Marmot Principles

Professor Sir Michael Marmot

 

Professor Sir Michael Marmot is a world leader on the causes of avoidable unfairness in health outcomes, [health inequities]. Over the last 50 years he has led numerous research studies for governments, United Nations' agencies and NGOs on the main drivers of health and longevity. His Institute of Health Equity [IHE] at University College, London is the world's leading global think tank on the subject.

Sir William Beveridge's report in 1942 [referred to below] identified the five 'giants' of social problems in Britain: idleness, ignorance, disease, squalor and want. It was this hugely important document that laid the foundation for the Welfare State in Britain, presenting a tantalising future vision for a nation struggling to escape the seemingly endless horrors and deprivations of WW2. Evidence subsequently showed that one of these giants, health and disease, was strongly influenced by the other four and this explains the thrust of many Marmot reports which reveal why unfair avoidable health gaps, i.e. health inequalities, exist and suggests ways to remove them.

The situation in 2019 shows little variation in 2025.

Britain's health record is not impressive. Until 2010, life expectancy in the U.K. increased at the rate of roughly one year in every four years. Sadly from around 2010 for a decade, the rate of increase slowed then almost stopped and one recent result of this was the relatively ineffectual UK response to Covid which allowed Covid-19 to exacerbate health inequalities. From 2009 to 2023 life expectancy in the UK did not improve at all and this in a wealthy society which enjoyed the implied promise, the unspoken assumption, that life in general, particularly in health, would continue to improve.

Furthermore, as one might expect, health is seen to be strongly linked to deprivation. In most regions of England excluding London, life expectancy has been falling among people living in the most deprived areas. Ease of access to healthcare cannot be a major cause as estimates suggest that variations in health care are responsible for no more than 20% of the total. The main reason for this link can only be attributed to the social determinants of health, Beveridge's other four 'giants'. In 2024 the Institute of Health Equity published a calculation that if everyone in England had the low mortality rates of the people living in the least deprived 10% of areas, there would have been one million fewer deaths over the decade after 2009.

Between poor people living in deprived areas, and the rich living in greater affluence, there is a social gradient which means that at every step up, people get healthier and live longer. In the decade after 2009 one million people lived shorter lives than they could, or should have, which suggests that a Government which cares, must work to flatten the social gradient. Before 2009, the social gradient had been flatter but austerity made it substantially steeper and Marmot's IHE [Institute of Health Equity] calculated that 148,000 more people died as a result. One way in which austerity harmed health is the regressive way in which central government funded local government with the most deprived areas receiving the greatest funding cuts. The IHE promotes the principle of 'proportionate universalism', with most help going to those in most need but it discovered, post 2010, that the opposite had been happening.

Eight Marmot Principles.

These were developed for the first Marmot Review in 2010 and are based on evidence about the main drivers of health inequities found locally, nationally and globally.

1. Give every child the best start in life.

2. Enable everyone to maximise their capabilities with control over their lives.

3. Create fair employment and good work for all.

4. Ensure a healthy standard of living for everyone.

5. Create and develop healthy and sustainable places and communities.

6. Strengthen the role and impact of ill-health prevention.

7. Tackle racism, discrimination and their outcomes.

8. Pursue environmental sustainability and health equity together.

Andy Burnham, Mayor of Manchester

The first time I read the list above, I was both aghast and impressed at the extent of action demanded by Marmot, of local councils, government bodies, commerce, education, municipal endeavours, voluntary bodies. The breadth and depth of guidance offered by the Marmot Principles and the firm imperatives therein are superb but much education in this area is needed. However, arising from Marmot's ground-breaking work there are now over 50 places developing Marmot Communities in the UK. Public Health Scotland is working with IHE to develop a national health strategy and collaborating with three Scottish Marmot places: Aberdeen, North Ayrshire and South Lanarkshire. In Gwent, Marmot initiatives are underway, while the government of Wales has declared it is working to become a Marmot Nation. Legal and General are funding the Marmot Health Equity Network, making available £3 million for community and voluntary sector projects to improve health equity around the country. In Greater Manchester, under the inspiring leadership of the Mayor, Andy Burnham, IHE worked with ten local authorities, the health sector, social  services and the Vice-Chancellor of the University. At every level local, regional, national, it is inspiring to see the leadership provided by elected politicians and officials in establishing the Marmot Principles.

Chalking Up Streams of Protection

River Bourne at Winterbourne

 In October 2024, the Chalk Streams (Protection) Bill was introduced into Parliament and a news item on it caught my eye, indicated my ignorance on the subject and triggered this late interest. But first, a definition: A chalk stream is a rare, clear freshwater river fed by springs from underground chalk aquifers, creating a unique habitat with stable temperatures, clean gravel beds and high mineral content, supporting a rich biodiversity, especially in England where most of the world's chalk streams are found. The rich biodiversity includes a wide range of aquatic plants, invertebrates and fish species within the river and above the waters, bats and birds feed on insect life. These waterways create a network of vital corridors for wildlife across the country but they are also, sadly, so vulnerable to human impact. 

Kingfisher, an habitue of  
prey-hunting from chalk rivers

How do chalk streams form and function?

1. Water Source: Rainwater soaks into porous chalk bedrock, forming underground aquifers.

2. Springs: Water emerges as springs where the water table meets the surface, feeding the streams.

3. Consistency: This groundwater source provides clear, cool, mineral-rich water with less seasonal variation than other rivers, often flowing year round though some parts can dry up in drought,

Beachy Head and Seven Sisters Chalk Cliffs, East Sussex

Key Characteristics:

1. Clear, Gravelly Beds.  2 Alkaline Water containing minerals like nitrates, phosphates and potassium. 3.  Rich Ecosystem supporting unique aquatic plants like water crowfoot, and invertebrates, and famous for fish like salmon and trout.

Significance and Threats

1. Rarity:  Considered a globally rare habitat, often likened to England's 'rainforests'.

2. Threats: Water abstraction for supply, agricultural runoff and climate change all reduce flows, damage                                                                                    habitats and threaten their delicate balance.                                                                                     .

River Wensum

My limited research online quickly allowed me to discover the magnitude and complexity of the literature on a multi-faceted subject. I had the sensation of being an ignorant pilgrim searching for enlightenment, which points to reasons why this little blog probably skims over the surface of deeper waters. My ignorance of the subject of chalk rivers is just one indication of a lack of wider recognition of the subject even on the part of people who live in East Anglia. Certainly, one hopes that whatever steps local and national politicians subsequently take to start to remedy this lack of informed awareness, and instigate active protection of the plight of chalk rivers, will have measurable levels of success. 

The brown trout, iconic denizen of chalk streams.

There are only 210 chalk rivers in the world,160 of which are in the UK, mainly in southern and eastern England with most of the lowland ones found in Norfolk where chalk rivers like the Tas, Wensum, the Bure, Tud, the Nar and the Glaven all need ongoing protection to continue flourishing. The Norfolk Wildlife Trust signed a letter to Parliament in late 2024, advocating for policy changes to protect chalk rivers and their members' ongoing publicity to increase public awareness of, and official protection for, chalk rivers undoubtedly made a significant contribution to getting the Chalk Streams (Protection) Bill on the books in late 2024.

River Ouzel
One of the 'irreplaceable habitats' of
Norfolk's chalk streams

The recommendations of the Norfolk Wildlife Trust include instigating buffer zones around chalk streams, forbidding development on these sites and introducing compulsory consideration of sewerage systems in local development plans. Their document further urged the designation of chalk rivers as irreplaceable habitats and irreplaceable habitats are defined as those, like ancient woodlands, which are difficult or impossible to recreate and urgently require special protection particularly where local developments are under consideration. At present, chalk rivers do not enjoy this particular protection and many have been over-deepened by dredging or straightened out for aesthetic or commercial reasons, sometimes cut off from their natural flood plains whilst the movement of species like eels has been obstructed by weirs or sluices.

 

Three Little Nuns Who All Unwary ...

I was charmed last week to hear of three elderly nuns in

The three runaway nuns.

Austria who had, with some assistance, run away from the retirement home where they had been placed after the convent where they had always lived, was deemed unsafe for them. The three are Sisters Bernadette, 88, Regina, 86 and Rita, almost 82, and their superior, Provost Markus Grasl, from nearby Reichersberg Abbey, clearly felt a duty of care in not allowing three frail octogenarians to live independently in a huge but crumbling convent, the imposing Schloss Goldenstein, near Elsebethan near Salzburg. He also had strong doubts about the fading powers of the three ladies and subsequently claimed the move had been worked out with the sisters in advance though the nuns dispute this.

Schloss Goldenstein, near Elsebethan, Salzburg.

A former pupil of theirs, Christina Wirtenberger, has organised their return and assists them still, with others, daily in their newly-reclaimed home. Wirtenberger, a retired advertising director, started boarding at the convent school when she was 10 in 1970, and has defended her current unrepentant actions. The nuns had been transferred to the care home in late 2023 with the promise that their stay would be short term but after two years in situ and no visible signs of their leaving, the nuns remained deeply unhappy and their evident unhappiness spurred Wirtenberger and other supporters, to action. With the help of a lawyer and sympathetic parishioners, and accompanied by a handful of journalists, all committed to secrecy, the nuns were secretly removed from the care home and smuggled back to their familiar cloisters. A locksmith, an electrician and a plumber were all mysteriously on hand during the removal, to reconnect all services in the convent.

Christina Wirtenberger

Sister Rita, Ritsch, the keen gardener.

'Berna', Sister Bernadette, reputedly the strictest.
 At the convent for seven decades as pupil and teacher.

Until their removal, Regina, known affectionately by her former pupils as ‘Regi’ had been at the convent since 1959 and served as headmistress. She had taught six subjects and supervised the convent accounts. Rita, known as ‘Ritsch’, had a bubbly personality and was a keen gardener; she returned to the convent in 1969 permanently, after sporadic spells earlier, in residence. Bernadette, ‘Berna’, had been there the longest, for more than seven decades, first as a pupil, later as a teacher who also did much of the cooking and necessary sewing repairs. Over the period when the trio joined the convent, established over 150 years ago, there had been around 30 resident nuns but over the years, recruitment languished and numbers dwindled finally leaving just our trio. They believed that the contract each had signed enshrined their right to remain in the convent for the rest of their lives.  Stabilitas Loci is the vow of permanence which a person entering holy orders is required to make, expressing a commitment to both the physical location and a lifelong spiritual dedication to the order and the community.

Nuns on the run.

Sister Regina, Regi, once taught Maths and
calligraphy and supervised the accounts.
She also served as headmistress.

The nuns left most of their personal possessions behind when they were first moved out [temporarily, they believed] and twenty months later, on their return, the convent appeared to have been ransacked. The stair lift, which permitted them to reach the fourth floor living quarters, was missing as were their recipe books, photo albums, teaching notes, orthopaedic shoes, birth and school certificates. Also gone were the treasured letters and photos from former students including the film actor, Romy Schneider who attended from1949-1953 when she was a classmate of Bernadette, and who claimed that her early dramatic promise had been nurtured by the convent's gifted drama teacher, Sister Augustine.

The bank accounts to which they had had community access and into which their wages were paid, and which guarded Bernadette’s inheritance from her mother, were no longer accessible to them. Provost Grasl has appointed a P.R. crisis manager to deal with the complex situation which has, in fact, turned into a P.R. disaster for the Catholic church in Austria. A church spokesman, Harald Schiffl, claimed that the church had spent ‘years’ negotiating with the three Sisters about their terms of departure, denying 

Elisabeth von Trapp.

that they had been tricked into signing the contract as the nuns claimed. Furthermore, the church insisted that the nuns had now broken their sacred vows of obedience while it was acting out of charity.

At prayer, in the convent chapel.

Additionally, by 2023, conditions at the cloister had become ‘too precarious’ for the nuns to remain there and, he added, that they, ‘the Three’, in any case, can have no private possessions according to their vows. Anything they have, belongs to the community, including the bank accounts. “The provost is, by decree, responsible for the entire cloister property, including all the finances.”

Meanwhile, the nuns remain defiant, confident in their power based on the international fan club they have built up via social media with followers given a daily stream of insights into the lives of the three escapees. Among their well-wishers is the American folk singer, Elisabeth von Trapp, granddaughter of Maria von Trapp, an erstwhile novice whose story inspired ‘The Sound of Music.” Elisabeth visited the three, inevitably bringing more publicity as well as roses and telling them to stay 

Physical frailty but emotional strength.

brave. More than 50,000 vocal admirers are now following the Sisters on Instagram and they have a network of about 200 helpers including those providing security and others who cook their meals, as well as voluntary doctors and nurses offering regular medical care. Despite the undoubted charm of this story, it is relevant to point out the totality of the experience of the three sisters. Sister Rita has bemoaned the removal of the flower beds that once lined the graveyard plots, in use since the 1880s and which the trio had habitually tended. "I suppose they wanted to be able, more easily to mow the grass", she said. "But it's as if they're trying to erase all trace of us." In expressing the nuns' unfiltered feelings of hurt after a lifetime of service and devotion to the church, this must be the saddest comment of all and one to which the Catholic Church in Austria must surely respond. 

 

 

 

Blue and White Delft Tiles

 

 

Two of my Delft tiles, one shows a leaping boar; the other
a river fisherman with a splendid hat.

I have eight blue and white Delft tiles, almost certainly Delft as I bought them in Brugge, one place among many in the globe where these tiles are admired, and the rarer ones, coveted. I absolutely love mine despite cracks and chips and in one case, a missing one third of the original tile [though the image remains intact!]  The wounded tile, as it were, was donated to me by a Dutchman which somehow seems to make it even more authentic! The rule of thumb for the size of Delft tiles, to which my tiles conform, is the consistent measurement of 5.1 inches square, and the side view of the tile also informs; the thicker the tile, the older it is.

My first tile bought for me one August day during
the annual Bruges Early Music Festival. My husband
could not understand why I preferred the one early tile
to the two later ones costing the same amount of £60.

 Had I remained living longer in Bruges, my collecting would have probably developed into more of an obsession. These tiles are incredibly aesthetically pleasing but they have the added intellectual advantage of the historical background and associations. Taken as a group, as an artistic sub-set, they recount almost a national narrative. Writing this as I look up Delft tiles for sale online, my passion for these charming and quite primitive painted people and scenes is being quickly reignited. One can easily find on EBay for example, or on specialist websites, old Delftware for sale. I had read that the average price for one old tile normally would be around £200 but annoyingly, when I checked this morning, the three most gorgeous seventeenth  century tiles for sale were all priced at £395. How maddening is that?                                                                                                        I do remember when I was living in                                                                                                    Bruges, perhaps a decade ago, seeing a Delft                                                                                                tile for sale at 390 euros and simply not                                                                                                        believing it!                        

Vermeer's The Milkmaid. 1657/8
Note the line of Delft tiles along the skirting

Part of one design, enlarged to decipher detail.
Are the two animals (right) rabbits or huge snails?

Cupid on a Dolphin 1560

The heyday when these tiles, now known as Dutch faience or Delftware, were made and decorated, was from 1660 -c1720 [though their production began around 1570 and did not taper off until c1900]. The peak occurred when Europe began to imitate expensive Chinese porcelain imports  renowned for their stunning whiteness. The correct formula and clay needed to perfect production of these imitation Chinese tiles, were not identified until 1708 in Meissen, so before that discovery, European craftsmen added tin to a white glaze to try to imitate the Chinese wares. The very pleasing result was known as ‘faience’ in France and ‘maiolica’ in Italy and the fashion gradually spread through Britain and the Netherlands where the production settled and grew in Delft. Eventually, that town’s famous blue and white tiles were exported across the world, far beyond Europe. In Britain, tin-glazed earthenware with its distinctive blue decoration, made in Britain both before and after, the original Delft heyday, was known as English delftware [always with the small ‘d’ capital letter] Its popularity in England can be measured by the extraordinary number of around 50 delftware makers active in London between the mid sixteenth and mid eighteenth centuries.

Delft tile-enhanced kitchen sink

A somewhat flamboyant example of both wall and floor
tiling in Delft!

In Holland, in old canal houses for instance, one can find expanses of Delftware on chimney breasts or in designs on kitchen walls, but early architects and designers did not limit themselves to the traditional. There are delightful lines of tiles used as skirting boards or framing the bottom of staircases suggesting that zealous Dutch housewives did not want to damage or dirty their white-washed walls and so used the familiar tiles to act as buffers between passing traffic and their spotless kitchen walls! 

Johannes Vermeer was born in Delft in 1632 and lived there most of his life with his family. In his painting, The Milkmaid, one can just see part of the line of Delft tiles used as described above, as protective skirting.

Coronelli 1706
View of Delft

Why Delft? Delft is a relatively small town now, but in the seventeenth century, at the height of the Dutch Golden Age, it was really important, sandwiched as it was between the port of Rotterdam and the coastal city of The Hague and as a base for William of Orange, the hero of Dutch resistance to Catholic Spain. The Netherlands was reaching its power zenith, dominating European trade, setting up an outpost in Japan, founding universities and fighting to establish itself as a Protestant state against the force of Catholic Spain.  

Map of Delft 1558
from Civitates Orbis Terrarum
Georg Braun & Joris Hoefnagel

Hanging Mum's Pictures and Other Favours!

One of the tapestries worked by my mother
in the 1970s. She suddenly left behind her life-long
skilled hobby of FairIsle knitting and took
up tapestry.

 A large measure of the walls in my modestly sized apartment is covered by/enhanced by/decorated with, pictures of various types. There are few photographs, two taken in Florence, I think, by John who lived in San Francisco and, of course, those long-ago photographs taken when my sisters and I were 21, 19 and 16, by a professional photographer. And yes, also that photograph of my mother celebrating her 70th! In addition, there are prints, originals, drawings, paintings, maybe the occasional lithograph, one or two maps and certainly portraits in different media. I do seem to be somewhat obsessed with portraits! One thing IS clear, to a stranger entering, that the owner of this small flat has gallery-size aspirations with insufficient wall space to accommodate them.

Photo of my sister Heather age 16.
 One of 3 studio pictures taken of us three sisters at
the request of a professional photographer neighbour
who was looking to create three portraits to enter a competition.
'Our' photos won him the first three places. We felt inordinately
proud of that achievement though we did nothing but pose!

An old map of Brugge which I acquired about ten
years ago in a little back street shop near a canal. The 
owner was selling off his deceased mother's possessions 
and this had been one of her favourites as it now is mine
See below.

The "need to own pictures" seems to stem from several psychological, social, and practical human needs; for me, it is primarily, I think, for the deep aesthetic delight I obtain from simply looking at them, beautiful and pleasure-giving to me, the viewer and owner. This pleasure is prompted by both individual works of art as well as the combined pattern, the mosaic, of the whole collection presented. However, often, perhaps one painting helps me to recall memories of the place, person, occasion, when it was made or bought. And thus, pictures-on-the-wall do assist in the recall and preservation of both precious and mundane occasions through pictures-in-the-mind. And it almost goes without saying, that memories grow evermore precious and important to us as we age. Interestingly, I have noticed that some visitors hardly see or notice my pictures while others stop to admire the whole show and/or the individual image. Meanwhile family members who call, are often enticed to look at a picture before commenting on its beauty, the artistic skill involved in its creation or in remembering the person or the place or the event involved. And then we chat about that and thus, our social bonds are, by chance, strengthened through our memories-in -common!

This always melts the heart! Bought in a Beijing gallery
and drawn by a newly-retired surgeon who had
wanted to draw and paint for years! This was her
first sale.

My son was over briefly this week and he hung one or two newly-acquired pictures which had been hanging around, waiting to be hung! We rearranged several more following earnest discussions! He commented more than once that a certain print or picture was 'typical of my taste'and explained that he almost knew which pictures I would choose. It must be said, that these were chiefly portraits and perhaps not difficult to predict! But it reminded me that the identity of a picture owner/collector/admirer is inherently expressed through her choice of how to embellish her living area walls. And so, after a brief assessment, I seem to have discovered that collecting pictures fulfils three categories: preserving memories; expressing identity and strengthening social bonds. Who knew?

Dancing in the Surf by Sherree Valentine-Daines
My latest addition in a medley of blues, whites and greys.
Captures the sheer carefree joys of childhood.
Limited edition of 195.

A recent purchase, chosen as much for the
clever title as the very pleasing dots.
Title refers to the expensive Banksy sold at 
Sotheby's in Oct 2020 for over £7.5 million.