Link to previous article published in July here
Marmot calls for doubling of healthcare spending in the region over the next five years, as well as a refunding of local government, to tackle and prevent these inequalities and growing problems such as homelessness, low educational attainment, unemployment and poverty.
Future spending should prioritise children and young people, who had been disproportionately harmed by the impacts of Covid restrictions and lockdowns, and had experienced the most rapid increases in unemployment and deteriorating levels of mental health.
As well as damaging communities and harming health prior to the pandemic, funding cuts had “harmed local governments’ capacity to prepare for and respond to the pandemic and have left local authorities in a perilous condition to manage rising demand and in the aftermath of the pandemic”, the report said.
Key Social Determinants and Mental Health issues identified in the report
1. Education: As with inequalities in the early years, inequalities experienced during school years have lifelong impacts – in terms of income, quality of work and a range of other social and economic outcomes including physical and mental health.
Socioeconomic inequalities in educational attainment have persisted since 2010 entrenching trajectories of inequality which begin in the early years.
Young people living in more deprived areas continue to have significantly lower levels of attainment during secondary school, measured by GCSE results and attainment 8 scores, which measures pupils’ performance in eight GCSE-level qualifications.
2. Unemployment and poor quality work: are major drivers of inequalities in physical and mental health. Being in poverty and working in poor quality employment have marked effects on physical and mental health, including on children in the families concerned.
3. Poverty is associated with poor long-term physical and mental health and low life expectancy.
Living in poor quality housing, being exposed to poor quality environmental conditions, poor quality work and unemployment, not being able to afford nutritious food and sufficient heating for example all impact on health.
Poverty is also stressful. Coping with day-to- day shortages, facing inconveniences and adversity and perceptions of loss of status all affect physical and mental health in negative ways
Nearly half of those in poverty in the UK in 2018 – 6.9 million people – were from families in which someone had a disability.
Some ethnic groups also face much higher rates of poverty than others, particularly those who are Black and Bangladeshi and Pakistani origin where rates of poverty after housing costs are as high as 50 percent.
Persistent poverty refers to someone who has been in poverty in three of the past four years.
People in persistent poverty are at particularly high risk of having poor physical or mental health.
Rates have stayed roughly the same since 2010, at about 13 percent. Lone parents with children have the highest risk of being in persistent poverty
4. Empowering and sustaining communities was central to the 2010 Marmot Review, an overarching theme was to ‘create an enabling society that maximises individual and community potential.’
The Review described the importance of communities and places in shaping physical and mental health and wellbeing and described how inequalities among communities are related to inequalities in health.
Since 2010 these community inequalities have, in many ways, widened.
5. Poor quality housing, particularly damp and cold homes, directly harm physical and mental health and poor housing conditions continue to harm health in England and widen health inequalities. Unaffordable housing also damages health, 21 percent of adults in England said a housing issue had negatively impacted their mental health, even when they had no previous mental health issues, and housing affordability was most frequently stated as the reason. The stress levels resulting from falling into arrears with housing payments are comparable to unemployment.
7. Covid – 19: The City Region has also experienced particularly damaging longer-term economic, social and health effects from a combination of local and national lockdowns during the autumn of 2020 and through the first half of 2021.
Impacts include deteriorating community and environmental conditions as the public purse is further strained, widening inequalities during children’s early years and in educational engagement and attainment, increasing poverty and income inequality, rising unemployment, particularly for young people, and deteriorating mental health for all age groups but again particularly for young people.
All of these negative impacts will damage health and widen health inequalities in Greater Manchester. This report assesses these unequal impacts and makes proposals about how to take urgent, remedial action.
There has been an increase in poor mental health among children and young people from already concerning levels before the pandemic. A significant acceleration is needed in the provision of mental health services for young people and in programmes to support mental health in schools, further education and workplaces.
8. Community assets are important to health directly and indirectly: directly through the services and opportunities they offer that support physical and mental health, and indirectly through a sense of control and empowerment, levels of community cohesion and social interaction, all of which support good health.
9. Climate Change: Most residents noted the importance of green environments and local events and facilities to good wellbeing, which are highly supportive of good physical and mental health and help reduce inequalities.
10. The direct and indirect impacts of climate change are a threat to health and health inequalities in Greater Manchester, as globally. Immediate action to reduce greenhouse gas emissions can also improve health and reduce existing health inequalities.
The direct impacts of climate change on physical and mental health include: greater exposure to extreme heat/cold and UV radiation, more pollen, emerging infections, flooding and associated water-borne diseases, and impacts of extreme weather.
Action to reduce air pollution, by reducing the burning of fossil fuels, will not only have immediate health benefits, but will also contribute to achieving net-zero greenhouse gas emissions.
The indirect impacts of climate change on health and inequalities include increases in the price of food, water and domestic energy and increased poverty, unemployment and anxiety (34).
12. Homelessness: In Greater Manchester, huge strides have been made in reducing rough sleeping and further plans made for eliminating it (60).
Greater Manchester’s A Bed Every Night scheme and Housing First policy provide accommodation for people who sleep rough and offer support to improve their physical and mental health.
The NHS provides funding for the scheme as it is viewed as a form of prevention, reducing need for NHS services. The Mayor’s Homelessness Fund enables businesses and individuals to donate towards supporting local services to support homelessness reduction, too (61).
The Let Us ethical lettings agency in Greater Manchester provides management services to private landlords through the services of housing association partners, aiming to improve the private rental sector (62).
In March 2021 the Better Homes, Better Neighbourhoods, Better Health ‘Tripartite Agreement’ between Greater Manchester Housing Providers, Health and Social Care Partnership and the Combined Authority was launched.
The partnership aims to plan new housing and communities to enhance health, support more vulnerable households, support homeless people and those sleeping rough, and expand the ethical lettings agency to make an additional 800 homes available to those who are homeless or sleeping rough by 2024 (63).
The Greater Manchester Good Landlord Scheme, approved in March 2021, could help to address some of the issues by placing the onus on landlords and agents to improve and maintain standards in the private rental sector. The Scheme addresses some of the issues by: strengthening and focussing enforcement capacity in a co-produced model with districts; targeting capacity building for landlords (and agents) to help them better support their tenants, particularly those on low incomes; working with districts and key stakeholders to ensure tenants and landlords have access to accurate and up-to-date information and advice; and promoting the active growth of ethical/social investors in the sector (54).
Greater Manchester’s 2019–2024 Housing Strategy has two key priorities: to provide a safe, healthy and accessible home for all and to deliver the new homes Greater Manchester needs (45). It commits to providing 50,000 affordable homes, of which 30,000 will be for social rent, by 2037 (45).
However, this is too few and too slow to meet the demands for affordable housing, and given the impacts of the pandemic, the Strategy’s priorities are unlikely to be met in the 2019–24 timeframe.