The Marmot Review, published in 2010 as Fair Society, Healthy Lives, set out a clear message: the conditions in which people are born, grow, live, work and age shape health far more powerfully than many clinical interventions alone. It described a social gradient – the lower a person’s position in society, the worse their health tends to be – and called for action across six areas: giving every child the best start, enabling people to maximise their capabilities, creating fair employment, ensuring a healthy standard of living, building healthy and sustainable places, and strengthening prevention.
More than fifteen years later, the picture for many women is sobering.
The 2020 assessment, Health Equity in England: The Marmot Review 10 Years On, found that improvements in life expectancy had stalled across England for the first time in more than a century.
For women living in the most deprived 10% of areas, life expectancy actually fell in the years examined. People are spending more of their lives in poor health, and the gap between the most and least advantaged has widened.
Place matters too: living in a similarly deprived neighbourhood in the North East carries a greater health penalty than in London.
For women, these patterns intersect with the realities of daily life. Many women carry multiple responsibilities – paid work, unpaid caring, managing households – often on lower average incomes and with interrupted careers around childbearing. When resources are stretched, choices about food, heating, transport and time for self-care become constrained. The Review emphasised that these are not simply individual failings but consequences of how society is organised.
Women also describe a healthcare system that often feels fragmented. A concern about heavy periods or pelvic pain may lead to gynaecology; anxiety or low mood around the same time may be directed to mental health services; later, symptoms around menopause or cardiovascular risk may be handled in yet another clinic.
The woman herself frequently becomes the person trying to connect these threads, carrying her story between professionals who each see only part of the picture.
When symptoms are dismissed or the timing of life events is not considered, the result can be delayed understanding and, in some cases, avoidable harm.
There has been some positive movement. Local areas have adopted “Marmot Places” approaches, focusing on early years, employment quality and community conditions.
The Women’s Health Strategy and its 2026 renewal have invested in women’s health hubs and faster pathways for common conditions such as heavy menstrual bleeding and menopause care. These steps recognise that women have historically felt unheard and that community-based, joined-up support can make a difference. Yet national progress on the broader social conditions Marmot highlighted remains limited, and waiting lists for gynaecology and other services continue to affect thousands of women.
What does this mean in practice? It means that many women experience healthcare as episodic and reactive rather than continuous and preventative. It means that biological transitions – menstruation, pregnancy and its aftermath, perimenopause and menopause – which influence cardiovascular risk, bone health, mental wellbeing and medication response, are still too often managed in silos. And it means that the social gradient Marmot documented continues to shape who has the resources and the voice to navigate a complex system.
Women are not passive in this story
Many advocate for themselves and others, share experiences, and push for change. The evidence suggests, however, that individual effort alone cannot close gaps created by policy and system design.
Real improvement requires action on the conditions of daily life alongside responsive clinical care that sees the whole woman across her life course.
Internal Links
For more on how these patterns appear in maternity services and the experiences of being heard or unheard, see our related analysis on maternity care and patient voice.
For discussion of menopause in the workplace and later-life health, explore our pages on the female life course.
References
- Fair Society, Healthy Lives: The Marmot Review. Strategic Review of Health Inequalities in England (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).
- Office for National Statistics data on life expectancy and disability-free life expectancy, as analysed in the Marmot reports.
- Institute of Health Equity resources on Marmot Places and local implementation.
Mandatory Disclaimer
This article is for general information and discussion only. It is not medical or legal advice, nor a substitute for professional advice. To contribute evidence, ideas, or corrections, please email womenshealthproject@outlook.com. Please do not share personal data when emailing. Individual cases cannot be reviewed. This project does not offer any form of legal service and cannot assist with complaints, claims or individual advocacy. This platform is independent and not affiliated with any law firm, regulator, inquiry or clinical body.
© 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.