NATIONAL SYMPOSIUM ON AGEING RESEARCH Canberra 24 September, 2003

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NATIONAL SYMPOSIUM ON AGEING RESEARCHCanberra24
September, 2003 Linking research, policy and
practice Michael MarmotInternational Centre
for Health and SocietyUCL
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TRANSLATING RESEARCH EVIDENCE INTO POLICY

• SUCCESSES AND FAILURES

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TRANSLATING RESEARCH EVIDENCE INTO POLICY

• SUCCESSES

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All Cause Mortality by Grade of
Employment Whitehall Men 25 year Follow-up
Relative rate
40-64yrs 64-69yrs
70-89yrs
Marmot and Shipley, 1996
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• Independent Inquiry into
• Inequalities in Health
• REPORT
• CHAIRMAN SIR DONALD ACHESON

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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
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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
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AREAS FOR FUTURE POLICY DEVELOPMENT (2)

• MOTHERS AND FAMILIES
• OLDER PEOPLE
• ADULTS OF WORKING AGE
• GENDER
• ETHNICITY

Independent Inquiry into Inequalities in Health
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• Tackling Health Inequalities
• Summary of the 2002
• Cross-Cutting Review
• HM TREASURY

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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.

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TRANSLATING RESEARCH EVIDENCE INTO POLICY

• FAILURES?

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STRATEGIES FOR BUILDING RESEARCH CAPACITY
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WHY DO WE NEED INTERDISCIPLINARY RESEARCH?
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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
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• EPIDEMIOLOGY
• STATISTICS
• SOCIOLOGY
• SOCIAL PSYCHOLOGY
• PSYCHOBIOLOGY
• NEURENDOCRINOLOGY
• ECONOMICS
• MOLECULAR GENETICS

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FUNDING INTERDISCIPLINARY RESEARCH
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FUNDING INTERDISCIPLINARY RESEARCH?
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RESEARCH INTO AGEING

• Ageing as a lifelong process
• Needs of older people

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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
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RESEARCH INTO AGEINGThe English Longitudinal
Study of Ageing(ELSA)

• General Background

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The English Longitudinal Study of Ageing (ELSA)

• 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

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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

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Broad questionnaire coverage

• Demographics
• Health
• Social participation
• Housing
• Employment and earnings
• Pensions and retirement

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Broad questionnaire coverage (cont)

• Income and assets
• Cognitive function
• Psychosocial
• Expectations
• Measurements
• Self completion (social support, GHQ12, Beck
  depression inventory)

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Collaboration with UK panel studies

• 1946 birth cohort
• Whitehall II
• Testing of explanations for inequalities in
  health
• Cohort growing older and retiring

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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

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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

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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)

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FUTURE DIRECTIONS FOR AUSTRALIA?