'Fair Society Healthy Lives', aka. the Marmot review (2010) provided evidence for health inequalities and the social determinants of health in England, and a strategy to improve them. 10 years on, this review finds that almost all health inequalities in England have been increasing since 2010, with austerity being a leading cause. 
In the report conclusion on page 32, the report re-emphasises the importance of a universal approach:

The aim of all policies should be to level up, for everyone to enjoy the good health and wellbeing of those at the top of the social hierarchy – hence our reiteration of proportionate universalism: universalist policies with effort proportionate to need. We extend this to include investment – over the last decade government allocations of funding have declined most in poorer areas and this must be reversed. Funding should be allocated in a proportionate way – those areas that have lost the most and are more deprived must receive renewed investment first - and at higher levels.

See the Executive Summary here

Life expectancy and health

  • Increases in life expectancy have slowed since 2010, with the greatest slow down in the most deprived areas

  • Female life expectancy has actually declined in the most deprived areas. 

  • The least deprived areas have seen a steady rise in life expectancy- showing a widening inequality in life expectancy both within and between regions. 

  • Most deprived areas have the lowest healthy life expectancy (the years one is expected to live in good health) and healthy life expectancy has declined for women since 2010. 

Early Years 

  • Since 2010, progress has been made in early years development, measured by school readiness. But clear socioeconomic inequalities persist. 

  • Rates of child poverty have increased since 2010 with over 4 million children affected. 

  • Over 70% of children in workless families live in poverty 

  • Funding for sure start and children's centres have been significantly cut, particularly in more deprived areas. 

Children and young people

  • There has been no improvement of socioeconomic inequalities in educational attainment since 2010 

  • Regional inequalities: London has the highest levels of attainment at age 16, with the north of england the lowest. 

  • Pupil numbers have increased while funding has decreased by 8% per pupil. 

  • Rise in the number of children being excluded from school 

  • Youth services have been cut considerably since 2010 and violent youth crime has increased greatly over the period. 


  • Work is not a way out of poverty: low wages, low levels of benefits and the cost of living and housing mean that many people working are in poverty. 

  • Although employment has increased, quality of work hasn't, and more people are reporting work related stress anxiety and depression,

  • Wages have barely in real terms since 2010 and the rise of zero hours contracts all contribute to widening health inequalities.

  • There is huge regional inequality in these figures too, with the north east experiencing the worst effects of unemployment, universal credit and zero hours contracts. 

Standard of living 

  • Regional inequalities in wealth have increased. 

  • Wealth inequality has increased

  • Food insecurity has increased 

  • Social mobility has declined

  • Tax and benefit reforms have widened income and wealth inequalities 

Places and communities 

  • Regional inequalities: there are more areas of intense deprivation in the north, Midlands and southern coastal towns than the rest of england

  • Government spending has decreased most in the most deprived areas

  • Cuts in services outside of health and social care have hit most deprived communities hardest

  • Costs of housing, including social housing, has increased, pushing many people into poverty and ill health

  • Quality of housing has improved

  • Increase in homelesness 

  • Health harm from climate change is increasing