Sir Michael Marmot has challenged pharmacists to react to health inequalities and help tackle the social determinants of health.

Speaking at the Royal Pharmaceutical Society annual conference today, Sir Michael said that trends in worse health outcomes among more deprived populations, such as higher mortality rates during Covid-19, showed that social factors exacerbated medical problems.

‘And that's where pharmacy comes in,’ he told delegates. ‘You're at the medical end, and we're trying to get people at the medical end to deal with the social determinants of health.’

His keynote speech challenged pharmacists to ‘do the heavy lifting’ in response to the growing problem of health inequalities, which he said had been exacerbated by the Covid-19 pandemic while the current cost-of-living crisis was having a disproportionate impact on the poorest households.

Image: Dr Raliat Onatade, Priyanka Patel, Nicola Stockmann, Paul Forsyth, Marc Donovan, next to Andrew Evans (CPhO for Wales)

Other speakers at the event also shared ideas on how pharmacy professionals could address health inequalities.

Paul Forsyth, lead pharmacist of clinical cardiology, NHS Greater Glasgow and & Clyde, argued that addressing social deprivation requires an understanding of the communities that you’re trying to serve – meaning that community pharmacies have a key role to play.

‘This is something that the trust that community pharmacy, the social capital that they have, can really foster,’ he said.

He also highlighted the importance of system leaders, such as ICS leaders, trusting individuals within the system to know what is needed in the locations where they work.

Dr Raliat Onatade, chief pharmacist at the North Thames GMSA, North East London Integrated Care Board, highlighted that as more technology was used in patient interactions, those developing the systems needed to pay attention to people who are digitally excluded.

She gave the example of people who don’t have access to or are unable to use technology – and called on decision-makers to ensure that new technological developments don’t contribute to widening inequalities and where possible, seek to close the gap.

Marc Donovan, director of healthcare development at Boots UK, said that ‘we need to strive for a consistency of a healthcare professional in every community pharmacy’ so that patients can get to know them and other healthcare professionals can work with them.

He said: ‘It’s a real community asset to be able to have an accessible healthcare professional on every high street in every community.’

Growing health inequalities

In his speech, Sir Michael Marmot attributed growing health inequalities, such as a stalling in life expectancy that was out of line with other countries, to three main factors: the decade of austerity since 2010, the Covid-19 pandemic and the current cost-of-living crisis.

Referencing the impact of cuts to government spending between 2010 and 2020, he said: ‘We lost a decade. These terrible problems that we’re suffering are a political choice.’

He also compared the UK to countries such as Finland where taxation and benefits are used to offset child poverty among the poorest households. ‘If your mission was to increase inequalities and make poor people poorer, we’re on track,’ he said.

Sir Michael argued that the pandemic had exposed and amplified inequalities, and the cost-of-living crisis was having a disproportionate impact on the poorest households – and suggested that the rate of inflation amongst the poorest households was nearly 18%, because a higher proportion of income was spent on food and energy.

In fact, he shared figures that suggested that it would cost the poorest households 75% of their income to eat in line with NHS healthy eating guidelines (the NHS Eatwell Guide), compared to less than 20% for middle and less than 10% for the highest percentile earners. ‘They’re not ignorant, they’re not feckless, they’re poor’, he said.

He called for the Government to ‘put equity of health and wellbeing at the heart of all government policy’, warning that a repeat of 2010 austerity measures would ‘grind people into the ground’, but that a tax increase of 1% could nearly ‘fill the fiscal black hole’.

Sir Michael also highlighted that spending in local government budgets had been cut by £413 per person in the North of England and £388 per person across England, while levelling up spending in 2021 was equivalent to just £32 per person – a discrepancy he described as ‘insulting’.

He said that policies to address health inequalities needed to strive for a universal level of outcome, with targeted effort where it was needed – which he called ‘proportionate universalism’ and added that lots could be done at a local level to ‘build back fairer’.