Pain delayed but not avoided

Pain delayed but not avoided • Despite falls in GDP and employment, average take-home incomes continued to grow in 2009-10 mainly driven by growth in income from benefits and tax credits; • “In 2011–12 and beyond, the coalition government’s cuts to benefits and tax credits are likely to reduce household incomes, all else being equal” Source: Poverty and Inequality in the UK: 2011 IFS Commentary 13th May 2011

Odds ratios (OR) for risk of mental illness in people with increasing numbers of debts:GB unadjusted (♦), adjusted for income (■) adjusted for income and key sociodemographic variables (age, ethnicity, marital status, household size, household tenure, education, social class,employment status, urban or rural, and region ( ). Source: Jenkins et al 2008

Fair Society: Healthy Lives: 6 Policy Objectives • Give every child the best start in life • Enable all children, young people and adults to maximise their capabilities and have control over their lives • Create fair employment and good work for all • Ensure healthy standard of living for all • Create and develop healthy and sustainable places and communities • Strengthen the role and impact of ill health prevention

Published by Friends of the Earth and Marmot Review Team Parliamentary Launch 12th May 2011

Direct health impacts - Mortality • Excess winter deaths are almost three times higher in the coldest quarter of housing than in the warmest quarter • 40% excess winter deaths attributable to cardio-vascular diseases • 33% excess winter deaths attributable to respiratory diseases

Direct health impacts - Morbidity • Children living in cold homes more than twice as likely to suffer from respiratory problems than children living in warm homes • More than 1 in 4 adolescents living in cold housing are at risk of multiple mental health problems, compared to 1 in 20 adolescents in warm housing • Cardio-vascular and respiratory diseases • Mental health • Colds and flu, exacerbates existing conditions such as arthritis and rheumatisms

Indirect health and social impacts • Cold housing negatively affects: • children’s educational attainment, emotional well-being and resilience • family dietary opportunities and choices • dexterity; and increases the risk of accidents and injuries in the home • Investing in the energy efficiency of housing can help stimulate the labour market and economy, as well as creating opportunities for skilling up the construction workforce

We can do better – international comparisons

Countries with more energy efficient housing have lower excess winter deaths (Healy 2003)

Greener living environments: lower health inequalities, England Deaths from circulatory disease Income group 4 is most deprived Source: Mitchell & Popham, Lancet 2008

Marmot Review: 6 Policy Objectives • Give every child the best start in life • Enable all children, young people and adults to maximise their capabilities and have control over their lives • Create fair employment and good work for all • Ensure healthy standard of living for all • Create and develop healthy and sustainable places and communities • Strengthen the role and impact of ill health prevention

Only 4 per cent of NHS funding is spent on prevention

Average weekly alcohol consumption by sex and socioeconomic class, GB: 2008 Mean number of units a week ONS General Lifestyle Survey 2008

Alcohol-attributable hospital admissions by small area deprivation quintile in England,2006-07

Action on the wider determinants - to tackle health inequalities • “Every sector a health sector” • Local authorities, Health and Social Services, Voluntary Sector have a key role to play at local level • Empower individuals and communities – create the conditions for people to take responsibility www.marmotreview.org

Marmot Review: recommended targets Across the social gradient: • Life expectancy • Healthy life expectancy • Readiness for school • Young people not in education, employment or training Target that progressively increases: • Proportion of households that have an income, after tax and benefits that is sufficient for healthy living

Public Health White Paper recognises: • that disadvantage accumulates over lifetime; • the need to address the wider determinants of health; • and approved the use of proportionate universalism as in Fair Society Healthy Lives • role of local authorities in leading on public health in partnership with the NHS

But: • Giving local communities control is challenging when they face budget cuts of 20-25%; • “responsibility deals” • Evidence from history suggests that public health advances – clean water, reduction of air pollution, healthier working conditions, reduction in drink-driving – have come to greater degree from action by local and central government than by voluntary agreements with industry. • While the White Paper picked up five of the six domains of recommendations from the Marmot Review it was silent on ensuring a healthy standard of living for all

Cost-Related Access Problems in the Past Year, by Income (Adjusted) percent experienced at least one of three problems** Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status. * Indicates significant within-country differences with below-average income (p < 0.05). ** Did not fill/skipped prescription, did not visit doctor with medical problem, and/or did not get recommended care. Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.

Percentage shares of equivalised total gross and post-tax income, by quintile groups for all households, 1978 – 2007/8

Trends in income share among top income decile, US: 1913-2007 Source: Piketty and Saez (2003), series updated to 2007 by Saez in 2009

International comparisons of income mobility Higher score = lower intergenerational mobility Source: Blanden (2009) in NEP 2010.

Good Society? 1. Health inequalities Health and the distribution of health as social accountant 2. The causes of the causes Every Minister a Health Minister 3. Fundamental drivers

Health inequalities are not inevitable or immutable

Age standardised mortality rates by socioeconomic (NS SEC) in the North East and South West regions, men aged 25-64, 2001-03

SMRs by cause, all ages: Glasgow relative to Liverpool & Manchester Source: Walsh D, Bendel N., Jones R, Hanlon P. It’s not ‘just deprivation’: why do equally deprived UK cities experience different health outcomes? Public Health, 2010 from H Burns, CMO, Scotland

Health improvement in difficult times • A major element of the excess risk of premature death seen in Scotland is psychosocially determined • Study evidence of low sense of control, self efficacy and self esteem in population in these areas Source: H. Burns, CMO Scotland

A Fair Society Conditions in which individuals &communities: Have control over their lives and Participate fully in society Website www.marmotreview.org

Pain delayed but not avoided