Marmot Review

Policy Objective A: Give every child the best start in life Priority objectives: 1. Reduce inequalities in the early development of physical and emotional health, and cognitive, linguistic, and social skills. 2. Ensure high quality maternity services, parenting programmes, childcare and early years education to meet need across the social gradient. 3. Build the resilience and well-being of young children across the social gradient. Policy recommendations: 1. Increase the proportion of overall expenditure allocated to the early years and ensure expenditure on early years development is focused progressively across the social gradient. 2. Support families to achieve progressive improvements in early child development, including: Giving priority to pre- and post-natal interventions that reduce adverse outcomes of pregnancy and infancy; Providing paid parental leave in the first year of life with a minimum income for healthy living; Providing routine support to families through parenting programmes, children's centres and key workers, delivered to meet social need via outreach to families; Developing programmes for the transition to school. 3. Provide good quality early years education and childcare proportionately across the gradient. This provision should be: Combined with outreach to increase the take-up by children from disadvantaged families; Provided on the basis of evaluated models and to meet quality standards.

Policy Objective B: Enable all children, young people and adults to maximise their capabilities and have control over their lives Priority objectives: 1. Reduce the social gradient in skills and qualifications. 2. Ensure that schools, families and communities work in partnership to reduce the gradient in health, well-being and resilience of children and young people. 3. Improve the access and use of quality lifelong learning across the social gradient. Policy recommendations: 1. Ensure that reducing social inequalities in pupils' educational outcomes is a sustained priority. 2. Prioritise reducing social inequalities in life skills, by: Extending the role of schools in supporting families and communities and taking a 'whole child' approach to education; Consistently implementing 'full service' extended school approaches; Developing the school-based workforce to build their skills in working across school–home boundaries and addressing social and emotional development, physical and mental health and well-being. 3. Increase access and use of quality lifelong learning opportunities across the social gradient, by: Providing easily accessible support and advice for 16–25 year olds on life skills, training and employment opportunities; Providing work-based learning, including apprenticeships, for young people and those changing jobs/careers; Increasing availability of non-vocational lifelong learning across the life course.

Policy Objective C: Create fair employment and good work for all Priority objectives: 1. Improve access to good jobs and reduce long-term unemployment across the social gradient. 2. Make it easier for people who are disadvantaged in the labour market to obtain and keep work. 3. Improve quality of jobs across the social gradient. Policy recommendations: 1. Prioritise active labour market programmes to achieve timely interventions to reduce long-term unemployment. 2. Encourage, incentivise and, where appropriate, enforce the implementation of measures to improve the quality of jobs across the social gradient, by: Ensuring public and private sector employers adhere to equality guidance and legislation; Implementing guidance on stress management and the effective promotion of well-being and physical and mental health at work. 3. Develop greater security and flexibility in employment, by: Prioritising greater flexibility of retirement age; Encouraging and incentivising employers to create or adapt jobs that are suitable for lone parents, carers and people with mental and physical health problems.

Policy Objective D: Ensure a healthy standard of living for all Priority objectives: 1. Establish a minimum income for healthy living for people of all ages. 2. Reduce the social gradient in the standard of living through progressive taxation and other fiscal policies. 3. Reduce the cliff edges faced by people moving between benefits and work. Policy recommendations: 1. Develop and implement standards for minimum income for healthy living. 2. Remove 'cliff edges' for those moving in and out of work and improve flexibility of employment. 3. Review and implement systems of taxation, benefits, pensions and tax credits to provide a minimum income for healthy living standards and pathways for moving upwards.

Policy Objective E: Create and develop healthy and sustainable places and communities Priority objectives: 1. Develop common policies to reduce the scale and impact of climate change and health inequalities. 2. Improve community capital and reduce social isolation across the social gradient. Policy recommendations: 1. Prioritise policies and interventions that reduce both health inequalities and mitigate climate change, by: Improving active travel across the social gradient; Improving the availability of good quality open and green spaces across the social gradient; Improving the food environment in local areas across the social gradient; Improving energy efficiency of housing across the social gradient. 2. Fully integrate the planning, transport, housing, environmental and health systems to address the social determinants of health in each locality. 3. Support locally developed and evidence-based community regeneration programmes that: Remove barriers to community participation and action; Reduce social isolation.

Policy Objective F: Strengthen the role and impact of ill-health prevention Priority objectives: 1. Prioritise prevention and early detection of those conditions most strongly related to health inequalities. 2. Increase availability of long-term and sustainable funding in ill health prevention across the social gradient. Policy recommendations: 1. Prioritise investment in ill health prevention and health promotion across government departments to reduce the social gradient. 2. Implement an evidence-based programme of ill health preventive interventions that are effective across the social gradient by: Increasing and improving the scale and quality of medical drug treatment programmes; Focusing public health interventions such as smoking cessation programmes and alcohol reduction on reducing the social gradient; Improving programmes to address the causes of obesity across the social gradient. 3. Focus core efforts of public health departments on interventions related to the social determinants of health proportionately across the gradient.