Taking action on social determinants of health

1. Taking action on social determinants of health Michael Marmot Wellington July 2011

2. Inequalities between countries Glasgow men(Lenzie) 82* Glasgow men (Calton) 54 National data WHO 2009, Glasgow data: Hanlon et al. 2006

3. Trends in life expectancy at birth: Zambia, Viet Nam, Costa Rica, Sri Lanka (1950 – 2005, both sexes) UN data

4. Social justice • Material, psychosocial, political empowerment • Creating the conditions for people to have control of their lives www.who.int/social_determinants

5. Translating the CSDH recommendations into different country/regional contexts

9. 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.”

10. Review of the Social Determinants of Health and the Health Divide in the WHO European Region The CSDH – closing the gap in a generation The Marmot Review – Fair Society Healthy Lives

11. A Fair Society

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

13. Social determinants of health across the lifecourse

14. Fair Society: Healthy Lives: 6 Policy Objectives • Give every child the best start in life • Enable all children, young people and adults to maximise their capabilities and have control over their lives • Create fair employment and good work for all • Ensure healthy standard of living for all • Create and develop healthy and sustainable places and communities • Strengthen the role and impact of ill health prevention

15. Marmot Review: 6 Policy Objectives • Give every child the best start in life • Enable all children, young people and adults to maximise their capabilities and have control over their lives • Create fair employment and good work for all • Ensure healthy standard of living for all • Create and develop healthy and sustainable places and communities • Strengthen the role and impact of ill health prevention

16. Inequality in early cognitive development of children in the 1970 British Cohort Study, ages 22 months to 10 years Feinstein 2003

17. Links between socioeconomic status and factors affecting child development, 2003-4 Source: Department for Children, Schools and Families

18. Socio-emotional difficulties at age 3 and 5:Millennium Cohort Study Age 3 Age 5 Fully adjusted = for parenting activities and psychosocial markers Kelly et al, 2010

19. 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

20. 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

21. Marmot Review: 6 Policy Objectives • Give every child the best start in life • Enable all children, young people and adults to maximise their capabilities and have control over their lives • Create fair employment and good work for all • Ensure healthy standard of living for all • Create and develop healthy and sustainable places and communities • Strengthen the role and impact of ill health prevention

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

23. Marmot Review: 6 Policy Objectives • Give every child the best start in life • Enable all children, young people and adults to maximise their capabilities and have control over their lives • Create fair employment and good work for all • Ensure healthy standard of living for all • Create and develop healthy and sustainable places and communities • Strengthen the role and impact of ill health prevention

24. Seasonally adjusted trends in unemployment for young people in the UK, 1993-2011 37.7% 16-17 18.3% 18-24 8% 16 and over Source: Office for National Statistics, Labour Force Survey

25. Population attributable Risk (PAR) for all combined* 46%95% CI 37%-53% adjusted for other predictors 34%95% CI 24%-43% ERI= Effort reward imbalance *calculated from odds ratios adjusted for age, sex, employment grade J Head et al,2007

26. Fair Society: Healthy Lives: 6 Policy Objectives • Give every child the best start in life • Enable all children, young people and adults to maximise their capabilities and have control over their lives • Create fair employment and good work for all • Ensure healthy standard of living for all • Create and develop healthy and sustainable places and communities • Strengthen the role and impact of ill health prevention

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

28. Poor Prospects for living standards • 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 by Mervyn King, Governor of the Bank of England At the Civic Centre, Newcastle 25 January 2011