What the Marmot Review tells us about the places we live, the opportunities we have and why healthier communities need more than healthcare.
When we talk about improving health, it’s tempting to start with hospitals, GP appointments and waiting lists. All enormously important, of course.
But what about everything that happens before someone needs an appointment?
The home they live in. The money available after paying the bills. Whether they feel safe in their neighbourhood. The opportunities they had growing up. The people they can turn to when things become difficult.
These aren’t separate from health. They’re part of what shapes it.
And that’s something the Marmot Review has been telling us for more than 15 years.
The research that changed the conversation
In February 2010, Professor Sir Michael Marmot published Fair Society, Healthy Lives, an independent review of health inequalities in England.
Its central argument was that differences in health are not simply the result of individual choices or access to healthcare. They are closely connected to the social and economic conditions in which people live.
The report identified what researchers call the social gradient in health. Put simply, health tends to improve at each step up the social and economic ladder.
This isn’t just about the very richest and poorest. There is a gradient running through society.
The review called for action across childhood development, education, employment, living standards, neighbourhoods and prevention. It also introduced an important principle: proportionate universalism.
That means making support available to everyone, while providing greater intensity of support where disadvantage is greater.
Fifteen years on, how much has changed?
In 2020, the Institute of Health Equity published Health Equity in England: The Marmot Review 10 Years On.
Its findings were deeply concerning. Improvements in life expectancy had slowed dramatically, inequalities between wealthier and more deprived areas had widened, and life expectancy had actually declined for women in the most deprived tenth of areas during the period examined.
More recent figures show why these issues remain urgent.
In April 2026, the Office for National Statistics reported that, for 2022–2024, healthy life expectancy at birth in England’s most deprived areas was estimated at:
49.8 years for men and 48.2 years for women.
In the least deprived areas, the equivalent estimates were 69.2 years for men and 68.5 years for women.
That’s a difference of approximately 19 years for men and 20 years for women in the number of years expected to be spent in good general health.
These are population estimates based on area deprivation, not predictions about individual lives. The ONS also identifies uncertainty in its healthy life expectancy estimates. Nevertheless, the scale of the gap demands attention.
What does this mean for community development?
A healthier community isn’t created by healthcare services working alone.
Decent housing, financial security, social connection, accessible opportunities and having some influence over local decisions all matter.
This is where community development has a part to play.
A welcoming workshop can create opportunities for connection and confidence. A community growing project can help people learn, participate and take pride in their neighbourhood. Practical support can help someone maintain an outdoor space that has become difficult to manage.
At ACE Impact, these are among the ideas behind projects such as Shed Inside, Incredible Edible Laindon and Blooming Neighbours.
We don’t claim that a gardening visit closes the national health inequality gap. That would be rather ambitious for a lawnmower.
But, locally shaped activity can contribute to the conditions that support wellbeing, participation and independence.
The important distinction is between understanding why an activity might help and collecting evidence that shows what it actually achieves.
Communities need influence, not just interventions
There’s another message worth taking from Marmot.
People shouldn’t simply receive programmes designed elsewhere and delivered into their neighbourhoods. They should have meaningful opportunities to shape the decisions that affect their lives.
That requires listening, recognising local strengths and involving people from the beginning.
It also requires honesty about the limits of community action.
Local projects cannot substitute for adequate incomes, safe housing, properly resourced public services or wider policy changes. Tackling health inequalities needs action at all those levels.
But community organisations can build relationships, identify barriers, bring people together and help make local responses more relevant.
A question worth asking
When we develop a new service or community project, we should ask more than whether people will use it.
Will it reach those facing the greatest barriers? Will people have a say in shaping it? And will it make a meaningful difference to their everyday lives?
The Marmot Review remains important because it challenges us to think about the conditions that make good health possible in the first place.
And that’s a conversation communities deserve to be at the centre of.
Read the research
- Fair Society, Healthy Lives: The Marmot Review (2010)
- Health Equity in England: The Marmot Review 10 Years On (2020)
- ONS: Healthy life expectancy by deprivation in England and Wales (15 April 2026)
