The Marmot Reviews: Fair Society, Healthy Lives (2010) and 10 Years On (2020)
Sir Michael Marmot and the Institute of Health Equity
Summary
The original Marmot Review showed that health in England follows a social gradient: the more deprived the area people live in, the shorter their lives and the more years they spend in poor health — and this applies at every step of the ladder, not just between the richest and poorest. It argued that these inequalities are avoidable and driven largely by the social determinants of health: early childhood, education, employment, income, housing and communities. It proposed 'proportionate universalism' — universal action, with effort scaled to the level of disadvantage. The follow-up in 2020 found that improvements in life expectancy had stalled over the previous decade, that inequalities had widened, and that life expectancy had fallen for women in the most deprived areas. It linked this to austerity and reduced spending on the services that shape health outside the NHS.
Why it matters at interview
Health inequality is one of the most frequently examined current-affairs themes. Marmot gives you the vocabulary — social gradient, social determinants, proportionate universalism — to answer with depth.
Key takeaways
- Health follows a social gradient across the whole population.
- Social determinants (education, income, housing, work) drive much of the gap.
- Proportionate universalism: universal action scaled to need.
- The 2020 update found stalled progress and widening inequalities.
How to use it
When discussing obesity, smoking or 'self-inflicted' illness, use Marmot to show behaviour is shaped by circumstance — which changes the ethics of blame.
Questions it helps with
- Why have you applied to this medical school?
- One donor liver is available. Two patients need it: a 45-year-old with liver failure caused by alcohol, and a 45-year-old whose liver failure is caused by a genetic condition. Who should get it?
- What are the values of the NHS, and which one do you think is most important?
- What do you think is the biggest challenge facing the NHS at the moment?
- What are health inequalities, and what can doctors do about them?
- Should the government tax unhealthy food to tackle obesity?
- Interpret this data on childhood vaccine uptake and discuss what it might mean.