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Michael Marmot University College London Strategic Review of Health Inequalities in England Post 2010 - the Marmot Review Secretary of State for Health in England: set up a review, charied by Michael Marmot, to advise on a health inequalities strategy based on the best global evidence

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michael marmot university college london
Michael Marmot

University College London

strategic review of health inequalities in england post 2010 the marmot review
Strategic Review of Health Inequalities in England Post 2010 - the Marmot Review
  • Secretary of State for Health in England: set up a review, charied by Michael Marmot, to advise on a health inequalities strategybased on the best global evidence
  • Timeline
    • Announced November 2008
    • Preparatory work November to December 2008
    • Meetings January 2009 to September 2009
    • Report to Department of Health in December 2009
    • Publish Report early 2010.
slide3

Summary:

  • The evidence matters
  • Importance of social justice.
  • Empowerment at the heart
    • Material – income
    • Psychosocial – control
    • Political- having voice
  • Evidence
    • Social determinants.
    • Social gradient.
  • Action
    • Improve daily life
    • Tackle distribution in power,
    • money and resources.
    • Understand problem
csdh key message
CSDH key message
  • "(The) toxic combination of bad policies, economics, and politics is, in large measure responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible….Social injustice is killing people on a grand scale."

Commission on Social Determinants of Health Final Report, 2008

slide8
Deaths rates (age standardized) for all causes of death by deprivation twentieth, ages 15-64, 1999-2003, England and Wales

males

men

females

women

The dashed lines are average mortality rates for men and women in

England and Wales

Romeri et al 2006

the review will cover
The Review will cover:
  • Strategic: what sort of society we want…
  • Mechanisms of delivery across government and locally
  • Specific areas for policies
  • Metrics and targets
  • Need for evidence
task groups areas for action
Task Groups – Areas for Action
  • Early Childhood development and education.
  • Employment and work conditions
  • Social Protection
  • Built environment
  • Sustainable development
  • Social exclusion and social mobility
  • Priority public health conditions
  • Economic analysis
  • Delivery systems
emerging conceptual framework
Emerging conceptual framework
  • Create an enabling society which maximises individual and community capabilities
    • Equity from the start
    • Fair employment : decent work
    • Chances to develop skills and opportunities to control lives
  • Reshape our society around social justice and equity.
    • Make health equity part of all policies, systems and programmes.
    • Effective delivery of the social gradient based on the evidence.
    • Positive action to tackle discrimination to ensure equity for all.
    • Ensure adequate living standards.
    • Build community assets and tackle neighbourhood deprivation.
  • Prioritise health and wellbeing as much as wealth.
    • Strengthen the role and impact of prevention on the social gradient.
    • Work towards healthier and more sustainable environment and food policies.
create an enabling society that maximises individual and community capabilities
Create an enabling society that maximises individual and community capabilities
  • Equity from the start
  • Education to maximise potential
  • Chances to update life skills
  • Good, flexible, balanced work
slide13
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

slide14
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

slide15

Trends in percentage of pupils achieving 5+ A*-C GCSE

including English and Maths (2003-2007):England

Source: DCSF 2009

slide16

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

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

%

Source: Artazcoz et al 2005

trends in unemployment rates for young people in uk seasonally adjusted 1992 2009
Trends in unemployment rates for young people in UK (seasonally adjusted) 1992 - 2009

Unemployment rates

at 29.3%

for ages 16 and 17

Office for National Statistics

reshape our society around social justice and equity
Reshape our society around social justice and equity
  • Health equity at the heart of all policies
  • Focus on social and material inequalities
  • Building community assets and tackle neighbourhood disadvantage
slide20

Life expectancy at birth for selected London electoral wards, 2002-06

Haringey

Tottenham Green

LE for men: 71 years

Kensington & Chelsea

Queens Gate ward:

LE for men: 88 years.

(data from London Health Observatory)

Areas in blue are known as “Spearhead Authorities”

proportion of homes measured as non decent by tenure england
Proportion of homes measured as non-decent by tenure: England

Source: www.poverty.org.uk from English House Condition Survey

living environment by neighbourhood income england
Living environment by neighbourhood income: England

Index: poor housing, air quality and road traffic accidents

prioritise health and wellbeing as much as wealth
Prioritise health and wellbeing as much as wealth
  • Strengthen the role and impact of prevention on the social gradient
  • Work towards healthier and more sustainable environmental and food policies
prioritise health
Prioritise health
  • Sustainability
  • Prioritise prevention over amelioration /cure
    • address
  • Give due weigh to maximising wellbeing.
    • Low level stress key indicator
    • Isolation
    • Social network and capital impact
slide26

Some cross-cutting challenges for the Review

  • Reducing the gradient
  • Beyond mortality: Inequalities in “being well” and “well being”
  • The role of resilience
  • Breaking down national and local silos
united nations ecosoc meeting july 2009
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.”
slide28
Thank you

For further information, please visit

www.ucl.ac.uk/gheg/marmotreview