Professor Peter Goldblatt. Dr Mike Grady Marmot Review Team. UCL.

2. Social justice Material, psychosocial, political empowerment Creating the conditions for people to have control of their lives

6. Starting at the beginning:early years care and education RHS: Public Health Event & Pembury Fun Day Linden Children’s Centre, Aug 2009 LHS: Bromley by Bow CentreRHS: Public Health Event & Pembury Fun Day Linden Children’s Centre, Aug 2009 LHS: Bromley by Bow Centre

7. Inequality in Early Cognitive Development of British Children in the 1970 Cohort, 22 months to 10 years Inequality in the Early Cognitive Development of British Children in the 1970 Cohort Author(s): Leon Feinstein Source: Economica, New Series, Vol. 70, No. 277 (Feb., 2003), pp. 73-97 The definition of SES categories is as for Figure 1 with medium SES children omitted. Children in the 2nd and 3rd quartile at 22 months are also omitted. Standard error intervals are not shown to ease clarity of exposition. Important details of significant differences are given in the text. Inequality in the Early Cognitive Development of British Children in the 1970 Cohort Author(s): Leon Feinstein Source: Economica, New Series, Vol. 70, No. 277 (Feb., 2003), pp. 73-97 The definition of SES categories is as for Figure 1 with medium SES children omitted. Children in the 2nd and 3rd quartile at 22 months are also omitted. Standard error intervals are not shown to ease clarity of exposition. Important details of significant differences are given in the text.

8. Gaps in school readiness at 3 and 5 years by family income: UK Fig 2.22Fig 2.22

9. Per cent achieving 5+ A* - C grades inc Maths and English at GCSE by IDACI decile of pupil residence: England 2007 Deprivation and Education DCSF 2009; http://www.dcsf.gov.uk/research/data/uploadfiles/DCSF-RTP-09-01.pdf; accessed 13th July 2009 From table – Figure 4-4 on page 31Deprivation and Education DCSF 2009; http://www.dcsf.gov.uk/research/data/uploadfiles/DCSF-RTP-09-01.pdf; accessed 13th July 2009 From table – Figure 4-4 on page 31

13. Living environment by neighbourhood income More disadvantaged areas are typically disadvantaged across many domains. This figure for example looks at the relationship between incomes of neighbourhoods and the quality of the living environment (an index of poor quality housing, air quality and road traffic accidents). It shows a clear gradient. Source: Index of Multiple Deprivation 1 Living Environment Score is based on measures of housing in poor condition, an air quality index and road traffic accidents. Income domain score is based on claimants on means test income related benefits and tax credits and NASS vouchersMore disadvantaged areas are typically disadvantaged across many domains. This figure for example looks at the relationship between incomes of neighbourhoods and the quality of the living environment (an index of poor quality housing, air quality and road traffic accidents). It shows a clear gradient. Source: Index of Multiple Deprivation 1 Living Environment Score is based on measures of housing in poor condition, an air quality index and road traffic accidents. Income domain score is based on claimants on means test income related benefits and tax credits and NASS vouchers

15. Key themes from the evidence

16. Implications of the gradient Without health inequalities in England – Each year, if all had the mortality rate of 1) those with university education: Prevent 202,000 people aged 30+ dying prematurely (40 % of deaths); 2.5 million life years gained; 2) those in most affluent 10% of areas: 2.8 million extra years of life free from limiting illness or disability In England, 43% of people over 30 years die early every year because of health inequalities; Additionally 1.3 -2.5 million life years are lost because of health inequalities Without health inequalities there would be 2.8 million extra years of life free from limiting illness or disability Financial losses Productivity losses of £31-33 billion; Lost taxes and higher welfare payments in the range of £20-32 billion; Additional NHS healthcare costs in excess of £5.5 billion per year; E.g.Predicted cost to NHS of inequalities in obesity alone to rise from £2 billion per year to nearly £5 billion per year by 2025 In England, 43% of people over 30 years die early every year because of health inequalities; Additionally 1.3 -2.5 million life years are lost because of health inequalities Without health inequalities there would be 2.8 million extra years of life free from limiting illness or disability Financial losses Productivity losses of £31-33 billion; Lost taxes and higher welfare payments in the range of £20-32 billion; Additional NHS healthcare costs in excess of £5.5 billion per year; E.g.Predicted cost to NHS of inequalities in obesity alone to rise from £2 billion per year to nearly £5 billion per year by 2025

23. 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 action focussed on the social determinants of health.

24. Monitoring progress Life expectancy (Years of Life) Health expectancy (quality of years) Wellbeing. (when developed) Readiness for School Young People not in education or unemployment. Increase in proportion of households with an income sufficient for healthy living.

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