Introduction; Coventry as a Marmot city
For us in Coventry, the Marmot Partnership and being a Marmot city is at the centre of all we do, across all the city partners and programmes with the sole aim of reducing unjust inequalities that exist within our communities. Our Marmot journey is landmarked by some achievements, outcomes and outputs in the phases below.
Phase One: 2013 - 2016
Coventry coined the phrase ‘Marmot city’. As the first, we have helped to develop the Marmot city ‘framework’ now used with other Marmot places across the UK.
With the support of Professor Sir Michael Marmot and the Institute of Health Equity (IHE) at University College London, we established a ‘Marmot Steering group’ between the Council, NHS, Police, Fire, and VCSE partners to develop a framework to embed the Marmot Principles in what we do in Coventry. It was originally a three-year project.
When considering impact and outcomes of our Marmot work, it is important to note:
- There were no additional resources, or finances.
- The programme was not set up as a control trial. This was the first of its kind and an exploratory venture.
- Being a Marmot city is not a clearly defined intervention, but an approach to developing and delivering change across services, civic functions of the council and via community-led action.
Phase Two: 2016 - 2019
There was appetite and agreement with the Institute of Health Equity (IHE) at University College London and partners to continue working on this endeavour for another 3 years.
Phase two built on that three-year period of discussions, where we developed that initial thinking from a ‘skeleton’ framework to ‘fleshing out’ with action. Priorities areas were identified, and partners began to consider where and how do we now drive this forward.
2019: It was agreed at our summit held in 2019 where Professor Sir Michael Marmot and colleagues from the Institute of Health Equity joined us, that the Marmot Steering group would lead and drive this work forward for the city.
During 2019, a trainee Public Health registrar conducted an evaluation of our two phases of Marmot work to report on the changes made, lessons learned, and impact made.
2020: Marmot Evaluation
Our Marmot Evaluation found there were positive signs for Coventry since becoming a Marmot city. The indices of deprivation (IMD) data between 2015 - 2019 highlighted our change in ranking; an improvement of 22 places, compared to other areas.
2020 - 2022: COVID-19 pandemic and the cost of living crisis
The COVID-19 pandemic significantly impacted the work of the Marmot Partnership.
- Some partners moved roles, retired, some services closed; resulting in a loss/ changeover of people involved in the Marmot work.
- Services and organisations were having to be reactive to the COVID-19 pandemic, rather than thinking proactively and about prevention.
- Focus on responding to the cost of living crisis.
- Inequalities widened.
- The health of the nation got worse, life expectancy had stalled and had began to decline.
2023: Marmot Monitoring Tool
A discussion with Marmot Partners highlighted:
- We needed a way of seeing where we, as a system wide partnership, were making progress in reducing inequalities and narrowing the gap.
- Where health inequalities were getting worse, and the gap was widening.
- A way of capturing impact for residents of Coventry, and the difference of our Marmot work.
Two workshops were facilitated by public health with Marmot Partners to produce a new framework for our work, that would include indicators and measures we felt were important and would help to capture the impact of the Marmot work for Coventry residents.
The Marmot Monitoring Tool was developed and launched in July 2023.
Workshops and inequalities training sessions were held to support new members of the Marmot Partnership and re instate Marmot Principles in work.
2024: Ten years as a Marmot city: Coventry’s reflections
An Institute of Health Equity colleague who had attended a Marmot Partnership meeting in early 2024, noted that things felt different in Coventry compared with other, newer Marmot places; more mature and evolved. This prompted the further discussion of how we capture the ‘essence of what we do’ in Coventry; what was special, and different, what had we learned from the ten years of us being the longest Marmot city.
A series of workshops were held in May 2024 where Marmot Partners were all invited to share their reflections on what they felt had been successes, challenges, the journey we had been on and what we had learned along the way, how did we feel going forward, and what our next steps should be.
Ten years as a Marmot city: Coventry’s reflections was produced. Part one telling the story of these reflections and Part two showcasing the work and Marmot approach of our partners across the city working with people who experience the most inequalities.
It highlighted that the Marmot approach is a philosophy, a way of thinking and collaborating so that processes and services are best designed to reduce inequalities, and impacts are made from culture shift, working in partnership, embedding the Marmot approach in existing processes.