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Mike Grady University College London

Mike Grady University College London. Our four tasks. Identify evidence to underpin future policy and action; Show how evidence can be translated into practice; Advise on possible objectives and measures, build on experience of the current PSA target on infant mortality and life expectancy;

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Mike Grady University College London

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  1. Mike Grady University College London

  2. Our four tasks • Identify evidence to underpin future policy and action; • Show how evidence can be translated into practice; • Advise on possible objectives and measures, build on experience of the current PSA target on infant mortality and life expectancy; • Publish a report to contribute to development post-2010 health inequalities strategy. (Feb 2010)

  3. Male life expectancy at birth by social class.

  4. Female life expectancy at birth: inequality gap England 1993 -2008 and 2010 target. Progress since baseline: A rise of 14% in the gap Age in years Target: 10% minimum reduction in relative gap, from 1.77% in 1995-97 to 1.59% in 2009-11 83 82.0 1.59% 1.59% 82 2.02% 2.02% 81 England 80.4 79.7 80 1.77% 1.77% 79 78.3 78 Spearhead Group 77 0 1993-95 1995-97 1997-99 1999-01 2001-03 2003-05 2005-07 2007-09 2009-11 baseline Progress target

  5. Reduce health inequalities and improve health and wellbeing for all Policy Goals Create an enabling society that maximises individual and community potential. Ensure social justice, health and sustainability are at heart of policies. Policy objectives Give every child the best start in life. Create fair employment & decent work for all. Create and develop healthy and environmentally sustainable places & communities. Strengthen the role and impact of ill-health prevention. Enable all children, young people & adults to maximise their capabilities & control their lives. Ensure healthy standard of living for all. Policy mechanisms Equality & health equity in all policies. Effective evidence-based delivery systems.

  6. Areas of action Sustainable communities and places Healthy Standard of Living Early Years Skills Development Employment and Work Prevention Life course Accumulation of positive and negative effects on health and wellbeing Prenatal Pre-school School Training Employment Retirement Family building Life course stages

  7. Inequality in Early Cognitive Development of British Children in the 1970 Cohort, 22 months to 10 years High SES Low SES High Q at 22m Low Q at 22m Source: Feinstein, L. (2003) ‘Inequality in the Early Cognitive Development of British Children in the 1970 Cohort’, Economica (70) 277, 73-97

  8. 1) Give every child the best start in life Priority objectives 1. Reduce inequalities in the early development of physical and emotional health, and cognitive, linguistic, and social skills. 2. Ensure high quality maternity services, parenting programmes, childcare and early years education to meet need across the social gradient. 3. Build the resilience and well-being of young children across the social gradient.

  9. Per cent achieving 5+ A* - C grades inc Maths and English at GCSE by IDACI decile of pupil residence: England 2007 % achieving 5+ A*-C GCSEs inc Maths and English Most deprived Income Deprivation Affecting Children Index (IDACI) Least deprived Source: DCFS 2009

  10. Low educational qualifications, low job prospects, low pay

  11. 2) Enable all children, young people and adults to maximise their capabilities and control their lives Priority objectives 1. Reduce the social gradient in skills and qualifications. 2. Ensure that schools, families and communities work in partnership to reduce the gradient in health, well-being and resilience of children and young people. 3. Improve the access and use of quality lifelong learning across the social gradient.

  12. Mortality* of men aged 16-64 by social class and employment status at the 1981 census Employed in 1981 Unemployed in 1981 Standardised Mortality Rate I II IIIN IIIM IV V I II IIIN IIIM IV V Social Class 1981 LS Cohort. *England & Wales: mortality 1981-92

  13. Priority objectives 1) Improve access to good jobs and reduce long-term unemployment across the social gradient. 2) Make it easier for people who are disadvantaged in the labour market to obtain and keep work. 3) Improve quality of jobs across the social gradient. 3) Create fair employment and decentwork for all

  14. Minimum income for healthy living – Morris et al Diet Physical activity/body and mind Psychosocial relations/social connections/active minds Telephone Social contact and network, gifts for Grandchildren, holiday, TV set and licence. Travel Medical care Hygiene Housing

  15. Priority objectives1. Establish a minimum income for healthy living for people of all ages. 2. Reduce the social gradient in the standard of living through progressive taxation and other fiscal policies. 3. Reduce the cliff edges faced by people moving between benefits and work. 4) Ensure healthy standard of living for all

  16. Living environment by neighbourhood income Index: poor quality housing, air quality and road traffic accidents

  17. Percentage of population visiting green space infrequently

  18. 5) Create and develop healthy and environmentally sustainable places and communities Priority objectives 1. Develop common policies to reduce the scale and impact of climate change and health inequalities. 2. Improve community capital and reduce social isolation across the social gradient.

  19. Prevalence of underweight, overweight and obese children in Year 6, by ethnic category, England, 2008/9

  20. Adult male obesity prevalence by social class 1997-2007

  21. Adult Female obesity prevalence by social class 1997 - 2007

  22. 6) Strengthen the role and impact of ill-health prevention Priority objectives 1. Prioritise prevention and early detection of those conditions most strongly related to health inequalities. 2. Increase availability of long-term and sustainable funding in ill-health prevention across the social gradient.

  23. Key themes Reducing health inequalities is a matter of fairness and social justice Action is needed to tackle the social gradient in health – Proportionate universalism Action on health inequalities requires action across all the social determinants of health Reducing health inequalities is vital for the economy – cost of inaction Beyond economic growth to well-being of society: sustainability and the fair distribution of health

  24. Delivery • Cross cutting national and local leadership to create conditions where people and communities take control • National/local partnership - national strategic direction and aspirations ; local problems, solutions, accountability and delivery • Local Strategic Partnerships engaging local communities and stakeholders • Agreed long term vision and priorities • Shared data • Joint planning and commissioning • Scaled up systematic and sustained engagement and intervention • Plans and actions on Social determinants of health. • Health Equity Impact Assessment • Scaled up and systematic interventions. • Revitalised primary care as community hub • Critical role of the third sector. • Leadership and management training in Private sector to maximise contribution.

  25. For further information www.ucl.ac.uk/gheg/marmotreview Final Report Launched and available online 11 February 2010

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