The Final Report – All Together Fairer

Professor Sir Michael Marmot, Director of the University College London Institute of Health Equity and 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 – has been 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 sub-region as a whole, to create a fairer, equitable society.

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.

Click here to read the full report, or an executive summary.


Watch the launch event:

In 2021, the Institute of Health Equity (IHE) was commissioned by Champs: Public Health Collaborative and the Population Health Board of the Cheshire and Merseyside Health and Care Partnership to support work to reduce health inequalities through action on the social determinants of health and to Build Back Fairer from Covid-19.

IHE will provide added focus and priority to existing work on health inequalities in the sub-region and develop new momentum and recommendations for effective action in the context of the Covid-19 pandemic.

In late 2021, an interim report from Professor Sir Michael Marmot’s team at the IHE was published, with the final report expected to be published in spring 2022.

The Marmot Review

Led by Professor Sir Michael Marmot, the Marmot Review into health inequalities in England was published on 11 February 2010. It proposes an evidence-based strategy to address the social determinants of health – the conditions in which people are born, grow, live, work and age and which can lead to health inequalities.

It drew further attention to the evidence that most people in England aren’t living as long as the best off in society and spend longer in ill-health. Premature illness and death affects everyone below the top.

The report, titled ‘Fair Society, Healthy Lives’, proposes a new way to reduce health inequalities in England post-2010. It argues that, traditionally, government policies have focused resources only on some segments of society. To improve health for all of us and to reduce unfair and unjust inequalities in health, action is needed across the social gradient.

This report was followed up by Sir Michael 10 years later with criticism for the lack of progress in those 10 years and calling for a renewed need for decisive and determined action, with a concentration on the social determinants of poor health and the need for health equity at the centre of all decision-making.

Find out more, here.

Becoming a Marmot Community

Cities and areas that are already Marmot Communities or aim to be soon include Coventry and Greater Manchester. The underlying feature of all Marmot Communities is a determined and joint effort to true integration across of number of sectors in order to achieve six common goals, as set out in Sir Michael’s original report from 2010:

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 prevention

Areas awarded Marmot Community status are those which can provide evidence that these six goals are seen throughout local policymaking and decision-making, and that improved health and reduced inequalities are at the centre of how the area develops approaches to early years, education and skills, transport, housing, places and spaces, and jobs and businesses.


Cheshire and Merseyside becoming a Marmot Community

In September 2019, a Cheshire and Merseyside vision for population health event was held with senior leaders from health and care. Professor Sir Michael Marmot spoke at the event, offering his expertise on the current state of health inequalities in the UK and worldwide, and what can be done to begin to decrease this gap, including developing ‘Marmot-friendly’ communities.

Both organisers and attendees of the event reached a consensus on key prevention priorities; it was also agreed that the sub-region would become what’s known as a Marmot Community.

Speaking in 2021, Professor Sir Michael Marmot said: “I am delighted to be working with Cheshire and Merseyside on the sub-region’s journey to becoming a Marmot Community. It is my belief that for this kind of work, integration across the sectors, not just the health and care system, is vital. The key social determinants of health often lie outside of the health and care system, and by having a cross-sector approach and working together with partners, we can make much greater progress and get more things done, instead of working in isolation.”

Our journey so far...

  • May 2022: The final report, titled ‘All Together Fairer: Health Equity and the Social Determinants of Health in Cheshire and Merseyside’ was published. Find out more here.
  • January 2022: Professor Sir Michael Marmot and his team from the Institute of Health Equity (IHE) presented the interim Marmot report for Cheshire and Merseyside to our Partnership Board.
  • November 2021: Professor Sir Michael Marmot’s team at the Institute of Health Equity published ‘Building Back Fairer in Cheshire and Merseyside: Evidence for action and key approaches’. This interim report is the first key publication from the team since it was commissioned to support work to reduce health inequalities in the sub-region through action on the social determinants of health.
  • July 2021: More than 280 partners from across Cheshire and Merseyside came together to discuss health inequalities and kick-start the sub-region’s journey to become a Marmot Community. Find out more about the event and watch the recording on the Champs website.
  • April 2021: Eileen O’Meara, Director of Public Health at Halton and on behalf of Champs: Public Health Collaborative, gave a presentation updating our Partnership Board on progress with this work. She explained the project had been commissioned, but work paused during the pandemic. All Health and Wellbeing Boards across the Cheshire and Merseyside footprint have signed up to becoming a Marmot Community.
  • September 2019: Health and care leaders from across Cheshire and Merseyside agreed the sub-region would become what’s known as a Marmot Community. Progress was delayed due to the Covid-19 pandemic, but work restarted in 2021.

Here is what Professor Sir Michael Marmot said:

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