Michael Marmot University College London

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 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.

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

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

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