be a
seven year gap for men and a six year gap for women. The gap in healthy life
expectancy is also largely unchanged for men (13 years), but it has widened for
women such that the gap is now 20 years. This means that a woman living in the
most deprived part of Gwent today lives just 48 years of life in good health.3
Figure
1: Life expectancy at birth (years), most vs least deprived quintiles, Aneurin
Bevan University Health Board area, 2011-13 to 2018-20.
Source: Public Health Wales
Figure 2: Healthy life expectancy at
birth (years), most vs least deprived quintiles, Aneurin Bevan University
Health Board area, 2011-13 to 2018-20.
Source: Public Health Wales
For people in all communities in Gwent
to live healthy, fulfilled, dignified lives means reducing the inequality gap.
This will need all of Gwent’s public, private and voluntary sector to work
together with communities to address the social determinants of health. Housing should be health-improving, climate-change
resilient and suitable for an ageing population. Communities should be safe, with a focus on well-being
and empowerment. Education should result
in more equitable opportunities and narrow the attainment gap. Transport should enable access to employment,
education, culture and leisure, and be health and climate-improving. Employment should provide a fair income and
good, health-improving and protecting work, and be climate change resilient. The environment should promote well-being,
and be protected from biodiversity loss and climate change.
The opportunities and challenges identified
in the Gwent Well-being Assessment are set against the backdrop of what has
been described as the ‘triple challenge’ of the Covid-19 pandemic, the UK leaving
the European Union, and the climate emergency.4 This is further
intensified by the heightening cost of living crisis. Whilst the long-term
impacts are not yet known, these factors all have the potential to further widen
inequalities.
By becoming a Marmot region, Gwent will
work across the wide range of social determinants for a healthy society. Professor Sir Michael Marmot (Director of the
UCL Institute of Health Equity) has developed eight Marmot Principles for achieving
greater equity in health. He first proposed his original six principles in his
Strategic Review of Health Inequalities in England (2010), ‘Fair Society,
Healthy Lives’, which illustrated in detail that the more deprived the area,
the shorter the life expectancy.5 Professor Marmot has continued to
advocate these guiding principles as the framework for action in his subsequent
reviews of health inequalities in England, including in Marmot communities and
regions (see Gwent PSB Marmot proposal for further information and references).
In his most recent report, ‘All Together Fairer: Health Equity and the Social
Determinants of Health in Cheshire and Merseyside’, Professor Marmot advocates
for the inclusion of two additional principles (see principles 7&8 in
Section 1).6
The table below highlights the fit
between the 8 Marmot Principles and the 15 issues for response in Gwent’s
Well-being Assessment:
Table 1: The Marmot Principles and ‘fit’
with the Well-being Assessment
# |
Marmot principles |
Gwent Well-being Assessment - Issues
for response |
1 |
Give every child the best start in life |
Future housing and thermally efficient
existing homes Supportive local economies Food |
2 |
Enable all children, young people and adults
to maximise their capabilities and have control of their lives |
Future transport modes and
infrastructure Future housing and thermally efficient
existing homes Supportive local economies Food Skills for the future Digital futures |
3 |
Create fair employment and good work for all |
Future transport modes and
infrastructure Supportive local economies Skills for the future Digital futures |
4 |
Ensure a healthy standard of living for all |
Future transport modes and
infrastructure Future housing and thermally efficient
existing homes Supportive local economies Food |
5 |
Create and develop healthy and sustainable
places and communities |
Community safety Cohesive and empowered communities Future transport modes and
infrastructure Future housing and thermally efficient
existing homes Supportive local economies Food Flood risk |
6 |
Strengthen the role and impact of ill health
prevention |
Covid-19 Future housing and thermally efficient
existing homes Supportive local economies Food |
7 |
Pursue
environmental sustainability and health equity together |
Climate change – adaptation and
mitigation Biodiversity and species loss Ecological footprint Future housing and thermally efficient
existing homes Supportive local economies Food Skills for the future Flood risk Digital futures |
8 |
Tackle racism, discrimination and their outcomes |
Cohesive and empowered communities Future housing and thermally efficient
existing homes Supportive local economies Skills for the future Digital futures |
·
Housing
As
noted in the table above, a recurring element to addressing inequalities is future
housing and thermally efficient existing homes.
The
advisory group for the UK Committee on Climate Change, chaired by Professor Sir
Michael Marmot, produced the report titled “Sustainable Health Equity: A Net
Zero UK,” in 2020.7 The report noted that living in a cold home that
is difficult or expensive to heat increases the risk of exposure to cold and is
associated with a variety of health impacts, especially respiratory infections
- the leading cause of excess winter
mortality.
Poor
housing also has well evidenced effects on mental health in adults, including
worry about debt and affordability and stress due to cold and damp environments.
Fuel poverty has also been associated with poorer respiratory health and
depressive symptoms. Conversely, warm homes have been found to contribute to
reductions in the incidence of cardiovascular disease, cardiopulmonary disease,
lung cancer and childhood asthmas and improved mental health and well-being. 8,9,10,11
It
is estimated that close to one-third of excess winter deaths are attributable
to living in a cold home. Cold-related deaths are more likely in older
properties and homes with the poorest thermal efficiency ratings, and among
older occupants. Overall, cold homes follow the social gradient: the lower a
person’s socioeconomic status, the more likely that they will live in a cold
home. 8,9,10,11
Actively
reducing exposure to cold homes through improving their thermal and energy
efficiency has also been found to contribute to wider social and health
benefits, including: 8,9,10,11
·
Delaying
and reducing the need for primary care and social care
·
Preventing
hospital admissions
·
Increased
school attendance
·
Increased
engagement with (community and social) services
·
Reduced
incidence of risky health-related behaviours
·
Enabling
timely discharge from hospital, and preventing re-admissions
·
Enabling
rapid recovery from periods of ill health or planned admissions.
Table
1 above lists the eight Marmot Principles that will be worked towards as
well-being objectives under this priority theme within the Gwent Well-being Plan.
There
is a 13 year difference for men and a difference which has widened to 20 years for
women in how long life is lived in good health between the richest and poorest
neighbourhoods in Gwent. The gap in life
expectancy between the most and least deprived neighbourhoods is approximately
7 years for men and 6 years for women.3 This is unjust, unfair and amenable to action
by Gwent PSB partners.
Reducing
health inequalities in Gwent by addressing the social determinants of health,
and the historical legacy of housing, will require a cross-sector response
which includes actions for the short, medium and long-term. Long-term will be
up to 25 years ahead, in line with the definition in the Well-being of Future
Generations Act (Wales) Act (2015).
The
table below highlights the contribution of the eight Marmot Principles to Wales’ seven well-being goals.
Table
2: The 8 Marmot Principles and the 7
Well-being Goals
# |
Marmot
principles |
Well-being
goals |
1 |
Give every child the best start in life |
Healthier More Equal Cohesive Communities Vibrant Culture and Thriving Welsh
Language |
2 |
Enable all children, young people and adults
to maximise their capabilities and have control of their lives |
Prosperous Healthier More Equal Cohesive Communities Vibrant Culture and Thriving Welsh
Language |
3 |
Create fair employment and good work for all |
Prosperous Resilient Healthier More Equal Cohesive Communities Vibrant Culture and Thriving Welsh
Language Globally Responsible |
4 |
Ensure a healthy standard of living for all |
Healthier More Equal Cohesive Communities Vibrant Culture and Thriving Welsh
Language |
5 |
Create and develop healthy and sustainable
places and communities |
Resilient Healthier More Equal Cohesive Communities Vibrant Culture and Thriving Welsh
Language Globally Responsible |
6 |
Strengthen the role and impact of ill health
prevention |
Healthier More Equal Cohesive Communities Vibrant Culture and Thriving Welsh
Language |
7 |
Pursue
environmental sustainability and health equity together |
Prosperous Resilient Healthier More Equal Cohesive Communities Vibrant Culture and Thriving Welsh
Language Globally Responsible |
8 |
Tackle racism,
discrimination and their outcomes |
Prosperous Healthier More Equal Cohesive Communities Vibrant Culture and Thriving Welsh
Language Globally Responsible |
The
current situation is set out in both the Gwent Well-being Assessment2
and the proposal for Gwent to become a Marmot region (link on page 1),
including the health inequalities ‘headlines’ in section 4 above.
As
illustrated in the local government diagram below, local authorities have an
influence in every social determinant of health, with some services, e.g. Planning,
influencing more than one determinant of the health and well-being of the local
population.12
Figure 3: Local government and the social determinants
of health and well-being
Source: Local Government Association
(2020)
The
table in Annex 1 shows the linkages
between the 2018-23 local well-being objectives for the five former PSBs in the
Gwent region and the Marmot Principles. The table in Annex 2 shows examples of linkages between the delivery programmes
of the five former PSBs in the Gwent region and the Marmot Principles. Both
tables are informed by published documents from the five former Gwent PSBs.
There will be a whole host of interventions in
place currently. Some interventions Gwent
PSB partners will be aware of as either funded programmes or areas of direct
delivery. Some will be happening as a
result of less formal community action which Gwent PSB partners may not be
aware of. A picture of what is
happening, and crucially what is the impact, will need to be explored further
with the Institute of Health Equity during the first year of the Well-being
Plan.
There is a need to strengthen business sector
involvement and collaboration in the Marmot programme. Business and the economy
has a key part to play in improving social conditions that affect health and
health equity, including employment conditions, goods and services, and wider impacts.13
South Wales Fire and Rescue Service are
ensuring all children receive education at Key Stage 1&2 on fire safety in
the home. Adults deemed most vulnerable to accidental fires have comprehensive
home fire safety checks.
Examples of work underway in Newport City
Council are listed in Annex 3.
In
respect of tackling the historic legacy of the poor thermal efficiency of the
existing housing stock in Gwent, progress is being made. With the target set by Welsh Government,
informed by the research “Better
Homes, Better Wales, Better World – decarbonising the existing homes in Wales”14,
the social housing sector is leading in this area. As noted above, from the
report titled “Sustainable Health Equity: A Net Zero UK”7 it
highlights the importance of improving thermal efficiency, and the
decarbonisation programme that flows from the Welsh Government targets will
address a number of the eight Marmot Principles. This is illustrated below:
Table
3: Housing and impact on the eight Marmot
Principles
# |
Marmot
principles |
1 |
Give
every child the best start in life |
|
Decarbonisation of existing homes
(i.e. improve the thermal efficiency) supports the healthier well-being goals
of reducing health inequalities that living in a cold home that is difficult
or expensive to heat, or both, increases the risk of exposure to cold and is
associated with a variety of health impacts |
3 |
Create
fair employment and good work for all |
|
Decarbonisation of existing homes (i.e.
improve the thermal efficiency) supports the prosperous well-being goals as
the target requires retrofitting of the affordable housing sector by 2030 at
a cost of up to Ł1bn, which in turn will create a significant number of new
green jobs in the region. This is
sustainable as that programme will continue after 2030 with home owners
seeking such improvements (the demand enhanced by the 2022 cost of living
crisis impact on energy costs). |
4 |
Ensure
a healthy standard of living for all |
|
See above
(Marmot Principle 3) in terms of sustainable jobs from decarbonisation |
7 |
Pursue environmental sustainability and health equity
together |
|
Decarbonisation of existing homes (i.e.
improve the thermal efficiency) supports the Gwent region’s response to
climate change, given the significant impact that decarbonisation by
achieving Energy Performance Standard A on reducing the levels of greenhouse
gases emissions that come from (directly or indirectly) residential homes |
At
a local level, some work will be extremely effective. Whether in relation to early years, housing,
training and employment, there will be some examples of effective
practice. However, the gap in healthy
life expectancy across Gwent is not narrowing, which suggests that population
level impact is not currently being achieved and a coordinated, whole system
approach is necessary.
South Wales Fire and Rescue Service has found that, since the introduction of preventative measures, the fire service has seen a reduction in Accidental Dwelling Fires deaths of over 60%.
In
respect of the decarbonisation of the existing social housing homes, there is
ongoing monitoring across the country by Welsh Government on the energy
efficiency improvements being delivered by the housing association sector. Currently, Welsh Government is in the
evaluation mode, using an investment programme called the ‘Optimise Retrofit
Programme’, which is being used to help determine the most effective way to
deliver decarbonisation at scale.
The
table below illustrates how becoming a Marmot region will align to the 5-ways
of working.
Table
4: The 5-ways of working and Gwent becoming a Marmot region.
5-ways of working |
Steps being taken |
Collaboration
|
Gwent
becoming a Marmot Region is a collaborative programme of Gwent PSB. |
Integration |
The
delivery of the Marmot programme will be whole system and include all PSB
partners in working together. |
Involvement |
The
delivery of the Marmot programme will be underpinned with a communications
and engagement plan, which will reach out to cross-sector stakeholders and
Gwent’s communities. |
Long-term |
The
recommendations which will follow from the Institute of Health Equity should
inform delivery over the next 10-25 years. |
Prevention |
The
Marmot principles have preventing inequalities as their core (the causes of
the causes), together with a specific Marmot principle on preventing
ill-health. |
How
the decarbonisation of homes links to the 5-ways of working is illustrated
below.
Table
5: How decarbonisation of existing homes aligns with the Well-being of Future
Generations Act’s 5-ways of working.
5-ways of working |
Steps being taken |
Collaboration
|
Joint working within housing sector – housing
associations and local authorities - around supply chains / procurement /
contracts Public Bodies collaborating on commitment,
leadership, funding Opportunities for joint pilots and trials
across Gwent |
Integration |
Reduced Greenhouse gas emissions Increased economic activity and prosperity A more resilient housing stock A healthier population Reduced inequality More cohesive communities |
Involvement |
Making best use of local communities and
community groups Using existing regional and community
networks Important role for SMEs Engagement with stakeholders and public Enhanced roles for planning and building
control |
Long-term |
30-year programme to deliver immediate and
long-term benefits |
Prevention |
Tackling fuel poverty and providing
improvements to the health and well-being of citizens More cohesive communities enabled by
improving the housing stock |
During 2022-23, a series of Marmot region
events will be held to develop a set of partnership actions and accompanying
delivery plan, facilitated by the Institute of Health Equity. This work should be completed in the first
half of 2023 and will inform how each of the Marmot Principles can contribute
to reducing health inequalities in Gwent. The table below lists examples from
Marmot cities/regions/communities elsewhere in the UK to provide an
illustration of some of the areas of focus likely to come out of this
process.
Table 6:
Examples of areas of focus of Marmot cities/regions/communities
Marmot
Principle |
Areas
of Focus |
1.
Give every child the best start in life |
Reducing
the impact of child poverty Improving
the quality and availability of early years services |
2. Enable all children, young people and
adults to maximise their capabilities and have control of their lives |
Reducing
inequalities in educational attainment Reducing
school exclusions Ensuring
all young people are engaged in education, employment or training Improving
the prevention and treatment of mental health problems among young people |
3. Create fair employment and good work for
all |
Reducing
in-work poverty Providing
post-school apprenticeships and support for in-work training Providing
good, fair work Increasing
local recruitment into jobs |
4. Ensure a healthy standard of living for all
|
Introducing
a health equity in all polices approach Introduce
contractual mechanisms where ‘additional social value’ is included in the
tender requirements and contracts partly awarded on the basis of what
additional social value they bring in terms of good employment, local procurement
and sustainability. Supporting
food aid providers and charities Supporting
community and voluntary sector provision of debt advice. Offering
support for those who are in debt |
5. Create and develop healthy and sustainable
places and communities |
Use
place based approaches to service delivery Engage
with communities on local priorities and service design Develop
resilient communities Provide
affordable, good quality housing |
6. Strengthen the role and impact of ill
health prevention |
Develop
equity targets for services with clear lines of accountability Develop
actions to improve community safety and reduce anti-social behaviour. Improve
leadership for health inequalities Develop
shared local indicators Train
staff in the social determinants of health |
7. Pursue environmental sustainability and
health equity together |
· Minimise
air pollution from all sources · Design
and retrofit homes to be energy efficient, climate resilient and healthy · Build
a sustainable, resilient and healthy food system Develop
a transport system that promotes active travel and road safety, and which
minimises pollution · Develop
healthy and sustainable models of work Also see Environment
theme in Response Analysis |
8. Tackle racism, discrimination and their
outcomes |
Improving
the quality of recording of ethnicity Improve
the analysis of ethnic inequalities related to service use Develop
culturally competent and inclusive services Assess
equality as well as quality of services Also see Community
Cohesion theme in Response Analysis |
With
the decarbonisation of existing homes, there is work required on behaviour
change. Given that reducing greenhouse gas (GHG) emissions from existing homes
in Gwent will require both people and organisations to change their behaviours;
interventions drawing on the science of behaviour change are needed to
understand and promote the necessary change.
In Wales, 84% of all homes are owner-occupied or privately rented. It is
clear that for decarbonisation to succeed across Gwent, then policy and
delivery must be designed with homeowners and private landlords in mind.
Alongside
business and the education sector, Gwent PSB will need to involve and work
collaboratively with communities across Gwent who are living with the impacts
of inequalities. The Institute of Health Equity will provide advice on how best
to engage with citizens, alongside other resources including Public Health Wales’ ‘Principles of Community Engagement for Empowerment’
and the ‘National Principles of Community Engagement’ framework.15,16
There
is now a body of evidence from other parts of the UK of the galvanising effect
on health inequalities of adopting the Marmot Principles. This includes Coventry (Coventry: a Marmot City
– Coventry City Council), Greater Manchester City Region (Greater Manchester is a
“Marmot city region” – what does that mean, and how will it improve our health
and reduce inequalities? - GMHSC) and Cheshire and Merseyside Champs | Public Health
Collaborative (champspublichealth.com).
Wigan
Council adopted an approach with some similarities to the ways of working found
in Marmot regions. Called ‘The Deal’, this
was a series of tailored agreements with communities aimed at creating a better
borough. In ‘The Deal’, the Council’s
pledges are published alongside the part which it needs local residents and
businesses to play.17
In
terms of impact, Coventry has the longest history of working to the Marmot Principles
and, whilst it is not possible to solely attribute changes in population
indicators to their ‘Marmot City’ status, there is evidence of a narrowing of
health inequalities and falling levels of deprivation.18 Wigan’s
headline achievement in relation to population health is a significant increase
in healthy life expectancy, as well as reductions in premature mortality from
cardiovascular disease and cancer.17i
The
Local Government Association’s Health Inequalities Hub (England) is a rich
source of case-studies. Table 7 illustrates some examples of local community action
across the Marmot 8 Principles.19
Table
7: Examples of local community case-studies which contribute to the social
determinants of health / Marmot Principles
Name
of case-study |
Example
of contribution to Marmot 8 Principles |
No child left behind: Cheltenham
Borough Council’s year of action |
1.
Give every child the best start in life |
2. Enable all children, young people and
adults to maximise their capabilities and have control of their lives |
|
Greater Manchester Combined Authority:
building an integrated skills and work system |
3. Create fair employment and good work for
all |
4. Ensure a healthy standard of living for all
|
|
5. Create
and develop healthy and sustainable places and communities |
|
Kent: using health and wellbeing shop
to reach out to communities facing health inequalities |
6.
Strengthen the role and impact of ill health prevention |
Cheshire West and Chester Council:
Enhancing health, tackling climate change |
7. Pursue
environmental sustainability and health equity together |
Tackling inequalities and
disproportionality – Camden Council |
8. Tackle
racism, discrimination and their outcomes |
· Are additional resources required or re-tasking of existing
resources?
It is difficult at this stage to be
prescriptive about resources as the list of agreed actions for Gwent are not
decided. However, the experience of
other Marmot regions/cities/communities, as well as other similar programmes in
the UK, is that this is not about new money, but it is about how existing money
is allocated and decisions about how resources are deployed. This may involve discussions about pooling
funding to create scale, increasing the proportion of funding spent on
prevention, and working more directly with communities to decide how money is
spent.
· What resources would be needed? Are they already in place?
The resources required to make an impact on the
social determinants of health are in place.
The amount of capital, both human and physical, among Gwent partners and
within Gwent communities is sufficient to reduce the gaps in life expectancy
and healthy life expectancy. It may
require difficult or challenging thinking about how resources are deployed, but
the resource is available.
In respect of housing, decarbonisation is not
fully funded, although research is underway to find ways to support grant funding.
Through
the involvement of the UCL Institute of Health Equity a series of workshops
with a wide-range of cross-sector stakeholders and representatives of local
communities will be held in 2022. These hybrid workshops are currently being
scoped with the Institute of Health Equity for delivery from early autumn
onwards.
The
draft well-being plan is subject to a 12-weeks formal consultation.
A
professional audience will be part of the Marmot workshops (above). Also see
section 5 above on need for further involvement and collaboration with business
and education sectors.
To be able to reduce inequalities, it is the
correct approach to address health inequalities in parallel with improving
community cohesion and mitigating and adapting for a changing climate and loss
of biodiversity. This is reflected in the eight Marmot Principles.
Community cohesion – As highlighted in
Greater Manchester’s ‘Marmot City region’ work, strengthened community
resilience and social cohesion, and improved safety support good health and
reduce inequalities. Health equity interventions which strengthen community
assets are important, including the provision of accessible and affordable
public transport. build-back-fairer-in-greater-manchester-executive-summary.pdf
(instituteofhealthequity.org)
Environment - Action to improve health equity can
also be consistent with measures to decarbonise. Professor Marmot’s report ‘Sustainable
Health Equity: Achieving a Net-Zero UK’, which was commissioned by
the UK Committee on Climate Change, identifies four key areas for action:7
· Minimising
air pollution
· Building
energy efficient homes
· Promoting
sustainable and healthy food
· Prioritising
active and safe transport
The
Chief Medical Officer for Wales’ Special Report,
‘Protecting Our Health’,20 published following the first phase of
Covid-19 advocates for the ‘One Health’ concept which recommends work across
sectors and disciplines to address issues or risks that occur at the animal health,
human health, and environmental health interface, including disaster
preparedness and food and water safety and security. It recommends that the
strong collaborations forged in response to the Covid-19 pandemic, including
public bodies, third sector and academia, should be built upon to prioritise
these threats.
Tensions have not been identified at this stage
as objectives and actions are not agreed, but this will be worked through as
part of action plan development in 2022-23.
Health, as measured by life expectancy, has
stopped improving, and health inequalities are widening.3 The Gwent
Well-being Assessment2 shows that, in 2015-17, people in the most
deprived communities in Gwent were dying 6-7 years earlier than they
should. More recent figures from ONS for
Wales as a whole demonstrate that the gap in life expectancy has widened still
further during the COVID-19 pandemic.21,21i As well as how long
people live, how many years’ people live in good health also shows a strong
social gradient. Women in particular will now spend almost a third of their
life in poor health in the most deprived communities in Wales.3
This situation is unjust and almost entirely due
to social conditions - poverty, poor-quality housing, low-paid or unstable jobs,
food insecurity, lack of public transport links, limited access to green space
and social isolation. It is unjust that it is a person’s postcode at birth rather
than their genetic code that is the predictor of how long they will live and how
long they will live in good health. This is illustrated in The Health
Foundation infographic below.
Figure 4: What makes us healthy?
Source: The Health Foundation https://www.health.org.uk/
The areas where partners in Gwent need to
prioritise action are captured in the Marmot Principles and the commitment
already made by Gwent Public Services Board to become a Marmot region. The underlying
feature of a Marmot region is a determined and joint effort to true partnership
working across a number of areas to improve the lives of all, but in a way that
is proportionate to the level of need. The areas of focus are enshrined in the
Marmot Principles:
1.
Give
every child the best start in life
2.
Enable
all children, young people and adults to maximise their capabilities and have
control of their lives
3.
Create
fair employment and good work for all
4.
Ensure
a 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 prevention
7.
Pursue
environmental sustainability and health equity together
8.
Tackle
racism, discrimination and their outcomes
Through this commitment, improved
health and reduced inequalities will be at the centre of how partners in Gwent
develop approaches to early years, education and skills, transport, housing,
places and spaces, and jobs and businesses over the short, medium and long term.
The specific actions that Gwent will take to respond to each of the eight Marmot Principles will be worked through during 2022/23 as part of year one of the Well-being Plan. As such, this Response Analysis does not put forward recommendations for specific interventions at this stage. This is, in essence ‘the’ objective of the response plan when it comes to health inequalities – to embed the eight Marmot Principles in order to tackle health inequalities between communities in the region.
References:
2 Gwent Well-being
Assessment - Gwent Public Services Board Gwent Public Services Board
(gwentpsb.org)
3 https://phw.nhs.wales/news/inequalities-in-life-expectancy-on-the-increase-in-wales/
6 Champs | Public Health
Collaborative (champspublichealth.com)
8 The-Case-for-Investing-in-Prevention-Housing.pdf
(phwwhocc.co.uk)
9 https://phw.nhs.wales/files/housing-and-health-reports/a-case-for-investment-report/
12 https://www.local.gov.uk/publications/social-determinants-health-and-role-local-government
13 The Business of Health
Equity: The Marmot Review for Industry - IHE (instituteofhealthequity.org)
14 Independent review on
decarbonising Welsh homes: report (gov.wales)
17 What is The Deal?
(wigan.gov.uk)
17i The King’s Fund (2019)
A citizen-led approach to health and care:
Lessons from the Wigan Deal.
Available at: https://www.kingsfund.org.uk/publications/wigan-deal
18 Institute of Health Equity (2020) Coventry Marmot City Evaluation 2020. Available at: https://www.instituteofhealthequity.org/resources-reports/coventry-marmot-city-evaluation-2020
19 Case studies | Local Government Association
21 Office for National
Statistics (2021) National life tables –
life expectancy in the UK: 2018 to 2020.
Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/nationallifetablesunitedkingdom/2018to2020
21i Office for National
Statistics (2022) Health state life
expectancies by national deprivation quintiles, Wales: 2018 to 2020. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthinequalities/bulletins/healthstatelifeexpectanciesbynationaldeprivationdecileswales/2018to2020
Version: v0.8
Date: 17/06/22
Please now complete the table on the next page
outlining what initial steps could be taken to achieve each potential
objective.
[Table can be completed before 30 June if
possible, but above must be completed by 30 June]
If the
PSB chose this as a well-being objective, what key steps should be undertaken
in the first 12 months, and by whom? (We acknowledge that the objective is a long-term
issue, but identifying some initial steps will help the PSB to understand what
could be done)
Objective
1: Embed the Marmot principles in order to tackle health inequalities in the
region
Objective
1: Steps |
Partners involved |
Lead organisation |
Target Date |
Comment |
All Gwent PSB partners will work with
the UCL Institute of Health Equity in 2022/23 to create a common position on
the impact of health inequalities in Gwent, and agree system-wide actions and
commitments to reduce equalities. |
All PSB partners |
ABUHB |
March-May’23 |
|
Objective
2: To embed addressing the thermal efficiency of the homes in Gwent as a key
determinant in reducing health inequalities in Gwent
Objective
2: Steps |
Partners involved |
Lead organisation |
Target Date |
Comment |
Workshops with business to highlight
the opportunities created by the green agenda in the form of decarbonising
the homes of Gwent. |
|
|
|
Seeking to develop the market of
suppliers into this emerging green sector |
Explore the appetite for joint
procurement opportunities for decarbonisation, using the collective impact of
the Gwent PSB. |
|
|
|
Help drive down costs on what
initially could be expensive new technologies |
Workshops with education sector in
Gwent to drive training initiatives within the new decarbonisation economy. |
|
|
|
Ensure in the medium term that
sufficiently trained local people become available to support this emerging
green sector |
Annex
1:
Linkages between the first set of local well-being objectives of Gwent’s
PSBs and the ‘Marmot Principles’ |
Marmot
Principles |
|||||
PSB Well-being Objectives |
Giving
every child the best start in life |
Enabling all children, young people and adults to
maximise their capabilities and have control over their lives |
Creating fair employment and good work
for all |
Ensuring a healthy standard of living
for all |
Creating and developing sustainable
places and communities |
Strengthening the role and impact of
ill health prevention |
Blaenau Gwent |
|
|
|
|
|
|
Blaenau Gwent wants everyone to have
the best start in life |
|
|
|
|
|
|
Blaenau Gwent wants safe and friendly
communities |
|
|
|
|
|
|
Blaenau Gwent wants to look after and
protect its natural environment |
|
|
|
|
|
|
Blaenau Gwent wants to forge new
pathways to prosperity |
|
|
|
|
|
|
Blaenau Gwent wants to encourage and
enable people to make healthy lifestyle choices in the places that they live,
learn, work and play |
|
|
|
|
|
|
Caerphilly |
|
|
|
|
|
|
Positive Change – a shared commitment
to improving the way we work together |
|
|
|
|
|
|
Positive Start – Giving our future
generations the best start in life |
|
|
|
|
|
|
Positive People – Empowering and
enabling all our residents to achieve their own potential |
|
|
|
|
|
|
Positive Places – Enabling our
communities to be resilient and sustainable |
|
|
|
|
|
|
Newport |
|
|
|
|
|
|
Everyone feels good about living,
visiting, and investing in our unique city |
|
|
|
|
|
|
Everyone has the skills and
opportunities they need to develop, prosper, and contribute to a thriving
sustainable city |
|
|
|
|
|
|
Everyone belongs to resilient,
friendly, connected communities, and feels confident and empowered to improve
their well-being |
|
|
|
|
|
|
Newport has healthy, safe, and
resilient environments with an integrated sustainable travel network |
|
|
|
|
|
|
Monmouthshire |
|
|
|
|
|
|
Provide children and young people with
the best possible start in life |
|
|
|
|
|
|
Respond
to the challenges associated with demographic change |
|
|
|
|
|
|
Protect
and enhance the resilience of our natural environment whilst mitigating and
adapting to the impact of climate change |
|
|
|
|
|
|
Develop opportunities for communities
and business to be part of an economically thriving and well connected county |
|
|
|
|
|
|
Torfaen |
|
|
|
|
|
|
Develop a functional, connected
network of natural areas that support the current and future well-being needs
of local populations |
|
|
|
|
|
|
Develop mitigation and adaptation
responses to the impacts of climate change |
|
|
|
|
|
|
Provide children and young people with
the best possible start in life |
|
|
|
|
|
|
Support healthy lifestyles and enable
people to age well |
|
|
|
|
|
|
Tackle the inter-generational patterns
of poverty and develop economic resilience |
|
|
|
|
|
|
Improve local skills through
work-force planning, training, apprenticeships, and volunteering
opportunities |
|
|
|
|
|
|
Create safe, confident communities and
promote community cohesion |
|
|
|
|
|
|
Annex
2: Examples of linkages between the delivery programmes of
Gwent’s PSBs and the ‘Marmot Principles’
Giving every child the best start in life |
Enabling all
children, young people and adults to maximise their capabilities and have
control over their lives |
Creating fair
employment and good work for all |
Ensuring a healthy
standard of living for all |
Creating and
developing sustainable places and communities |
Strengthening the
role and impact of ill health prevention |
|
GWENT PUBLIC
SERVICES BOARD |
||||||
Delivery of Local
Well-being Plans |
||||||
Flying Start |
SE Wales Education Achievement Service |
Cardiff Capital Region City Deal |
Communities for Work (Blaenau Gwent) |
Gwent Green Grid Partnership |
Building a Healthier Gwent |
|
SE Wales Safeguarding Children Board |
Children and Families Strategic
Partnership |
Cardiff Capital Region Skills
Partnership |
Caerphilly Academy –Gateway to
Employment |
Health and Housing Strategic
Partnership |
Gwent Regional Partnership Board |
|
Best Start in Life programmes |
21st Century Schools
Programme |
Regional Economic Growth Partnership |
Welfare Reform Group / Partnership |
Resilient Greater Gwent |
Gwent Healthy Travel Charter |
|
Healthy Pre-schools |
Gwent Care Career Pathway |
Our Valleys Our Future (2016-21) |
Financial Inclusion Strategy (Torfaen) |
Sustainable Food Partnerships |
Resilient Communities (Caerphilly) |
|
First 1,000 Days Community of Practice |
Learning Network Schools |
EU Rural Development Programme |
Skills@Work (Monmouthshire) |
Caerphilly Cares |
Healthy Schools |
|
Early Years Integrated Transformation
Programme |
Early Action Together (All Wales) |
CLES Progressive Procurement |
Gwent VAWDASV Partnership Board |
Sustainable Travel (Newport) |
Mental Health and Learning Disability
Partnership |
|
What Matters Approach |
The Iceberg Model |
Right Skills Board (Newport) |
Reach Restart (Newport) |
Climate Ready Gwent Network |
Integrated Well-being Networks |
|
|
Youth Engagement and Progression
Framework (Newport) |
The Newport ‘Offer’ / City Centre
Regeneration |
Employment Support Programmes |
Green and Safe Spaces Network (Newport) |
Mental Well-being website ‘MELO’ |
|
|
Digital / Film Careers Sector
(Newport) |
Economy and Skills Strategy (Torfaen) |
|
Gwent Future Scenarios |
Participatory Budgeting |
|
|
Youth Councils |
Community Wealth Building |
|
Blaenau Gwent Climate Assembly |
|
|
|
Operation Encompass |
|
|
Gwent Citizens Panel |
|
|
|
|
|
|
Placemaking Wales Charter (Newport) |
|
|
|
|
|
|
Blaenau Gwent on the Move |
|
|
Sources:
The
Blaenau Gwent We Want Three Years of Progress 2020-2021
Caerphilly
PSB Delivery Plan Progress Reports March 2021, Sept2021
Monmouthshire
Public Service Board Well-Being Plan Annual Report 2021
Torfaen
Public Services Board Annual Report April 2020 to March 2021
Newport’s
Well-Being Plan 2018-23 Annual Report 2020-21
Annex 3: Examples of work in Newport City Council