Agenda item

Cllr Kate Gregory, Cabinet Member for Public Health & Inequalities, Ansaf Azhar, Director of Public health, and Kate Holburn, Deputy Director of Public Health, have been invited to present a report on Inequalities in a Marmot County.

The Committee is asked to consider the report and raise any questions, and to AGREE any recommendations it wishes to make to Cabinet arising therefrom.

Cllr Tim Bearder, Cabinet Member for Adults, Ansaf Azhar, Director of Public health, and Kate Holburn, Deputy Director of Public Health, attended to present a report on Inequalities in a Marmot County. They were joined by Karen Fuller, Director of Adult Social Services, and Victoria Baran, Deputy Director of Adult Social Care, to support.

The Director of Public Health introduced the Marmot report, highlighting Michael Marmot’s expertise in health inequalities and his eight principles on the wider determinants of health. He explained that the Marmot approach involves system-wide partnerships and collaboration with local areas over two years, offering evidence-based recommendations. Oxfordshire became a Marmot Place in November 2024, focusing on three principles: best start in life, workplace and health, and housing, aiming to tackle the root causes of ill health and reduce demand on services.

Members raised the following questions and comments:

·       How the rural areas in Appendix 2 of the Marmot report had been chosen. In response, The Director of Public Health explained that the process involved systematically identifying areas that had not already been included in the ten areas of deprivation, using factors such as urban density, existing knowledge, and ongoing conversations with local people. The Director of Public Health acknowledged that some rural inequalities were not easily captured by available data, so the approach combined quantitative analysis with qualitative insights from community engagement. This process was described as iterative, with the selection of areas being continually refined as more granular data and local feedback became available.

·       Members asked about the likely effects of Oxfordshire’s Marmot County status on rural communities. The Director of Public Health said there was no national model for addressing rural inequalities, but Oxfordshire’s approach involved gathering local data and consulting parish Councils, voluntary groups, and community organisations to identify specific needs. Although no formal recommendations have been set, the initiative aimed to shape healthcare planning, including that of the Integrated Care Board (ICB), with rural access as a priority. Service delivery will stay with healthcare providers, who will be expected to apply Marmot principles. The Director highlighted that future healthcare would be more data-driven, community-focused, and preventative, with rural needs considered.

·       Members queried how the recurring cycle of deprivation in certain areas could be addressed, and whether the Council held powers to ensure delivery of wellbeing projects like health facilities or allotments. The Director of Public Health acknowledged the Council's limited direct powers but highlighted collaborative work with partners such as District Councils and the voluntary sector. This included mapping community assets, collecting local insights, and tailoring responses to each area’s needs. Community profiles have helped identify common and specific issues. Partnership forums, notably the Health Inequalities Forum, enable resource pooling and the delivery of targeted programmes, like the "well together" initiative, focused on issues such as loneliness and mental health. This approach was being expanded beyond the initial priority areas.

·       Members asked about the challenges of embedding best practice across cabinet portfolios, Council departments, and communities, particularly where health and climate priorities intersect. The Director of Public Health highlighted that cross-organisational collaboration was central to the Marmot approach, with Oxfordshire making strides in breaking down professional boundaries through joint commissioning, pooled budgets, partnership forums, and initiatives like the whole system approach to physical activity. He noted climate interventions often yield immediate health benefits, especially for deprived and rural areas. While partnership working was strong, more progress was needed, and the Marmot framework serves as the "glue" to ensure health and inequality considerations were embedded in all decisions.

The Committee adjourned at 12:20 reconvened at 12:26