Social Determinants of Health: employment and working conditions

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1 Social Determinants of Health: employment and working conditions Michael Marmot UCL Institute of Health Equity 3 rd Nordic Conference in Work Rehabilitation 7 th May 2014

2 Fairness at the heart of all policies. Health inequalities result from social inequalities requires action on all the social determinants; the causes of the causes Focusing solely on the most disadvantaged will not reduce inequalities sufficiently action is needed across the social distribution.

3 Life expectancy and disability-free life expectancy at birth by neighbourhood income deprivation,

4 The Commission on Social Determinants of Health (CSDH) Closing the gap in a generation Strategic Review of Health Inequalities in England: The Marmot Review Fair Society Healthy Lives Review of Social Determinants of Health and the Health Divide in the WHO European Region

5 MACROLEVEL CONTEXT WIDER SOCIETY SYSTEMS LIFE COURSE STAGES Accumulation of positive and negative effects on health and wellbeing Prenatal Early Years Working Age Older Ages Family building Perpetuation of inequities

6 Difference in life expectancy at birth between EU Member States and the EU average, by sex, 2010 Males Italy Sweden Malta Cyprus Spain Netherlands United Kingdom Ireland Greece France Germany Austria Luxembourg Belgium Denmark Finland Portugal Slovenia Czech Republic Poland Slovakia Hungary Estonia Bulgaria Romania(p) Latvia Lithuania Life expectancy at birth - difference from EU average (years) Female France Spain Italy Cyprus Sweden Malta Finland Austria Luxembourg Ireland Slovenia Netherlands Germany Belgium Portugal Greece United Kingdom Denmark Czech Republic Estonia Poland Slovakia Lithuania Hungary Latvia Romania(p) Bulgaria Life expectancy at birth - difference from EU average (years)

7 Life expectancy at age 25 by education, men Source: Health inequalities in the EU 2013

8 Life expectancy at age 25 by education, women Source: Health inequalities in the EU 2013

9 Estimated odds of reporting poor or very poor general health by socioeconomic characteristics, 25 EU Member States*, 2010 Level of education None or pre-primary (0) Primary (ISCED 1) Lower secondary (2) Upper secondary (3) Post-secondary, non-tertiary (4) Tertiary (5&6) - BASELINE Income distribution Lowest decile 2nd 3rd 4th 5th 6th 7th 8th 9th Highest decile - BASELINE Material deprivation 4+ items 3 items 2 items 1 item 0 items - BASELINE Source: Health inequalities in the EU 1st-4th 5th-9th Odds ratio 3 variables in the model 1 variable in the model One variable in the model Three variables in the model

10 Life course approach

11 Links between socioeconomic status and factors affecting child development, Source: Department for Children, Schools and Families

12 Gaps in school readiness at 3 and 5 years by family income: UK Average percentile score Waldfogel & Washbrook 2008

13 Children achieving a good level of development at age five, local authorities 2011 Good level of development at age 5 % Local authority rank based on Index of Multiple Deprivation

14 Low education groups more likely to experience unemployment

15 30,0 25,0 20,0 15,0 10,0 Unemployment rates (ages years)by level of educational attainment, various countries ,0 0,0 Pre-primary, primary and lower secondary education (ISCED levels 0 to 2) (1) Upper secondary and post-secondary non-tertiary education (ISCED levels 3 and 4) (2) Tertiary education (ISCED levels 5 and 6) (3) Source: EUROSTAT

16 Unemployment associated with poor mental and physical health

17 Mortality* of men aged by social class and employment 190 status at the 1981 census Employed in 1981 Unemployed in Standardised Mortality Rate I II IIIN IIIM IV V I II IIIN IIIM IV V * adjusted for age and salarysocial class 1981 LS Cohort. *England & Wales: mortality

18 Unemployment and Mortality 1% rise in unemployment associated with: -0.8% Suicide -0.8% Homicide -1.4% Traffic death No effect on allcause mortality Source: Stuckler et al 2009 Lancet

19 Pyschosocial factors Having control over one s life and participating in decisions that affect your life

20 Employment and working conditions have powerful effects on health and health equity When these are good they can provide:- financial security paid holiday social protection benefits such as sick pay, maternity leave, pensions social status personal development social relations self-esteem protection from physical and psychosocial hazards all of which have protective and positive effects on health Source: CSDH Final Report, WHO 2008

21 Psychosocial stress and occupational class: SHARE 12 European Countries Wahrendorf & Siegrist 2011

22 Meta analysis of published cohort studies on job strain and CHD Steptoe & Kivimaki. Nature Reviews 2012

23 Higher work stress among older workers in countries with lower employment rates among older workers Dragano et al 2010

24 Association between work stress and depressive symptoms varies by welfare regime: baseline Effort-reward imbalance Adjusted Odds Ratio (95% 3,5 CI) 3 2,5 2,64 2 2,12 2,14 1,96 1,5 1,69 1 Pooled Liberal Southern Conservative Scandinavian Dragano et al 2010

25 6.7 million of the 13 million people in poverty are in working households, UK 2011/12 (JRF 2013 using DWP data)

26 Higher income inequality associated with lower intergenerational mobility Intergenerational earnings elasticity 0.6. The Great Gatsby Curve United Kingdom United States France Sweden Germany New Zealand Japan y = 2.2x R² = Finland Norway y = 2.2x R² = 0.76 Denmark Inequality (1985 Gini Coefficient) Source: Corak (2011), OECD, CEA estimates 0.2

27 Per cent of the population aged 16 and over reporting bad or very bad health in EU-SILC by social protection expenditure per person in Euros purchasing power parity, 2010 Per cent of population aged 16+ in bad or very bad health 20 Portugal 15 Latvia Lithuania Hungary Poland Slovakia Estonia Slovenia 10 5 Bulgaria Romania Czech Republic Cyprus Malta Greece Spain Iceland Belgium Italy Germany Austria Norway France Denmark Finland United Kingdom Sweden Netherlands Ireland Luxembourg Social protection expenditure per person in Euros using purchasing power parity Source: Report on Health Inequalities in the EU, 2013

28 Each 100 USD per capita greater social spending reduced the effect on suicides by: 0.38%, active labour market programmes 0.23%, family support 0.07%, healthcare 0.09%,unemployment benefits Social Protections Help Spending> 190 USD no effect of unemployment on suicide Source: Stuckler et al 2009 Lancet

29 Welfare generosity and non employment by education in 26 European countries Secondary Primary Tertiary Increasing generosity Increasing generosity van der Wel, Dahl & Thielen 2011, data from EU SILC (2005)

30 Do something Do more Do better Michael Marmot

31 UCL Health and Society Summer School: Social Determinants of Health July 2014 For further information