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TRANSLATING RESEARCH EVIDENCE INTO POLICY

NATIONAL SYMPOSIUM ON AGEING RESEARCH Canberra 24 September, 2003 “Linking research, policy and practice” Michael Marmot International Centre for Health and Society UCL. TRANSLATING RESEARCH EVIDENCE INTO POLICY. SUCCESSES AND FAILURES. TRANSLATING RESEARCH EVIDENCE INTO POLICY. SUCCESSES.

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TRANSLATING RESEARCH EVIDENCE INTO POLICY

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  1. NATIONAL SYMPOSIUM ON AGEING RESEARCHCanberra24 September, 2003 “Linking research, policy and practice” Michael MarmotInternational Centre for Health and SocietyUCL

  2. TRANSLATING RESEARCH EVIDENCE INTO POLICY SUCCESSES AND FAILURES

  3. TRANSLATING RESEARCH EVIDENCE INTO POLICY SUCCESSES

  4. All Cause Mortality by Grade of Employment Whitehall Men 25 year Follow-up Admin 2 Prof/Exec 1.9 Clerical 1.8 Other 1.7 1.6 1.5 1.4 1.3 1.2 1.1 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 Relative rate 40-64yrs 64-69yrs 70-89yrs Marmot and Shipley, 1996

  5. Independent Inquiry into Inequalities in Health REPORT CHAIRMAN: SIR DONALD ACHESON

  6. GENERAL RECOMMENDATIONS • 1. Health Inequalities Impact Assessment All policies to favour the less well-off. • 2. High priority to women of childbearing age, expectant mothers and young children. • 3. Further steps to reduce income inequalities and improve living standards of poor households. Independent Inquiry into Inequalities in Health

  7. AREAS FOR FUTURE POLICY DEVELOPMENT (1) • POVERTY & INCOME • HOUSING AND ENVIRONMENT • EDUCATION • MOBILITY, TRANSPORT, POLLUTION • EMPLOYMENT • NUTRITION • NATIONAL HEALTH SERVICE Independent Inquiry into Inequalities in Health

  8. AREAS FOR FUTURE POLICY DEVELOPMENT (2) • MOTHERS AND FAMILIES • OLDER PEOPLE • ADULTS OF WORKING AGE • GENDER • ETHNICITY Independent Inquiry into Inequalities in Health

  9. Tackling Health Inequalities Summary of the 2002 Cross-Cutting Review HM TREASURY

  10. National Targets for Tackling Health Inequalities • Infant Mortality (Deaths in the first year of life) “Starting with children under one year, by 2010 to reduce by at least 10% the gap in mortality between routine and manual groups and the population as a whole” • Expectation of Life“Starting with local authorities, by 2010 reduce by at least 10% the gap between the fifth of areas with the lowest life expectancy at birth and the population as a whole.”

  11. TRANSLATING RESEARCH EVIDENCE INTO POLICY FAILURES?

  12. STRATEGIES FOR BUILDING RESEARCH CAPACITY

  13. WHY DO WE NEED INTERDISCIPLINARY RESEARCH?

  14. Material factors Social structure Work Brain Neuro- endocrine and immune Psychological Social Environment Health Behaviours Patho-physiological changes Organ impairment Early Life Well-being Mortality Morbidity Genes Culture

  15. EPIDEMIOLOGY • STATISTICS • SOCIOLOGY • SOCIAL PSYCHOLOGY • PSYCHOBIOLOGY • NEURENDOCRINOLOGY • ECONOMICS • MOLECULAR GENETICS

  16. FUNDING INTERDISCIPLINARY RESEARCH

  17. FUNDING INTERDISCIPLINARY RESEARCH?

  18. RESEARCH INTO AGEING • Ageing as a lifelong process • Needs of older people

  19. THE NATIONAL RESOURCE OF LARGE LONG-TERM COHORT STUDIES • has or is about to collect DNA •  data collection period 1946 cohort: www.nshd.mrc.ac.uk 1958, 1970 & Millennium cohorts: www.cls.ioe.ac.uk ALSPAC: www.alspac.bristol.ac.uk ELSA & Whitehall: www.ucl.ac.uk

  20. RESEARCH INTO AGEINGThe English Longitudinal Study of Ageing(ELSA) General Background

  21. Research team International Centre for Health and Society, UCL Institute for Fiscal Studies and UCL National Centre for Social Research plus researchers from Cambridge, Oxford, Nottingham Funding from NIA and UK government The English Longitudinal Study of Ageing (ELSA)

  22. Key Research Areas • Health trajectories, disability and healthy life expectancy • The relationship between economic position and health • The determinants of economic position in older age • The timing of retirement, and post retirement labour market activity • The nature of social networks, support and participation • Household and family structure, and the transfer of resources

  23. Broad questionnaire coverage • Demographics • Health • Social participation • Housing • Employment and earnings • Pensions and retirement

  24. Broad questionnaire coverage (cont) • Income and assets • Cognitive function • Psychosocial • Expectations • Measurements • Self completion (social support, GHQ12, Beck depression inventory)

  25. Collaboration with UK panel studies • 1946 birth cohort • Whitehall II • Testing of explanations for inequalities in health • Cohort growing older and retiring

  26. Collaboration with UK panel studies • 1946 birth cohort • Whitehall II • BHPS • Full age cross-section • Focus on older people in 2002 wave • Sharing of topics and measures

  27. Comparative issues • Ex-ante policy evaluation difficult • Understanding causal relationships difficult • Comparative data can: • Help understand differences between countries • Expand sources of variation available to researchers (conditional on enough observables to make the comparison valid) • Help examine role of institutions directly • Principal international comparators: Health and Retirement Study (HRS), SHARE

  28. ELSA will look quite like HRS • Two-yearly frequency • Exit interview (post mortality, with proxy) • Modular structure + core content • Unfolding brackets • Financial respondent • Expectations • But with some differences: • biomedical health data • cognitive function • psychosocial factors • Face to face waves 1 and 2 (plus nurse visit wave 2)

  29. FUTURE DIRECTIONS FOR AUSTRALIA?

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