"Health equity in England: the Marmot review 10 years on" makes sobering reading. More than 90 years of improving life expectancy in England stalled in the past decade and regional differences between healthy life expectancy widened.
If the 2010 report gave plenty of food for thought, this 10-year review should be a wake-up call for all of us. Professor Sir Michael Marmot is unequivocal; a decade of austerity is to blame. The report is a good read, pointing to simple steps which this government and others can take to improve things and highlighting places that have found ways to buck the trend. The authors have worked hard to set an optimistic tone, hoping that the end of austerity will result in a return to that 90-year positive trend.
Education is set out as one of the five main social determinants of health. Inequalities in educational attainment are shown to have lifelong consequences for health outcomes and there is more evidence, from early years through to school and adult education, of the impacts of austerity. “Funding has become an even greater concern in the decade since the 2010 Marmot review as numbers of pupils have grown while secondary school funding, and particularly sixth-form funding and funding for education post-16, has been reduced,” the review notes.
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Despite the funding cuts, the report stays positive by pointing to some schools and areas that have been able to improve outcomes even in the most deprived circumstances. What it seeks, through some useful recommendations, is a national-level systematic approach to improving educational attainment. Amen to that.
Educational attainment clearly matters, with a strong correlation between the social gradient of educational inequalities and that of life expectancy. It would be a fascinating piece of work to analyse how closely the increased inequalities in life expectancy over the past decade mirror those in education. A decade of neglect of college funding and the collapse in adult education opportunities cannot simply be a coincidence.
That social gradient in education also offers an unusual opportunity, with improvements in educational attainment of every adult potentially helping to improve their life chances and healthy life expectancy. It would be nice if this led to valuing of investment in adult literacy akin to the value ascribed to investment in bachelor’s degrees.
There are also marked regional differences in life expectancy, particularly among people living in more deprived areas, with the largest decreases in life expectancy seen in the most deprived 10 per cent of neighbourhoods in the North East. No wonder the government is talking about "levelling up". This report starkly sets out how challenging that will be to achieve.
For colleges, and for the Department for Education, we need to take care to also look at the other determinants of good health if we are to fully appreciate both the challenge and the opportunity. Colleges touch on all aspects of this report and have roles to play in each. Two aspects stand out for me: fair employment and good work for all along with healthy and sustainable places and communities.
These two issues have been central in the discussions and debates in the Commission on the College of the Future. They are two major areas in which colleges have struggled to play their rightful part due to a decade of funding cuts and a narrow view of their roles. I am hopeful that will change over the coming years.
Colleges are an untapped resource for facing up to these challenges. Their reach into businesses and communities, and out to people from all walks of life, offers unique and fantastic opportunities for investment with an impact. They are vital anchor institutions everywhere, but particularly in places where there is low private sector investment.
The Towns Fund is already recognising this and the economic impact colleges have in their communities. Colleges also have the majority of 16- to 18-year-olds studying with them. Many NHS trusts have recognised this and are working closely with their local college to improve student health and wellbeing. Good jobs will be created from colleges being funded to provide advice and skills to small and medium-sized enterprises; places will be healthier if colleges have the funding to reach out to "left-behind people".
The report should be vital reading for every member of the Cabinet given the government’s oft-repeated goal of "levelling up" and reaching the "left-behind people and places". As Marmot himself says, the goal “should be to bring the level of health of deprived areas in the North up to the level of good health enjoyed by people living in affluent areas in London and the South”. Already, health secretary Matt Hancock has welcomed the report and conceded that the most important "levelling up" the government can focus on is health. I just hope that the education secretary has read it and recognises the roles colleges must play in this.
David Hughes is chief executive of the Association of Colleges and tweets @AoCDavidH