October’s Health Scrutiny – Marmot lays down gauntlet and IT’s HAPPENING

IT’s HAPPENING : EVERYBODY STAY CALM!

This month’s health scrutiny meeting had an item from a big celebrity name – Sir Michael Marmot of the Marmot review, a report detailing health inequalities in the UK and how to reduce them. I’ll get into the content of the meeting below but as always, just a few reflections.  

The most exciting part first – climate change is coming to the health scrutiny committee! It has been added to the work programme and will be landing in January or February of next year. We still don’t know the exact details of what will be discussed in that item, but now is the time to reach out to your councillors and talk about how climate change affects you and your health. That might be your experience with air pollution and asthma, or the effect of the climate crisis on your mental health, or the risk of heat exposure in your home. This is especially important if your councillor is on the health scrutiny committee as they will be able to bring your experiences and viewpoints into the discussion. Find out if your councillor is on the committee here.

Climate change is one of the social determinants of health mentioned in the original 2010 Marmot Review and again in the 2020 report. In fact, in 2020 it recommended reaching net zero carbon emissions by 2030 and ensuring health inequalities don’t widen as a result. Today’s meeting was focussed on the report about Greater Manchester, called Build Back Fairer, which includes this quote that’s really doing my job for me:

“The direct and indirect impacts of climate change are a threat to health and health inequalities in Greater Manchester, as globally. Immediate action to reduce greenhouse gas emissions can also improve health and reduce existing health inequalities because of the co-benefits of reducing local air pollution. The direct impacts of climate change on physical and mental health include: greater exposure to extreme heat/cold and UV radiation, more pollen, emerging infections, flooding and associated water-borne diseases, and impacts of extreme weather. The indirect impacts of climate change on health and inequalities include increases in the price of food, water and domestic energy and increased poverty, unemployment and anxiety.”

And secondly, as always it’s worth highlighting the good stuff. If you head over to the meeting’s page, you’ll find that there’s an estimated timestamp for when each agenda item would occur. This was posted ahead of time so you can come to whichever part of the meeting is relevant. It’s one of those small adjustments which genuinely increases the accessibility of the meeting for the public. And honestly, I would recommend watching the first hour for Marmot’s contribution – he’s a great speaker and pulled no punches throughout.

 Meeting summary

The meeting started with the usual – minutes accepted, no urgent business, no appeals, no interests. We then hopped straight into Professor Marmot’s talk, where he discussed health inequality on an international and local level. On both levels, Professor Marmot didn’t hold back, describing how policy changes after the 2010 report directly contradicted his recommendations, resulting in a decrease in life expectancy outside of London even before the pandemic. It’s also worse for your health specifically to live in the North West for the most deprived in our society. In this ten year gap, spending on social care reduced by 3% but more deprived people experienced greater reductions in funding, up to a shocking 16%. The Build Back Fairer report includes 44 Marmot Beacon indicators to support scrutiny committees across Greater Manchester. There are some areas that Manchester are doing well at, including supporting smoking cessation, but Manchester also scores highly on a lot of deprivation indices and has significant health inequalities. Cllr Green suggested bringing a future report looking at each of these beacon indicators and how to improve them.

This led onto the next item, also focussed on health inequalities and how we are addressing them across partner organisations in Manchester. The item was led by Dr Cordelle Ofori, who introduced the social determinants of health alongside discrimination and prejudice towards people with protected characteristics. This item, which lasted for the rest of the meeting, was hugely improved by the inclusion of service users and case studies of both positive and negative experiences, including a horrific case study of a Coffee4Craig service user who was denied her antibiotics prescription for an infected tooth due to a lack of ID or fixed address despite the fact she had used Coffee4Craig as a care of address. The pharmacy confiscated her prescription card and denied her treatment even though it wasn’t a restricted medication. She ended up removing her own tooth and passing out from the pain. This moving case study changed the mood in the room from ‘we are doing the best we can’ to scrutiny of where the system breaks down and how to prevent this. There was some good scrutiny here, including Cllr Leech asking about providing ID for homeless people –  Dr Manisha Kumar highlighted that that will always result in people falling through the gap and what we need is cultural and attitudinal changes towards not needing ID. There were also services and projects highlighted like While You Wait, a Greater Manchester project aimed at supporting people stuck on long waiting lists for hospital treatments, and the COVID sounding boards, which will hopefully continue to be used for general health equity work into the future.

With this, and the COVID update quickly taken as read, the very last sentence of the meeting was the news we’ve all been hoping for – that climate change and health has been added to the work programme. The next meeting will be on the Manchester local care organisation and Better Outcomes Better Lives programme.

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