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Consequences of the Economic Crisis for Social Determinants of Health Michael Marmot UCL Public Health Federations Istanbul 1 st May 2009 Dramatic inequalities dominate global health A social gradient in health exists in all countries and within cities Social justice

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consequences of the economic crisis for social determinants of health

Consequences of the Economic Crisis for Social Determinants of Health

Michael MarmotUCL

Public Health Federations

Istanbul

1st May 2009

slide2
Dramatic inequalities dominate global health
  • A social gradient in health exists in all countries and within cities
slide3
Social justice
  • Empowerment – material, psychosocial, political
  • Creating the conditions for people to take control of their lives
csdh areas for action
CSDH – Areas for Action

Health Equity in all Policies

Good Global

Governance

Fair Financing

Early child development and education

Healthy Places

Fair Employment

Social Protection

Universal Health Care

Market

Responsibility

Gender Equity

Political empowerment

– inclusion and voice

unemployment rates selected oecd january 2008 january 2009
Unemployment Rates(selected OECD ) January 2008 – January 2009*

*United Kingdom: November 07— November 08

Source: OECD.

growth in global industrial production and merchandise trade annualized three month percent change
Growth in Global Industrial Production andMerchandise Trade(Annualized three-month percent change)

IMF World Economic Outlook Jan 2009

slide9

Global unemployment according to three scenarios

Rise in unemployment from 5.7% in 2007 to between 6.1% and 7.1% in 2009

(between 18 million and 51 million people)

Source: ILO, Trends Econometric Models, December 2008

slide10

Working poverty scenarios (USD 1.25)

Working poor (less that $1.25 a day) predicted to rise to between 700 million

& 800 million; Increase in 200 million in working poor in most pessimistic scenario

Source: ILO, Trends Econometric Models, December 2008

long standing illness in 1991 and unemployment in 1971 and 1981 among men aged 15 40 in 1971
Long-standing illness in 1991 and unemployment in 1971 and 1981 among men aged 15-40 in 1971

Bartley and Plews 2002

slide13

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

* adjusted for age and salary

1981 LS Cohort. *England & Wales: mortality 1981-92

good work
Good work
  • Financial security
  • Social protection
  • Paid holiday
  • Social status
  • Personal development
  • Social relations
  • Self esteem
  • Protection from physical and psychosocial hazards
slide15

Global vulnerable employment according to three scenarios

Source: ILO, Trends Econometric Models, December 2008

prevalence of poor mental health in manual workers by type of contract spain
Prevalence of poor mental health in manual workers by type of contract: Spain

%

Artazcoz et al 2005

slide17

Mortality 1990-2001 for women on temporary contracts: Finland

reference group women in permanent employment

* adjusted for age and salary

Kivimaki et al 2003; American Journal Epid 158:663-668

the iso strain concept of stress at work
The Iso-strain concept of stress at work

Socially isolated

(no supportive co-workers or supervisors)

High strain

(High demands and low control)

odds ratio of metabolic syndrome by exposure to iso strain whitehall ii phases 1 to 5
ODDS RATIO* OF METABOLIC SYNDROME BY EXPOSURE TO ISO-STRAIN: WHITEHALL II PHASES 1 TO 5

Odds Ratio

Exposure to Iso-strain

*Adj. for age, employment, grade and health behaviours

Chandola, Brunner & Marmot, BMJ, 2006

odds of depression by control at work at home within grade women whitehall ii
ODDS OF DEPRESSION BY CONTROL AT WORK & AT HOME WITHIN GRADE - WOMEN WHITEHALL II

odds ratios

High Medium Low

EMPLOYMENT GRADE

Griffin et al, Soc Sci Med, 2002

prevalence of children s mental disorders by family characteristics gb 2004
Prevalence of children’s mental disorders by family characteristics: GB 2004

%

%

(Source: Survey of the mental health of children and young people in Great Britain, ONS)

not all business is declining
Not all business is declining…
  • McDonald's UK: 4,000 new jobs
  • extra two million customers a month compared to last year (Aug 2008)
  • McDonalds Europe: 240 new restaurants mostly in Spain, France, Italy, Russia and Poland
  • ‘consumers, particularly in Germany and Spain, favouring the cheapest menu items’ (Jan 09)

Photo: R. Bell

policy choices ilo recommended policy measures nov 2008
Policy choices: ILO recommended policy measures Nov 2008
  • wider coverage of unemployment benefits
  • re-skilling redundant workers
  • protecting pensions from devastating declines in financial markets;
  • public investment in infrastructure and housing, community infrastructure and green jobs;
  • support to small and medium enterprises;
  • social dialogue at enterprise, sectoral and national levels.
slide25
Unemployment benefits replace on average 40% of previous earnings – but there is huge variation within OECD

Average of net replacement rates over a period of 60 months of unemployment in 2004,

for four family types and two earnings levels in percentage – data are for 2004

Source: OECD 2007 SOCIETY AT A GLANCE

csdh areas for action27
CSDH – Areas for Action

Health Equity in all Policies

Good Global

Governance

Fair Financing

Early child development and education

Healthy Places

Fair Employment

Social Protection

Universal Health Care

Market

Responsibility

Gender Equity

Political empowerment

– inclusion and voice

slide28
Nancy Birdsall: developing countries will need $1 trillion over the next couple of years to pay for bank rescues, fiscal stimuli, and to maintain minimal social safety nets
meladi nagar
MELADI NAGAR

Before

After

Slide courtesy of Gujarat Mahila Housing SEWA Trust

global slum upgrading
Global slum upgrading
  • Cost estimate: less than US$ 100 billion.
  • Finance on shared basis, for instance by
    • international agencies and donors (45%),
    • national and local governments (45%), and
    • households themselves (10%), helped by micro-credit schemes.
slide31

A world where social justice is taken seriously

www.who.int/social_determinants/en