Building a Fairer Gwent: Wales’ first Marmot Region

Introduction & policy context

There are many factors within society, the economy and the environment that influence peoples’ health and wellbeing. Inequalities within these factors, the social determinants of health, such as the unequal distribution of wealth and resources drive the conditions in which people live and create unfair and unjust differences within societies. These differences can be seen in Gwent where there are significant inequities in health, education, housing, income and employment across local authority areas. For example, females in the most deprived quintiles in Gwent live 20 years less in good health, compared with those in the least deprived (ONS, 2022), and more than one in four children in all local authority areas in Gwent now live below poverty line (ONS, 2023).

Marmot Regions aim to reduce inequity across the life course.

Building on the 2019 Aneurin Bevan University Health Board (ABUHB) Director of Public Health Annual report, Building a Healthier Gwent, which had the ambition that by the year 2030, the places where people live, work, learn and play make it easier to live healthier and more fulfilled lives, in June 2022, Gwent Public Services Board (PSB) commissioned the University College London Institute of Health Equity (IHE) as global experts in the field of health inequalities, to come up with ideas and recommendations to help address some of these issues in the region. This complex task required an agile approach and involvement from diverse partners for systems change. In September 2022 to help drive change, the Building a Fairer Gwent (BAFG) team within ABUHB public health team was established for 12 months to work alongside the IHE and Gwent PSB to implement the first ‘Marmot Region’ in Wales.

Examples

In October 2022, the BAFG team brought leaders from across Gwent together at a launch event in which Professor Sir Michael Marmot, a leading expert in health inequities and Director of the IHE, spoke about tackling inequity and the IHE’s experiences working with other Marmot Regions in England. This event was the first real opportunity to gather momentum for the programme and gain the senior support required for system change.

One of the key tasks of BAFG in the first year was to work with local authority partners to align the BAFG programme’s aims and Marmot Region approach with the new Gwent PSB Well-being Plan, as well as local authority Well-being delivery plans and other corporate plans. To facilitate this alignment, a workshop in each local authority area, of which Gwent has five due to a merger in 2021, was held between November and December 2022 to discuss a draft of the PSB Well-being Plan. These workshops provided further opportunities to connect with partners and stakeholders to discuss needs within their work areas, get to know the Gwent system and discuss the BAFG programme, and showcased the desire within the partnership space for collaborative, systems working. On the back of these events, a further housing-specific workshop was held in March 2023 with housing association leaders, to discuss what actions need to be taken to address inequities and inadequacies in social housing in the Gwent.

To enable collaboration across the system, a Gwent-specific group has been set up on the Health Equity Network, launched by IHE in January 2023. The network will provide a platform for partners across Gwent to connect, ask for advice, request support and connect with other Marmot Regions and professionals working in the health inequality and social determinants arenas.

With five local authority areas to cover, a small programme team and a tight 12-month timescale, engagement with communities and citizens about BAFG has been limited. However, much of the preparation for the IHE report for Gwent involved speaking with public-facing professionals about their experiences and what’s important for them and the people they work with. Feedback from these conversations has influenced the IHE’s report, titled ‘Building a Fairer Gwent: Improving Health Equity and the Social Determinants’, which was published in July 2023. This report offers an extensive list of actions spanning all eight Marmot Principles that could be taken across Gwent to help improve inequities in the region. Alongside the suggested recommendations is a list of Gwent-wide indicators for monitoring health inequalities such as healthy life expectancy at birth and percent of children living in relative low-income families.

Conclusion

Work is underway to prioritise the recommendations for Gwent and to work collaboratively to solidify action plans both locally and region-wide for the short-, medium- and longer-term. Alignment to the Gwent PSB Well-being Plan and local delivery plans will add momentum and longevity to the BAFG programme’s aims and plans to undertake community-level engagement events by early 2024 will help to understand what’s important for people locally and what support is needed.

Outside of Gwent, the system-wide indicators and recommendations outlined in ‘Together with Hope: Health equity and the social determinants in Gwent’ can be assessed for suitability and application Wales-wide, as can the expert information provided throughout the report about the determinants of health and health inequalities. Key to addressing inequities both Gwent and Wales-wide is the application of equity (and sustainability) to policies across health, government, education, employment, housing, environment and more.

More information about the BAFG programme can be found on the Gwent PSB website.

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