The publication of the report Health Inequality in England: The Marmot Review Ten Years On last month set out some compelling and difficult findings for Government and policy-makers. Charting progress since his initial report in 2010, Sir Michael Marmot pulls no punches as he describes improvements in life expectancy as ‘slow[ing] dramatically, almost grinding to a halt’ since 2011. Indeed, for part of the decade 2010-2020, life expectancy fell in the most-deprived communities outside London for women and in others for men.
It’s shocking that, in the 21st century and in the fifth-largest economy in the world, life expectancy is slowing and the social gradient in health outcomes (the difference between those from poor neighbourhoods and those from more affluent neighbourhoods) has become steeper.
A decade ago, Marmot’s top recommendation was to ensure that we give every child the best start in life. That recommendation has been ignored by Government. Since 2010, local authority funding for children and young people’s services fell by around £3 billion, including a £1 billion cut to Sure Start Children’s Centres. In the most deprived local authorities, spending on children’s services has fallen almost five times faster than in the least deprived local authorities.
While spending on early years education has increased in line with increases to entitlements, it remains below the OECD average and is less progressive than a decade ago. Tax-Free Childcare and the free 30 hours have overwhelmingly benefited families on middle and higher incomes. In 2007/08, 45 per cent of all Government spending on the early years and childcare support was targeted explicitly at low-income families. By 2018, the share of spending on low-income families had decreased to 27 per cent.
And despite his evidence-based recommendations that early years workers should be highly qualified and well-paid, our own evidence (cited by Marmot) finds they suffered a real-terms pay cut of nearly 5 per cent between 2013 and 2018 and a significant proportion (44.5 per cent) are reliant on state benefits or tax credits.
The conclusion remains that investment in the early years is the most cost-effective and equity-effective time to invest. It is consistent with a wealth of empirical evidence domestically and globally. Yet Government policy couldn’t have strayed any further from Marmot’s recommendations and it doesn’t look like it will get back onto the right path any time soon.