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Working for Health Equity: The Role of Health Professionals

Working for Health Equity: The Role of Health Professionals. Michael Marmot BMA 18 th March 2013. European Review of Social Determinants and the Health Divide 2010-2012. Strategic Review of Health Inequalities in England: The Marmot Review – Fair Society Healthy Lives.

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Working for Health Equity: The Role of Health Professionals

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  1. Working for Health Equity: The Role of Health Professionals Michael Marmot BMA 18th March 2013

  2. European Review of Social Determinants and the Health Divide 2010-2012 Strategic Review of Health Inequalities in England: The Marmot Review – Fair Society Healthy Lives The Commission on Social Determinants of Health (CSDH) – Closing the gap in a generation

  3. Fair Society, Healthy Lives: 6 Policy Recommendations • 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

  4. Workforce Education and Training • Working with Individuals and Communities • NHS Organisations • Working in Partnership • Workforce as Advocates • The Health System – Challenges and Opportunities

  5. Workforce Education and Training • Working with Individuals and Communities • NHS Organisations • Working in Partnership • Workforce as Advocates • The Health System – Challenges and Opportunities

  6. Life expectancy and disability-free life expectancy at birth by neighbourhood income deprivation, 1999-2003

  7. Social determinants of health across the lifecourse

  8. The best start in life:Early Child Development (ECD) ECD means: physical, social/emotional, language/cognitive development ECD is socially determined and, in turn, is a determinant of health across the life course

  9. Socio-emotional difficulties at age 3 and 5:Millennium Cohort Study Age 3 Age 5 Fully adjusted = for parenting activities and psychosocial markers Kelly et al, 2010

  10. Working age people in England at high risk of mental illness by social class % with High GHQ12 score Source: Health Survey for England, DH; the data is the average for 2004 to 2006; England; updated June 2008

  11. Prevalence of obesity, by region and deprivation quintile, children aged 10-11 yrs

  12. Circulatory Disease death rates at ages under 75, by local ward deprivation level

  13. Cancer Death Rates at ages under 75, by local ward deprivation level

  14. Alcohol attributable hospital admissions by small area deprivation quintile

  15. Social Isolation and Loneliness • Social isolation and loneliness is associated with 50% excess risk of CHD Systematic literature review and meta-analysis of prospective cohort studies published up to December 2011 in CHD-free populations (nine studies) reported in Steptoe & Kivimaki 2012

  16. Percentage of those lacking social support by deprivation of residential area, 2005

  17. Workforce Education and Training • Working with Individuals and Communities • NHS Organisations • Working in Partnership • Workforce as Advocates • The Health System – Challenges and Opportunities

  18. Stress at work • Two models • Demand-control model: high job strain is characterised by high job demands and low job control, or decision latitude • Effort/reward imbalance: efforts at work are not adequately rewarded by pay, esteem, job security or opportunities for career advancement • Socially isolated • (no supportive co-workers or supervisors)

  19. Stress at work is associated with a 50% excess risk of coronary heart disease Kivimäki M, Virtanen M, Elovainio M, Kouvonen A, Väänänen A, Vahtera J . Work stress in the etiologyof coronary heart disease—a meta-analysis. Scand J Work Environ Health 2006;32(6 special issue):431–442.

  20. The association of civil service grade with job control, Whitehall II study, 1985–88 Job control High Low Employment Grade Chandola et al. BMJ 2006

  21. ODDS RATIO* OF METABOLIC SYNDROME BY EXPOSURE TO ISO-STRAIN: WHITEHALL II PHASES 1 TO 5 Odds Ratio Exposure to Iso-strain *Adj. for age, employment, grade and health behaviours Chandola, Brunner & Marmot, BMJ, 2006

  22. Workforce Education and Training • Working with Individuals and Communities • NHS Organisations • Working in Partnership • Workforce as Advocates • The Health System – Challenges and Opportunities

  23. Living in cold homes: effect on adolescents% children with four or more negative outcomes* Number of previous 5 years child has lived in these conditions % children with four or more negative outcomes* *i)A long-standing illness or disability, ii) to go without regular physical exercise, iii) in trouble for smoking, drinking or taking drugs, iv) bullied in or out of school, v) expelled or suspended from school, vi) does not see friends and does not attend organised activities, vii) has been in trouble with the police, viii)below average in key academic subjects, ix) family cannot afford an annual holiday, and, x) family in income poverty. Source: Barnes et al 2008

  24. Risk of fuel poverty according to household income

  25. Proportion of NEETs in London Boroughs by rank on the Index of Multiple Deprivation

  26. Birmingham Brighter Futures • Aims to improve the lives of all the city's children and young people; • Focus on improving children’s physical health, literacy and numeracy, behaviour, emotional health, social literacy, and job skills. • Specific programmes relevant to early years include: Family Nurse Partnership (FNP), Incredible Years Parenting Programme, Promoting Alternative Thinking Strategies (PATHS), Triple P Parenting Programme.

  27. Per cent 5 year olds achieving ‘good development score’,* Birmingham LA, West Midlands & England % *in personal, social and emotional development and communication, language and literacy Source: Department for Education: preliminary data

  28. Workforce Education and Training • Working with Individuals and Communities • NHS Organisations • Working in Partnership • Workforce as Advocates • The Health System – Challenges and Opportunities

  29. Projected relative AHC income poverty rates under current policies and without the coalition government’s tax and benefits reforms: UK IFS 2010

  30. Neighbourhoods affordable to Housing Benefit Recipients in 2011 and 2016

  31. Workforce Education and Training • Working with Individuals and Communities • NHS Organisations • Working in Partnership • Workforce as Advocates • The Health System – Challenges and Opportunities

  32. Health and Social Care Act 2012 • Legal duties to reduce health inequalities, for the first time • Public Health in Local Authorities • Health and Well Being Boards in LAs • Platform for joining up health services, social care services and health-related services at local level

  33. A Fair Society Creating conditions in which individuals and communities have control over their lives www.instituteofhealthequity.org

  34. UCL Health and Society Summer School 8-12 July 2013 INTERNATIONAL INSTITUTE FORSOCIETY AND HEALTH For further informationemail: catherine.conroy@ucl.ac.uk www.ucl.ac.uk/healthandsociety/

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