Agenda item

Medway declared its ambition to become a Marmot Place in April 2025. This report provides a summary of the progress to date and a draft set of recommendations from the Institute of Health Equity who have been commissioned to support Medway to achieve its ambitions to reduce health inequalities.

The Medway Marmot Place is not just a Medway Council initiative. In order to achieve the ambition of halving health inequalities over the next ten years, action will need to be taken by all public, private, voluntary, and academic sector partners.

Discussion:

The Strategic Service Manager for Public Health introduced the report which provided a summary of the progress to date and a draft set of recommendations from the Institute of Health Equity who had been commissioned to support Medway to achieve its ambitions to reduce health inequalities. He emphasised that Medway as a Marmot Place was a system wide ambition, not a Council owned initiative and that all partners were fully engaged and supportive. The report would be finalised, made fully accessible and shared with everyone.

Members then raised a number of questions and comments, which included:

• Health inequality – comment was made that there was considerable emphasis on what to do to tackle issues but not enough about why health inequalities existed.  In response officers confirmed that Sir Michael Marmot had identified eight Marmot principles which were based on evidence from data and science. He had also identified that health inequality had worsened following the introduction of austerity measures by the coalition government in 2011.
• Personal accountability – in response to a comment that individuals needed to take responsibility for their own health, officers agreed and were still exploring methods of communication to help individuals understand the building blocks that help support good health. This needed to be coupled with a concept of universal proportionalism in the distribution of funds and provision of services across the system.
• Universal proportionalism – an example of the benefit of delivering services in a more targeted, proportionate way was the NHS Health Check Programme.  Although a universal service, the service was delivered in a targeted way, so that those with the worst health outcomes were over represented. This was because in the most deprived areas, GP surgeries had the lowest recorded rate of patients of hypertension, yet the highest rate of cardio vascular disease mortality. This demonstrated that parts of communities were not accessing GPs with systems, and it needed to be understood what such barriers were, for example, inflexible working hours, lack of knowledge, varying health literacy or accessibility issues.
• Measuring impact – it was acknowledged that this was the most challenging aspect. Officers intended to work with partners to produce an annual report to monitor progress on halving health inequalities in two years. Neighbourhood health would provide additional opportunities for partners within the system to work collaboratively and partners across the Health and Wellbeing Board would be encouraged to continue to champion the ambitions.
• Violence against women and girls – it was requested that reference to the impact violence against women and girls has on health inequalities be strengthened, particularly given the frequency the issue shows as a factor in children social care cases or Emergency Department admissions as examples. It was suggested reference on violence against women and girls be strengthened and the issue explored in greater depth to understand the scale of the problem.
• Transient housing – reference was also made to the impact of transient housing on the health of families, and it was requested that reference to this be strengthened.

Decision:

The Board noted the report from the Institute of Health Equity regarding the progress of the Medway Marmot Place Partnership update subject to the comments raised above being reflected and/or explored in greater depth.