Sir Michael Marmot devised a new way of thinking. He believed that the health of a population is mostly shaped by social factors. That means the conditions in which people are born, grow, live, work and age.
Marmot devised eight principles he believed could be put into place which would improve people’s health enormously. These include giving children the best start in life, giving people control over their lives, fair employment, a healthy standard of living, strengthening the role of ill health prevention, developing healthy communities, tackling racism and discrimination, and improving environmental sustainability.
And Marmot’s ideas work. These are people who are using Marmot thinking to improve countless lives.
Pete Gladwell, Group managing director – public investments, Legal & General
Pete Gladwell. Image: Jasper White
An inclusive, growing economy and healthy society go hand in hand, and businesses and investors have a key role to play in supporting both. With regional prosperity depending on people’s health, reducing inequities in social determinants of health should be a priority for investors and government.
By partnering with Sir Michael Marmot and UCL’s Institute of Health Equity, we’re supporting place-based, localised initiatives that are essential to tackling the social, environmental, and economic challenges facing the UK – including reducing health inequalities. We’ve seen how integrating climate and environmental factors into investment decisions delivers long-term value. The same applies to health equity: investing in wellbeing strengthens communities and economies alike.
Legal and General has launched a £3 million Health Equity Fund in partnership with Sir Michael Marmot and the Institute of Health Equity aimed at tackling the social determinants of health – the conditions in which people are born, grow, live, work, and age. Grants have been awarded to 43 organisations across the UK, which will use the funding to tackle the social determinants of health that have an influence on local and national public health outcomes.
Advertising helps fund Big Issue’s mission to end poverty
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One such initiative is the Southend-based Homeless Action Resource Project (HAROP), which supports around 1,000 people each year who are homeless or at risk of losing their home. The charity’s teams work daily to meet people where they are, offering real alternatives to sleeping.
Services include street outreach, emergency and temporary accommodation, and emergency support through the Bradbury Day Centre, which operates 365 days a year. HARP helps people rebuild their lives by finding permanent housing, developing life skills, addressing health challenges and supporting pathways back into work or training. Support is tailored to what each person actually needs, whether that’s a quick intervention or longer-term assistance.
Another charity given funding by the L&G Health Equity Fund is Edberts House, Gateshead. The charity manages four community houses across Gateshead, each run by a group of local people to build happier, healthier and more connected communities. The houses are welcoming safe spaces where local people can pop in for a hot drink and a chat. They also offer a varied programme of activities and support, including fitness classes, craft sessions, youth clubs, bingo, and drop-ins.
Edberts House also runs a dedicated social prescribing team, embedded within primary care and working closely with secondary care midwives and palliative care services. And the charity leads Compassionate Gateshead with NHS North East and North Cumbria – a partnership project that brings together people and services to support one another through death, dying, loss and caring.
Ian Sinha, Consultant respiratory paediatrician, Alder Hey Hospital, Liverpool
Ian Sinha.
Childhood offers a one-off window to build healthy lives. Poverty slams that window shut, driving health inequalities that last a lifetime. Medicine alone can’t fix this. Systemic problems need systemic solutions, built-in partnership between clinicians, researchers, communities and policymakers. We tend not to think of our programmes as individual things. They’re all just part of the system-wide approach that we’re taking.
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We set up the world’s first Clean Air Clinic to advocate for individuals and families blighted by poor air quality. We’ve successfully supported families, including some whose houses are at risk of burning down because mould affects the electrics, and others who have been forced to sleep in cars to escape rats. But that alone isn’t enough. Therefore, to act at scale, we established the North West Health and Housing Joint Taskforce with councils, clinicians and housing agencies, so groups that once worked in silos now tackle the problem together.
Another example is the Liverpool Parent Champion programme, led by Dr Alice Lee* and supported by the Alder Hey Children’s Charity. It empowers mothers in deprived areas by strengthening their knowledge of infant health and housing, and drawing on their tacit expertise to reach other parents. Each year they speak with thousands of new and expectant mothers, with a credibility no NHS-led campaign could match. This approach cut urgent admissions for severe chest infections in babies by 25% – a striking, almost unprecedented NHS result – and is now replicated elsewhere in the UK. The thinking behind the programme was, ‘Let’s empower these mothers to mother’. It’s very much about giving children the best start in life.
The key Marmot sentence that we’ve always drilled home is that there’s no point getting these kids better to only send them back to the very situation that made them sick in the first place.
* Funded by the Health Data Research UK Inflammation and Immunity Driver Programme Project group: Ian Sinha, Alice Lee, Dan Hawcutt and Olufemi Olajidew
Gavin Flatt, public health principal, Liverpool City Council
Liverpool officially became a Marmot city in April 2025. We wanted to break down walls between sectors to work on our priorities – housing, mental health, maximising income, climate change – all areas that correspond to the Eight Marmot Principles.
As a result of that, we brought together what is now known as the Fairer Healthier Liverpool Partnership, which leads our Marmot approach.
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The first thing was to identify those priorities and start listening and thinking how to get to the causes of the causes, as we call them. Then we were going out, speaking to organisations, and making them aware that this wasn’t just Liverpool City Council.
We were driving it, but we needed to bring organisations together across all the city. In the past, it was difficult to get everyone around the table because everyone had competing priorities. Now we’re all working together to improve health outcomes and reduce inequalities.
The Fairer Happier Liverpool partnership is a group of organisations working together to improve the building blocks of health in the city. One of the programmes is the collaboration with the LFC Foundation, the official charity of Liverpool Football Club. A key focus is to create inclusive communities, seen in its work with refugees and asylum seekers.
In April 2024, the Foundation worked with Liverpool John Moores University to host its first Ramadan Evening Tournament. This event brought together eight teams, including refugees and local university students, improving cultural understanding and building community through football and a shared Iftar meal.
Over 700 refugees have benefitted from this and additional LFC Foundation events – such as the Refugee and Asylum Seeker Tournament and the Merseyside Refugee Derby – developing communication, improving health and fostering integration.
Another project which showed Fairer Happier Liverpool’s commitment to the Marmot Principles was a collaboration between the Liverpool Public Health Team and the charity End Furniture Poverty. In Liverpool, 26% of social housing tenants live in furniture poverty, lacking essential furniture and appliances, and only 2% of social homes are furnished, affecting tenants’ physical and mental health.
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The partnership with End Furniture Poverty encourages social landlords to furnish at least 10% of their properties. It includes the Furniture Flex scheme, which provides access to affordable furniture for landlords through flexible payment plans. Over 50% of landlords have signed up.
Nicola Ennis, South Yorkshire Children and Young People’s Alliance programme director
Nicola Ennis.
The Marmot Principles underpin our work on giving children the best start in life. Our aim is to ensure that there’s a guaranteed basic level of health that meets the needs of all young people, regardless of where they live.
We have had a focus on health and the wider social determinants related to school absence, targeting nine- and 10-year-olds from the most deprived areas of Rotherham. Teachers noted that pupils were struggling to attend school and knew that their mental health, emotional health and wellbeing were impacting on their attendance.
So we built an intervention using data and insights for children, that was led by the Rotherham United Community Trust (a trusted VCSE organisation). Over a six-month period, their youth workers provided a safe space to meet for a couple of hours every week. The children stated they gained a great deal from engaging with one another, either one-on-one or as a group.
We had a couple of children who were really struggling with school due to some difficult life events connected with loss. They presented as younger than their chronological age and initially were often very upset for much of the sessions.
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The youth workers were able to connect with partner organisations, sharing their observations and helping to build a better picture to ensure a joined-up offer of support. Over time, they were reported to be sleeping better, managing school more consistently and became more regulated. And since the intervention completed, they’ve been linked into other community supports that will offer them ongoing contact.
Another project is an early-years pilot called Bump, Birth and Beyond (BBB), which has been running for about a year and a half. The service is being led by Barnardo’s across South Yorkshire and supports pregnant women at the earliest stages, meeting them exactly where they need help. So that really underpins the Marmot Principles around housing, safe environments, safe spaces and early years.
Although there is a wealth of services, often each organisation has different acceptance criteria so people get bounced around services and many – probably the most vulnerable – don’t get access to these essential services. Projects like this mean that people have one consistent worker, helping them access the support families most need.
Dr Julie Nugent, Chief executive, Coventry City Council
When Coventry became the UK’s first Marmot City in 2013, we embarked on a journey that would fundamentally change how we work as a city. Looking back over the past decade, we are really proud of what we’ve achieved, while remaining clear about the challenges ahead.
The results speak for themselves. The number of young people not in education, employment or training (NEET) is 2% lower than the West Midlands average. We’ve improved our deprivation ranking by 22 places, moving from 60th to 81st most deprived local authority areas. Almost 5% more residents are now in work compared to five years ago. These aren’t just statistics – they represent real people whose lives have improved.
Being a Marmot City has helped to unite organisations across sectors. Our One Coventry partnership comprises all key public and voluntary sector partners – all working collaboratively toward shared goals. Critically, whenever we come to major policy decisions – be it planning, transport, housing or employment – we consider the impact on health inequalities.
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Our staff, partners and communities understand that health inequalities aren’t inevitable – they’re something we can collectively address. That said, our challenges remain. In particular, we recognise the relationship between poverty and health inequality, where too many of our communities die younger than those who live in more affluent areas.
We also know that there is too much inequity between different communities and ethnicities within this. We, along with our partners, work purposefully at hyper-local levels tailoring support to what communities need. Our early help family hubs bring maternity services to increase access to communities who have poorer health outcomes. Working with partners in places enables us to be more differentiated to meet need.
As the city that coined the phrase ‘Marmot City’ and which helped develop the framework now used across the UK, we remain committed to this approach. Coventry’s experience shows that sustained, collaborative action can, and must, deliver meaningful change in people’s lives.
Why influential figures back Marmot
Credit: PA Images / Alamy
Gordon Brown, former prime minister
“Michael Marmot’s pioneering work in Marmot cities and towns, his research showing the link between health and poverty, and the international cooperation on health inequalities that he has pioneered provides us with a blueprint for social progress and commitment to a fairer, healthier world.”
Andy Burnham, mayor of Greater Manchester
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Credit: Max Kent
“It forever altered my thinking, leading to a ‘health in all policies’ philosophy. It has guided everything I have done as mayor of Greater Manchester. As a proud Marmot City Region, we remain committed to a whole-system approach to the prevention of poor health, and reducing health inequalities by putting people and their individual needs at the centre of public services offers a ‘names not numbers’ approach.”
Alice Wiseman, director of public health, Newcastle and Gateshead
“Michael’s infamous question: “Why treat people and send them back to the conditions that make them sick?” is one I use regularly in my role. The only way to save the NHS is for us to collectively take action on the Eight Marmot Principles. Politics comes and goes, evidence for what we need to do remains.”
Paul Johnston, chief executive, Public Health Scotland
“I am determined to lead with relentless focus on tackling the range of factors that lead to ill health and that shorten the lives of so many of our citizens. We have brought Marmot Places to Scotland to galvanise both local and national action to improve health across the country.
“Partnerships have been stepping up work to tackle poverty, provide support for families and support people into work. We are seeing increased energy and commitment on work to strengthen the building blocks of health and there is a real sense of us just getting started.”
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Professor Habib Naqvi, chief executive, NHS Race and Health Observatory
“Racism is widespread and persistent across the UK, causing damage to individuals, communities and society as a whole. The impact of racial discrimination highlights the role structural inequalities play on the social determinants of health. Leadership support, at all levels, is critical for change.”
