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Inequalities in Health The challenge

Inequalities in Health The challenge. Michael Marmot World Congress of Public Health Rio de Janeiro 23 August 2006. What good does it do to treat people's illnesses . then send them back to the conditions that made them sick?. Yesterday’s lecture 1. INEQUALITIES BETWEEN COUNTRIES.

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Inequalities in Health The challenge

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  1. Inequalities in HealthThe challenge Michael Marmot World Congress of Public Health Rio de Janeiro 23 August 2006

  2. What good does it do to treat people's illnesses ... then send them back to the conditions that made them sick?

  3. Yesterday’s lecture 1 INEQUALITIES BETWEEN COUNTRIES

  4. Yesterday’s lecture 2 INEQUALITIES WITHIN COUNTRIES

  5. Yesterday’s lecture 3 GROWING INEQUALITIES

  6. 2) BEYOND MATERIAL CIRCUMSTANCES AND HEALTHCARE HEALTH MATERIAL CIRCUMSTANCES HEALTH EMPOWERMENT

  7. THE SOCIAL GRADIENT STRESS EARLY LIFE SOCIAL EXCLUSION WORK UNEMPLOYMENT SOCIAL SUPPORT ADDICTION FOOD TRANSPORT THE SOLID FACTS: 10 MESSAGES

  8. Social Gradient • People’s social and economic circumstances affect health throughout life, so health policy must be linked to the social and economic determinants of health.

  9. MORTALITY AND EDUCATION IN MEN* AGED 45-90 IN MATLAB, BANGLADESH, 1982-1998 Rate ratio Education *married at entry (Hurt, Ronsmans & Saha JECH 2004, 58, 315-320)

  10. CHILE: Social programmes for health • Chile Solidario • Child development and well-being • Family-focussed primary health care

  11. Stress • Stress harms health

  12. Early Life • The effects of early development last a life-time: a good start in life means supporting mothers and young children.

  13. YOUTH LITERACY SCORES (16-25 YEARS) AND PARENTS’ EDUCATION Literacy Scores Sweden Canada US Parents’ Education (years) Willms 1999

  14. IMPACT OF PROGRESA IN MEXIC0 ON GROWTH AND ANAEMIA Increase in height (cm) from baseline in 1998 to 2000 Prevalence of Anaemia in 1999 and 2000 Intervention (starting 1998) % 1.1 cm Crossover Intervention (starting 1999) 1999 2000 Age under 6 months in 1998 Poorest families (Source: Rivera et al.,JAMA, 2004)

  15. Social Exclusion • Social exclusion creates misery and costs lives.

  16. Probability of Survival From Age 15-65 Years Among US Blacks & Whites % probability of survival US White Poor White US Black Poor Black Males Males Males Males Geronimus et al, NEJM 1996

  17. SOCIAL COHESION AND TRUST • People here willing to help neighbours • This is a close-knit neighbourhood • People in this neighbourhood can be trusted • People here don’t get along • People don’t share the same values Sampson, Science 1997

  18. Work • Stress in the workplace increases the risk of disease.

  19. Transport • Healthy transport means reducing driving and encouraging more walking and cycling, backed up by better public transport.

  20. More than a million people worldwide are killed in road crashes every year • Low and middle-income countries account for 86% of the world’s road deaths but have only 40% of the world’s motor vehicles.

  21. Addiction • Individuals turn to alcohol, drugs and tobacco and suffer from their use. Use is influenced by the wider social setting.

  22. THE CAUSES OF THE CAUSES

  23. COMPARISON OF SMOKING PREVALENCE BETWEEN HIGH AND LOW SOCIOECONOMIC GROUPS SMOKING RATE RATIO BETWEEN LOW AND HIGH SOCIOECONOMIC GROUPS Bobak et al in ‘Tobacco control in developing countries’ ed: Jha & Chaloupka, 2000

  24. Food • Healthy food is a political issue.

  25. OBESITY PATTERNS ACROSS THE DEVELOPING WORLD % (Popkin, Development Policy Review, 2003)

  26. Commission on Social Determinants of Health Michael Marmot Chair

  27. CSDH: Knowledge for action “ The goal is not an academic exercise, but to marshal scientific evidence as a lever for policy change — aiming toward practical uptake among policymakers and stakeholders in countries”. WHO Director-General LEE Jong-Wook, address to the World Health Assembly, May 2004

  28. CSDH • Commissioners • Knowledge Networks • Country Work • Civil Society Work • Global Initiative • WHO Reference Group

  29. Knowledge network priority themes Women/ gender Measurement / Evidence Priority Public Health Conditions Health Systems Early Child Development Health Equity Globalization Urban Settings Employment Conditions Social Exclusion

  30. Expressions of interest and/or discussing potential Partnership Formal Partnership Established India Brazil Mozambique Canada Sri-Lanka Chile Senegal England China Iran Vietnam Kenya Pakistan Peru Kyrgyzstan Sweden Countries

  31. Brazilian Commission on Social Determinants of Health set up in March 2006

  32. ‘THE SUCCESS OF AN ECONOMY AND OF A SOCIETY CANNOT BE SEPARATED FROM THE LIVES THAT THE MEMBERS OF THE SOCIETY ARE ABLE TO LEAD…WE NOT ONLY VALUE LIVING WELL AND SATISFACTORILY, BUT ALSO APPRECIATE HAVING CONTROL OVER OUR OWN LIVES’Amartya Sen, Development as Freedom (1999)

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