Delivering a fairer and healthier Oxfordshire as a Marmot Place

Oxfordshire County Council last year launched itself as a Marmot Place: An area that recognises that health and health inequalities are mostly shaped by the social determinants of health. In this article, this decision and the council’s wider journey to tackle health inequalities are explored.

Launching Oxfordshire as a Marmot Place back in November was a significant step forward in our journey to tackling health inequalities. Oxfordshire is one of the most affluent places in the country. However, this hides the astonishing fact that there are 10 wards in the county featuring areas that are in the 20 percent most deprived in England. In many cases, these communities sit just next door to affluent ones, meaning many feel left behind or forgotten and that the prosperity of the county is not beneficial to them. As a result, health outcomes in these regions have remained significantly below the national average. Consequently, addressing these disparities has been a top priority for us in recent years.

While we are not the first area to become a Marmot Place, we are unique in being the first county area and a predominantly rural county. Crucially, inequality is evident in our rural communities, but it is harder to measure through tools like the Index of Multiple Deprivation. The lived experience of rural inequality among our residents is different to the urban challenge and therefore the solutions must also be different. Unfortunately, there’s been limited work to date to explore and find a solution to the issue of inequalities in a rural setting. For action to be effective, we can’t only focus on improving health outcomes but must also tackle the drivers that lead to them in the first place.

Housing has a significant influence on our health. In addition to offering shelter, its affordability, stability, and quality directly affect overall wellbeing. Although Oxfordshire appears wealthy, housing is a major factor in local health inequality. Housing is unaffordable across much of the county, with average house prices 61 per cent higher than the England average. We know that poor quality of housing stock can lead to cold, damp or mouldy homes and we have commissioned a county wider housing health needs assessment to fully quantify the local situation to then inform relevant action to improve this. We are already working closely with district councils writing their local plans and with developers themselves to take a health place-shaping approach in all we do.

Equally, good education and skills development can help lift people out of poverty and reduce income poverty. Yet we see our less well-off families are less likely to be school ready at age four and therefore those with the most to gain are least likely to develop the skills during childhood to support their future employment. The outcomes for these children are worse than those of their peers who are eligible for free school meals in other parts of the UK – despite the academic benefits that come with being in Oxfordshire. We are therefore working closely with the Oxfordshire Local Enterprise Partnership, Inclusive Economy Partnership and colleagues in the education sector to address this. We have built a system-wide consensus to use the evidence and experience of the Marmot team to help us go further and faster in  his local quest.

Essential to our work in Oxfordshire and unique to our local Marmot Place approach is the role the University of Oxford has agreed to play. They have agreed to work with us on the Marmot initiative both in terms of utilising its world class research capacity to address policy research relevant to the Marmot principles, but also as a local anchor institution committed to effective local engagement. To develop the policy research initiative, we’ve already been working closely to transform policy with our Oxford University and Oxford Brookes University colleagues through the Local Policy Fellowship Programme. The programme provides an opportunity for students and researchers to engage with their local community and to better understand the public policy context of the city and local environment where they live. They undertake research that will directly inform policy formation and decision making relevant to the county and district councils here.

When we add together the assets and financial resources of the universities, businesses, councils, and NHS, it’s possible to start to see the positive impact we can have together. In the coming months we hope to begin our work with communities and to see the all important cultural shift recognised in other Marmot places. 

One of the first things we have already started is the mapping of our existing work programmes across different organisations against the eight Marmot principles. With the help of the Marmot Team, we will add the best possible data to this in order to give clear insight on where to target the joint work.  We have already committed to undertake an “evidence call” on rural inequality in the county so that all partners can help build the picture of the challenge we see in this space – such as isolation, poor transport connectivity, seasonal work or lack of jobs- and then develop solutions to these problems. We are also hosting an early years summit in January to in order to better take action on supporting a healthy first 1000 days of life to ensure the best start in life.

This Marmot Place partnership will ensure a thorough system-wide approach to our work and guarantee health equity is a priority, and the Marmot Principle embedded in the work of all our local system partners.