The Marmot Review of 2010 provided clinicians with a robust evidence base on the social determinants of health. Its central insight – that health inequalities follow a gradient and that action must be universal but with greater intensity for those with greater disadvantage (proportionate universalism) – remains highly relevant to everyday consultations.
The 2020 update confirmed that progress had stalled or reversed in several areas, with life expectancy declining for women in the poorest 10% of communities and healthy life expectancy falling, meaning more years lived with illness or disability.
For clinicians, these findings translate into practical considerations. A woman presenting with symptoms in midlife may have a history of pregnancy complications that raise her later cardiovascular risk; she may be managing caring responsibilities that affect her ability to attend appointments or adhere to treatment; or she may be experiencing perimenopausal changes that influence mood, sleep, cognition and metabolic health. Treating each presentation in isolation risks missing the cumulative picture Marmot’s life-course perspective highlights.
Research and clinical observation show that women’s symptoms are sometimes attributed to psychological causes more readily than men’s, or that standard reference ranges and trial data derived predominantly from male populations may not fully capture female physiology. When social disadvantage is also present – lower income, unstable housing, language barriers or caring load – the likelihood of delayed diagnosis or fragmented care increases. The result can be presentations that become more complex over time, with repeated contacts across different services before a coherent understanding emerges.
Marmot’s emphasis on control and empowerment has direct clinical resonance. Patients who feel their concerns are taken seriously and who understand the reasoning behind recommendations are more likely to engage with care. Conversely, repeated experiences of not being heard contribute to disengagement and, in some cases, to the circumstances that later feature in safety investigations or clinical negligence claims. The pattern of information existing but not being acted upon in context is one that appears across multiple inquiries into women’s healthcare.
Proportionate universalism in practice means offering high-quality care to all while recognising that some patients require additional support to achieve equivalent outcomes. This may involve longer appointment times for those with complex social circumstances, proactive outreach, or better coordination between primary care, community services and specialist teams. It also means curiosity about the patient’s wider life – work, family responsibilities, housing, recent life events – rather than focusing solely on the presenting complaint or disease category.
The expansion of women’s health hubs offers one mechanism for more integrated care, particularly for menstrual, reproductive and menopausal health. Clinicians working in or alongside these hubs can model the joined-up approach Marmot advocated. However, hubs alone cannot compensate for upstream failures in employment quality, income security or early-years support that Marmot identified as foundational.
Clinical training and continuing professional development increasingly include social determinants and health equity. Embedding these alongside biological and sex-specific knowledge strengthens both diagnostic reasoning and the therapeutic relationship. It also reduces the risk of defensive practice by fostering genuine understanding rather than reliance on process alone.
For further discussion of how these issues manifest in specific areas such as cardiovascular risk assessment in women or medicines safety, see our clinical resources on sex differences in evidence and prescribing. For analysis of recurring patterns in safety investigations involving women, explore our pages on patient safety inquiries.
References
Fair Society, Healthy Lives: The Marmot Review. Strategic Review of Health Inequalities in England post-2010 (2010). Health Equity in England: The Marmot Review 10 Years On. Institute of Health Equity (2020). Renewed Women’s Health Strategy for England. Department of Health and Social Care (2026). Relevant NICE guidelines and Royal College curricula updates on women’s health and health inequalities (as referenced in strategy documents). Institute of Health Equity briefings on proportionate universalism and clinical practice.
Disclaimer
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© 2026 Women’s Health Inquiry Project (WHIP). This article includes original analysis of material from publicly available national sources. It may not be reproduced without permission.