Professor Sir Michael Marmot’s work has been central to understanding and tackling health inequalities.

By adopting his eight principles which range from giving every child the best start in life to improving housing, skills, transport and delivering fair employment and good jobs, Liverpool is now a ‘Marmot City’, the NHS Cheshire and Merseyside is a ‘Marmot Community’ and Mayor Steve Rotheram is on a mission to establish England’s first ‘Marmot City Region’.

Writing in The Municipal Journal (The MJ), Mayor Rotheram and Cheshire West and Cheshire Council Leader Cllr Louise Gittins explain how, through devolution, health equity can be hardwired into every local decision – so that people’s health and life chances are no longer determined by where they live.

(L-R) Sir Michael Marmot, Cllr Louise Gittins and Mayor Steve Rotheram at the Institute of Health Equity (IHE) Conference.

As regional leaders, we are often asked what devolution really means in practice. For us, it’s about more than shifting powers from Whitehall to communities, it’s about improving people’s lives. And there is no clearer measure of success than health.

The reality is that across Cheshire and Merseyside, people’s health and life chances still depend too much on where they live. In some communities, residents can expect to live up to 15 years less than those in more affluent areas. More than 111,000 children are growing up in poverty, two-thirds in working families. These inequalities are not inevitable, they are shaped by social and economic factors.

That is why, together, we recently met with Professor Sir Michael Marmot to explore how we can use the opportunities of devolution to hard-wire health equity into every aspect of local decision-making.

From treating illness to creating wellbeing

The Marmot approach challenges us to think differently about health, not simply as an NHS issue, but as something determined by the homes we live in, the jobs we do, the education we receive and the communities we belong to.

Through All Together Fairer, Cheshire and Merseyside has already embraced these principles. Since becoming a Marmot Community in 2019, the 9 local authorities, the NHS and the voluntary sector have worked side by side to understand what drives inequality and to align action across systems. We’ve made real progress, but we know we need to go further and faster.

As local leaders, we know that devolution offers the next big opportunity to do just that, giving local areas the levers and flexibilities to create the conditions for places and people to flourish. With the Liverpool City Region’s established powers and Cheshire and Warrington moving towards a Mayoral Combined Authority, we can harness devolution to make health equity one of the golden threads running through all our policies.

A shared ambition for fairer places

Our joint ambition is clear: to make Cheshire and Merseyside the fairest, healthiest and most inclusive place to live, work and do business. That means moving from words to action.

We are developing a whole-system programme that tackles the social determinants of health at every level. We want to see All Together Fairer Neighbourhoods that empower communities to take local action on the issues that matter most to them.

We are prioritising healthy homes and working to ensure no child goes without a warm bed. We are working to expand the Cradle to Career approach across all Liverpool City Region local authorities, giving every child the best possible start in life. And we’re committed to building an economy based on fair employment, mental wellbeing and inclusive growth.

Through Adult Skills Fund, Liverpool City Region supports tens of thousands of residents to gain qualifications and build successful careers. In partnership with local employers, we’re strengthening Fair Employment Charters, promoting the Real Living Wage, and supporting residents experiencing long-term unemployment into good quality work.

Improving access and affordability of public transport connects residents to jobs, education, public services and leisure – while simultaneously supporting the ambitions of improved physical activity, air quality and road safety – with opportunities to go further under bus franchising, creating an integrated transport network that keeps communities connected and our economies thriving. Building on the excellent initiative of our local authorities, we are identifying opportunities to scale public health interventions at regional level, including through healthier advertising standards.

The new Pride in Place programme, £2 million a year for ten years, offers a chance to support hyper-local communities to shape their own health and wellbeing. By bringing together residents, local MPs, the council, businesses and community organisations to decide local priorities, and by embedding Marmot principles into that process, we can help ensure resources are directed where they will have the greatest long-term impact.

Using devolved powers to improve lives

Devolution gives us the ability to join up decisions that were previously fragmented, linking housing to health, skills to opportunity, and transport to environmental justice. It also gives us the flexibility to respond to local needs rather than national templates.

We welcome that the government sees a more active role for mayors in health and in supporting the national ambition to halve the healthy life expectancy gap between our least and most deprived communities. As we move forward, we will shape how the new health improvement and health inequalities duty is implemented, ensuring it reflects the reality of our communities, supports the work already underway through All Together Fairer and fosters a whole-system approach.

In the Liverpool City Region, we are taking steps towards becoming a Marmot City Region, ensuring that tackling health inequalities is hardwired into everything we do. In Cheshire and Warrington, we are building the foundations of a new devolved system with health equity at its heart.

Health equity as a shared mission

We know this is a long-term commitment. Tackling health inequalities will take sustained focus, shared leadership and a willingness to work differently. But the evidence is clear: good health is not only a moral imperative, it’s an economic one. Healthier people are more able to work, learn and contribute; healthier places attract investment and talent.

Our vision is simple: a Cheshire and Merseyside where the place you are born no longer determines the life you live. A region where every community can thrive, and where devolution delivers fair and inclusive growth.

Sir Michael Marmot (centre) joins Mayor Steve Rotheram (5th from right), Cllr Louise Gittins (6th from right) and senior health leaders from across Liverpool City Region and Cheshire & Warrington at the Institute of Health Equity (IHE) Conference breakfast roundtable event.

Working together with our amazing partners, including the NHS Integrated Care Board, Directors of Public Health, and partners across the public, private, voluntary and academic sectors – alongside Sir Michael Marmot and the Institute of Health Equity – we believe we can make that vision a reality. Because ultimately, the success of devolution won’t be measured by the powers transferred, but by the number of lives improved.