Sir Michael Marmot on the need to ‘build back fairer’

x Sponsored content on Research Live and in Impact magazine is editorially independent.
Find out more about advertising and sponsorship.

1 ) You have noted that housing is a food issue because, if you can’t afford rent, how can you eat healthily? Is research too siloed to make connections between issues such as healthy eating and housing, or wellbeing and the environment?

Commonly, I am asked what one thing I would recommend to reduce health inequalities. A key reason for my refusing to answer that question is precisely because of the interconnections. Income is a housing question. Housing is a food question. Food insecurity is part of poverty.

We do need specific policies, but we need to look at them in the context of the conditions in which people are born, grow, live, work and age.

2 ) Data is in the spotlight like never before – has Covid-19 helped or hindered our relationship with evidence?

The pandemic has shown how reliant we are on good-quality data and, in the UK at least, how blessed we are to have such high-quality data systems.

In matters of public policy, scientists produce evidence and politicians decide how to act on that evidence. As you might expect, there is a spectrum. Some politicians are more receptive to evidence-based arguments than others.

The Covid-19 pandemic has shifted the balance quite markedly. The evidence has become front-page news. It is still the case that the evidence doesn’t make the policy decisions, but it is having a bigger impact. The Office for National Statistics has shown how vital it is to have an excellent statistical office.

3 ) ‘The Marmot Review: 10 years on’ was published just before the pandemic took hold in the UK, and Covid-19 has laid bare the existing inequalities in society. What impact will the pandemic have on how inequality is understood and addressed in future?

Because of the pandemic, in December 2020 we published ‘Build back fairer: the Covid-19 Marmot Review’, only 10 months, not 10 years, after the ‘10 years on’ report was published. We showed that pre-existing health inequalities had been amplified by the pandemic and made worse by the societal response. Hence, our call to ‘build back fairer’.

4 ) Where do you see the greatest need for further research/data collection? Is more international cooperation needed?

We have laid out an agenda for action on social determinants of health and health equity. In each of the key domains, we need firmer evidence of causal connections. We also need to track on health equity of societal changes.

We always have much to learn from how different contexts shape social determinants of health and assessing the effects of actions that have impact on health equity.

5 ) Is public health policy too focused on individual factors rather than social determinants?

I think we are making real progress in getting organisations to recognise the importance of social determinants of health.

6 ) What can researchers do to reduce the chance of work being misinterpreted or misused in a time of misinformation?

A good feature of what has happened under the pandemic is a great deal of high-quality public discussion about research findings. There will always be people who misuse information and evidence. That should not stop people of good faith discussing disagreements and differing views of the evidence in public.

7 ) What is the biggest challenge facing researchers working in health over the next 12 months?

The brilliant success of dedicated work on developing vaccines shows what well-funded science can do. As we emerge from the pandemic, we should give the same focus and resource to addressing the ongoing health challenges that we face.

This article was first published in the April 2021 issue of Impact.