Taking action on the Social Determinants of Health. Michael Marmot

Transcription

1 Taking action on the Social Determinants of Health Michael Marmot

2 Thanks to Ruth Bell

3 Review of Social Determinants of Health and the Health Divide in the WHO European Region 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

4 Key principles Social justice Material, psychosocial, political empowerment Creating the conditions for people to have control of their lives

5 Life course stages Accumulation of positive and negative effects on health and wellbeing Prenatal Pre-school School Training Employment Retirement Family building

6 Male life expectancy at birth, local authorities Life expectancy (years) Local authority rank - based on Index of Multiple Deprivation

7 Inequalities in male life expectancy within local authority areas, Largest inequalities Smallest inequalities Westminster 16.9 (84) Barking & Dagenham 5.2 (77) Stockton-on-Tees 15.3 (78) Newham 5.0 (76) Middlesbrough 14.8 (76) Isle of Wight 4.9 (79) Wirral 14.6 (77) Herefordshire Cty UA 4.8 (79) Darlington 14.6 (77) Wokingham 3.5 (82) Newcastle -u-tyne 13.7 (77) Hackney 3.1 (77) Figures in parentheses show life expectancy of the area

8 Female life expectancy at birth, local authorities Life expectancy (years) Local authority rank - based on Index of Multiple Deprivation

9 Fair Society, Healthy lives themes

10 Male life expectancy WHO European Region Country Year Life expectancy Highest Israel Iceland Sweden Switzerland Lowest Ukraine Republic of Moldova Kyrgyzstan Belarus Kazakhstan Russian Federation Source: WHO HFA database

11 Female life expectancy WHO European Region Country Year Life expectancy Highest Spain France Italy Switzerland Lowest Ukraine Russian Federation Turkey Kazakhstan Republic of Moldova Uzbekistan Kyrgyzstan Source: WHO HFA database

12 Years of life spent free of disability, women in selected European countries 2009 Source: EC health indicators

13 Differences between women and men in years spent free of disability, selected European countries 2009 Source: EC health indicators

14 Absolute inequality in males death rates by level of education Mackenbach et al 2008

15 Remaining life expecancy at 30 years of age for women and men based on educational level, : Sweden Women Men Age Age 4.1 3,2 Post secondary education 6 Secondary education 5 Lower secondary

16 Trends in probability of survival in men by education: Russian Federation 45 p p20 = probability of living to 65 yrs when aged 20 yrs University Less than secondary Source: Murphy et al 2006 Calendar year

17 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

18 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

19 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

20 Early child care and education Parenting and family support Perinatal services Care before and during pregnancy Help for new mothers Pre-school education and care Primary, secondary and tertiary education and training

21 Differences in PISA scores by attending preschool for more than one year before and after accounting for socioeconomic background Slovenia Ireland Netherlands TFYR Montenegro Serbia Lithuania Turkey United Kingdom Denmark Switzerland Italy France Belgium Israel OECD PISA 2009 database Before accounting for socioeconomic background After accounting for socioeconomic background

22 Child poverty rates <60% median before and after social transfers 2009 Iceland Norway Denmark Slovenia Cyprus Finland Sweden Czech Republic Austria Germany Netherlands Belgium France Slovakia Ireland Switzerland Estonia Malta United Kingdom Hungary Luxembourg Portugal Poland Spain Greece Italy Lithuania Bulgaria Latvia Romania Source: EU SILC Poverty rate Before social transfers After social transfers

23 Country ranking: equality in child wellbeing - material, education, and health Score Country 8 Denmark, Finland, Netherlands, Switzerland 7 Iceland, Ireland, Norway, Sweden 6 Austria, France, Germany, Poland, Portugal, Canada 5 Belgium, Czech Republic, Hungary, Luxembourg, Slovakia, Spain, United Kingdom 3 Greece, Italy, United States Source: UNICEF Report Card 9, ranking 24 OECD countries by their performance in each of three dimensions of inequality in child well-being

24 Country comparison on average rank in four dimensions of child wellbeing material, health, education, behaviours & risks, in early 2000s and late 2000s UNICEF 2013

25 Children achieving a good level of development at age five, local authorities 2011: England Good level of development at age 5 % Local authority rank - based on Index of Multiple Deprivation Source: LHO (2012)

26 Birmingham Brighter Futures Children and young people; Physical health, literacy and numeracy, behaviour, emotional health, social literacy, and job skills. Specific programmes: Family Nurse Partnership (FNP), Incredible Years Parenting Programme, Promoting Alternative Thinking Strategies (PATHS), Triple P Parenting Programme.

27 Source: Department for Education: preliminary data 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

28 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

29 Unemployment rates by education and country of origin in selected countries Source: Eurostat database

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31 Psychosocial stress and occupational class SHARE -11 European Countries Wahrendorf, Dragano and Siegrist 2011

32 Risk of poor health by effort-reward imbalance at work: European countries Salavecz et al 2010

33 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

34 Wider Society Social exclusion Social protection across the life course Communities

35 Relation between social welfare spending and all cause mortality in 18 EU countries, 2000 Stuckler D et al. BMJ 2010;340:bmj.c3311

36 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 Protection Spending> 190 USD no effect of unemployment on suicide Source: Stuckler et al 2009 Lancet

37 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

38 Macrolevel context: Economic Issues Sustainability and environment

39 Changes in self-reported health and access to health care in Greece between 2007 and 2009, adjusted estimates Source: Kentikelenis et al, 2011

40 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

41 London Health Inequalities Strategy

42 London HI Strategy: 5 strategic objectives: 1. Empowering individuals and communities 2. Equitable access to high quality heath and social care services 3. Income inequality and health 4. Health, work, and well-being 5. Healthy places

43 Strengthening Communities: Merseyside Fire & Rescue Service Promoting healthier, safer communities Community fire safety team follow up to home safety checks Youth programmes Community fire stations On site free gyms Gardens & gardening projects Community rooms

44 Local areas using 6 areas Fair Society Healthy Lives in local strategies:

45 Malmö, Sweden Commission for a Socially Sustainable Malmo, chaired by Sven-Olof Isaacson, March 2011 to translate the findings of the CSDH into a form suitable to address social determinants and health inequalities in Malmo Report March 2013

46 Malmö: Six areas for action Children and young people s livings conditions Living environment and urban planning Education Income and employment Health services Changes in processes for socially sustainable development

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48 Income, employment, housing and health Unemployment, low incomes and poor housing contribute to worse health; These problems are more likely to occur among particular groups within the population and among those already on low incomes.

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50 Projected relative AHC income poverty rates under current policies and without the coalition government s tax and benefits reforms: UK Institute for Fiscal Studies, 2011

51 A Fair Society