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Michael Marmot

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Michael Marmot. University College London. Strategic Review of Health Inequalities ... birth for selected London electoral wards, 2002-06. Haringey. Tottenham ... – PowerPoint PPT presentation

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Title: Michael Marmot


1

  • Michael Marmot
  • University College London

2
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
  • 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.

3
  • 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

4

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7
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
8
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
9
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

10
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

11
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.

12
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

13
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
14
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
15
Trends in percentage of pupils achieving 5 A-C
GCSE including English and Maths
(2003-2007)England
Source DCSF 2009
16
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
17
Prevalence of poor mental health in manual
workers by type of contract Spain

Source Artazcoz et al 2005
18
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
19
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

20
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
21
Proportion of homes measured as non-decent by
tenure England
Source www.poverty.org.uk from English House
Condition Survey
22
Living environment by neighbourhood income
England
Index poor housing, air quality and road traffic
accidents
23
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24
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

25
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

26
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

27
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.

28
  • Thank you
  • For further information, please visit
  • www.ucl.ac.uk/gheg/marmotreview
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