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Dr Mike Grady Marmot Review Team. UCL. The Conceptual Framework Reduce health inequalities and improve health and well-being for all. Create an enabling society that maximises individual and community potential. Ensure social justice, health and sustainability are at heart of policies.

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Dr Mike Grady Marmot Review Team. UCL.

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Dr Mike Grady

Marmot Review Team.



The Conceptual Framework

Reduce health inequalities and

improve health and well-being for all.

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 and good work for all.

Create and develop healthy and sustainable places and communities.

Enable all children, young people and adults to maximise their capabilities and have control over their lives.

Ensure healthy standard of living for all.

Strengthen the role and impact of ill health prevention.

Policy mechanisms

Equality and health equity in all policies.

Effective evidence-based delivery systems.

key themes
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

cost of inaction in lean times
Cost of Inaction in lean times

In England, dying prematurely each year as a result of health inequalities between 1.3 and 2.5 million extra years of life lost – the human cost- 200000 deaths of 30+.

Economic benefits in reducing losses from illness associated with health inequalities. Each year in England these account for:

productivity losses of £31-33B

reduced tax revenue and higher welfare payments of £20-32B

increased treatment costs well in excess of £5B.

making it happen a framework for delivery
Making it happen – A framework for delivery
  • Increased disability free life expectancy and reduction in inequalities across the gradient.
  • Empowering people : securing community solutions.
  • Intergovernmental action with dedicated leadership and executive team.
  • National Policies need effective local deliver focussed on health equity in all policies.
  • New model of civic and public sector leadership grounded in democracy and whole system thinking
  • Local Strategic Partnerships of Councils, NHS, 3rd Sector and Private Sector creating the conditions where individuals and communities take control.
  • Comprehensive, systematic, scaled up,coproduced action focussed on the social determinants of health.
partnerships with individuals and communities
Partnerships with individuals and communities
  • Critical success factor in addressing health inequalities through empowerment – creating the conditions in which people can take control
    • Bespoke individual responses
    • Population focused approaches
  • Asset based partnership – half full not half empty
    • Sharing power
    • Community led and long term
    • Shift in values and attitudes
    • Leadership and knowledge transfer.
  • Shared aspirations in improving health and wellbeing
    • Perceptions of local schools, health and social care service, housing type,employment,safety and social cohesion.
  • Balancing long-term gains and short-term pressures.
evaluating partnerships
Process issues

Engagement of Senior managers in partnership

Reorganisation impact

Lack of financial and human resources

Information sharing and best practice


Need for quick wins


Health outcomes

Monitoring and evaluation problems

Evaluating partnerships

Perkins et al (2009) What counts is what works? New Labour and partnership in public health. Policy Press


A Theory of Maturing Partnerships for Health Improvement

Process factors

Gaining collaborative advantage

for health improvement

Maturing partnership

Increasingly acting on social determinants of health



Little added value



Showing Added value

External contextual factors

No shared vision

Dominant partner

Top down

Project focussed

Quick wins

Funding constraints

Grant giving

Internal focus

Individual ownership

Health an NHS issue

Medical Model

Confidence in partners

Shared identity

Shared vision

Joint ownership


Joint posts

Citizen engagement



Health everyones business.

Addressing SDH

Adapted from Seymour M (2009) Do LSPs provide collaborative advantage for Health Improvement.

  • Olympic Host 5 Boroughs Strategic Regeneration Plan. Recommendations made to be incorporated into Stage 2 Plan to secure the Olympic legacy and convergence on health inequalities.
  • Bolton Local Strategic Partnership LSP developing action plan based on Marmot recommendations. To be submitted to marmot Team for comment.
  • Wakefield Council and PCT Working up a strategy for ratification by the LSP based on Marmot principles.
  • Yorkshire and the Humber NHS Action Plan to be agreed at next Board Meeting. Consideration being given to a 1 year dedicated post to oversee implementation of Marmot recommendations.
  • Coventry City Council and PCT Thematic Groups of the LSP to work up action plans on specific recommendations from the Marmot review.
  • North West Region Continuing development of regional strategy based on Marmot principles.
  • Greater London Authority. Marmot Team to facilitate and support implementation April 2010
  • Health Lives/ Healthy Places 30 PCT sign up
living well
‘Living Well’

Statements of intent to build vision of future

For further information