Key messages

• health inequalities in England have widened rather than narrowed over the past decade
• life expectancy improvements have stalled, with declines observed in some groups and areas
• health outcomes closely follow a social gradient linked to deprivation
• inequalities are strongly shaped by social, economic and environmental conditions
• action across multiple sectors and levels of government is required to address inequalities.

Policy implications

• neighbourhood health and care approaches must address wider social determinants, not only healthcare access
• place-based action is critical to tackling inequalities driven by local deprivation
• prevention and early intervention should be prioritised across the life course
• sustained national and local commitment is needed to reduce health inequalities.

Gaps

• limited evidence of effective large-scale policy action to reverse widening inequalities
• insufficient progress in embedding equity across all policy areas
• lack of accountability mechanisms to ensure action on social determinants.

Commentary
This review provides a critical backdrop for neighbourhood health and care policy. By showing that health inequalities have worsened over the decade following the original Marmot Review, it stresses the limitations of approaches that focus narrowly on healthcare delivery alone.

The findings reinforce the importance of place-based action. Neighbourhoods shape exposure to poverty, housing quality, employment opportunities and social connection, all of which influence health outcomes. From a care equity perspective, neighbourhood health and care offers a potential mechanism for acting on these determinants locally.

However, the review also highlights that local action cannot substitute for national policy. Without sufficient investment and cross-government commitment, neighbourhood initiatives risk operating in contexts where inequalities continue to deepen.

Overall, The Marmot Review 10 Years On strengthens the case for neighbourhood health and care that is explicitly equity-focused, prevention-oriented and connected to wider social and economic policy. Without this alignment, neighbourhood approaches are unlikely to reverse entrenched health inequalities.