The Health Gap

The Health Gap

The Challenge of an Unequal World

A joint event with the Policy Institute at King's College London as part of the Fair Society series


Dramatic differences in health are not a simple matter of rich and poor – poverty alone doesn't drive ill health, but inequality does. Indeed, suicide, heart disease, lung disease, obesity, and diabetes are all linked to social disadvantage.

In his book The Health Gap: The Challenge of an Unequal World, Professor Sir Michael Marmot argues that in every country, people at relative social disadvantage suffer health disadvantage and shorter lives – a key reason why we need to address societal imbalances in power, money and resources.

Since the book was published in 2015, Marmot's work has gone on to reveal how the health gap has grown between wealthy and deprived areas of the UK, and how inequalities in social and economic conditions before the pandemic contributed to the high and unequal death toll from Covid-19.

In this event, Sir Michael and the other panellists discussed why it is more urgent than ever that we tackle inequalities in order to improve health, why more progress has not been made in the last decade, and how we can rectify this failure in the era of levelling up.



  • Professor Sir Michael Marmot, Director of the UCL Institute of Health Equity, former President of the World Medical Association, and author of The Health Gap: The Challenge of an Unequal World
  • Jo Bibby, Director of Health at the Health Foundation
  • Chris Thomas, Senior Research Fellow (Health) at the Institute for Public Policy Research, and author of The Five Health Frontiers: A New Radical Blueprint
  • Jabeer Butt, Chief Executive of the Race Equality Foundation
  • Professor Richard Trembath, Senior Vice President (Health & Life Sciences), King's College London, and Executive Director of King’s Health Partners
  • Will Snell, Chief Executive of the Fairness Foundation (chair)

Our take

Sir Michael set the scene, arguing that little has changed since the publication of The Health Gap in 2015, and that we need to do something for those in absolute poverty, and do more for those in relative poverty (since relative income inequalities lead to absolute inequalities in terms of capabilities). We have been used to health outcomes improving, but between 2010 and 2020 improvements slowed, inequalities grew, and life expectancy in deprived areas actually went down. Then the COVID pandemic exposed and amplified the underlying inequalities; the social gradient in health applies to COVID too.

Jo Bibby argued that the reason for limited progress on tackling health inequalities, despite all the evidence, is public understanding and attitudes. If health inequality isn't a public priority, it won't be a priority for government. We don't communicate or frame the issues well enough. As a result most people don't think beyond the role of the NHS or individual lifestyle choices.

Chris Thomas suggested that, as a recent IPPR/Runnymede Trust report argued, we don't have enough 'rebels' in the public health world who can engage the public on the issues (as XR and others have done on climate). In addition, as another IPPR report set out, we are not making enough ‘totemic’ policy asks that can cut through to the public and increase pressure on politicians to act.

Jabeer Butt said that racism is a key barrier to progress on tackling health inequalities. It was not until dead bodies appeared that attention was given to the disproportionate impact of COVID on black and minority ethnic communities. Despite the positive impacts of educational improvements and the fact that there are many more black and minority ethnic people in the workforce than there were a few years ago, BAME people are more likely than others to be in insecure and poorly paid work. We have not been able to persuade politicians of the importance of addressing racial inequalities.

Richard Trembath set out a case for NHS providers to do more to address prevention and the social determinants of health, and the need for systemic change to facilitate this, and sounded a cautionary note about technological and medical advances that held the potential to exacerbate health inequalities (such as the use of genetics to identify who would benefit from specific, targeted health interventions).

A broad-ranging discussion followed, with the panel fielding questions focused on levelling up and the rebadging of health inequalities as health 'disparities', the portrayal of health in popular culture, how to be a health equity rebel (and the need for a health equity COP as we have for climate), different approaches across the four UK nations, and issues around missing or inadequate data. In closing, each of the panel outlined their policy priorities to address health inequalities if they were to become Prime Minister: eliminating child poverty; social housing, universal basic income and social care; more resources for public health and cross-government action on social determinants; a bigger role for business; and putting equity of health and wellbeing at the heart of all government policy.

Watch the recording