Taking action on social determinants of health

Michael Marmot

Wellington

July 2011

Inequalities between countries

Glasgow men (Calton) 54

Glasgow men(Lenzie) 82*

National data WHO 2009, Glasgow data: Hanlon et al. 2006

Trends in life expectancy at birth: Zambia, Viet Nam, Costa Rica, Sri Lanka

(1950 – 2005, both sexes)

UN data

• Social justice• Material, psychosocial,

political empowerment • Creating the conditions for

people to have control of their lives

www.who.int/social_determinants

• Translating the CSDH recommendations into different country/regional contexts

•

United Nations, ECOSOC meeting July 2009• “…Yet, inequities in health outcomes persist

within and among countries. Most of the difference is attributable to the conditions in which people are born, grow, live, work and age.”

The CSDH – closing the gap in a generation

The Marmot Review – Fair Society Healthy Lives

Review of the Social

Determinants of Health and

the Health Divide in the

WHO European

Region

•A Fair Society

Life expectancy and disability-free life expectancy at birth by neighbourhood income deprivation, 1999-2003

Social determinants of health across the lifecourse

A. Give every child the best start in life

B. Enable all children, young people and adults to maximise their capabilities and have control over their lives

C. Create fair employment and good work for all

D. Ensure healthy standard of living for all

E. Create and develop healthy and sustainable places and communities

F. Strengthen the role and impact of ill health prevention

Fair Society: Healthy Lives: 6 Policy Objectives

A. Give every child the best start in life

B. Enable all children, young people and adults to maximise their capabilities and have control over their lives

C. Create fair employment and good work for all

D. Ensure healthy standard of living for all

E. Create and develop healthy and sustainable places and communities

F. Strengthen the role and impact of ill health prevention

Marmot Review: 6 Policy Objectives

Inequality in early cognitive development of children in the 1970 British Cohort Study, ages 22 months to 10 years

Feinstein 2003

Links between socioeconomic status and factors affecting child development, 2003-4

Source: Department for Children, Schools and Families

Socio-emotional difficulties at age 3 and 5:Millennium Cohort Study

Age 3 Age 5

Kelly et al, 2010Fully adjusted = for parenting activities and psychosocial markers

Per cent achieving ‘a good level of development’* by deprivation decile: England

*in personal, social and emotional development and communication, language and literacy at age 5 Source: Department for Education

Per cent 5 year olds achieving ‘good development score’,* Birmingham LA, West Midlands & England

*in personal, social and emotional development and communication, language and literacy

Source: Department for Education

%

A. Give every child the best start in life

B. Enable all children, young people and adults to maximise their capabilities and have control over their lives

C. Create fair employment and good work for all

D. Ensure healthy standard of living for all

E. Create and develop healthy and sustainable places and communities

F. Strengthen the role and impact of ill health prevention

Marmot Review: 6 Policy Objectives

Percentage of pupils achieving 5+ A*–C grades inc English and Maths at GCSE by income deprivation of area of residence, England, 2008/9

A. Give every child the best start in life

B. Enable all children, young people and adults to maximise their capabilities and have control over their lives

C. Create fair employment and good work for all

D. Ensure healthy standard of living for all

E. Create and develop healthy and sustainable places and communities

F. Strengthen the role and impact of ill health prevention

Marmot Review: 6 Policy Objectives

Seasonally adjusted trends in unemployment for young people in the UK, 1993-2011

16-17

18-24

16 and over8%

18.3%

37.7%

Source: Office for National Statistics, Labour Force Survey

Population attributable Risk(PAR) for all combined*

46% 95% CI 37%-53%

adjusted for other predictors

34% 95% CI 24%-43%

*calculated from odds ratios adjusted for age, sex, employment grade J Head et al,2007

ERI= Effort reward imbalance

A. Give every child the best start in life

B. Enable all children, young people and adults to maximise their capabilities and have control over their lives

C. Create fair employment and good work for all

D. Ensure healthy standard of living for all

E. Create and develop healthy and sustainable places and communities

F. Strengthen the role and impact of ill health prevention

Fair Society: Healthy Lives: 6 Policy Objectives

Minimum Income Standard by family type as a percentage of median income, April 2008

• 12% addition to price level over next 4 years– Rise in import prices (commodities including foodstuffs,

base metals and cotton)– Rise in energy prices– Rise VAT

“in 2011 real wages are likely to be no higher than they were in 2005. One has to go back to the 1920s to find a time when real wages fell over a period of six years”

Source: Speech given byMervyn King, Governor of the Bank of EnglandAt the Civic Centre, Newcastle25 January 2011

Poor Prospects for living standards