Michael Marmot

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• Michael Marmot
• University College London

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Strategic Review of Health Inequalities in
England Post 2010 - the Marmot Review

• Secretary of State for Health in England set up
  a review, charied by Michael Marmot, to advise on
  a health inequalities strategy based on the best
  global evidence
• Timeline
• Announced November 2008
• Preparatory work November to December 2008
• Meetings January 2009 to September 2009
• Report to Department of Health in December 2009
• Publish Report early 2010.

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• Summary
• The evidence matters
• Importance of social justice.
• Empowerment at the heart
• Material income
• Psychosocial control
• Political- having voice
• Evidence
• Social determinants.
• Social gradient.
• Action
• Improve daily life
• Tackle distribution in power,
• money and resources.
• Understand problem

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CSDH key message

• "(The) toxic combination of bad policies,
  economics, and politics is, in large measure
  responsible for the fact that a majority of
  people in the world do not enjoy the good health
  that is biologically possible.Social injustice
  is killing people on a grand scale."

Commission on Social Determinants of Health Final
Report, 2008
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Deaths rates (age standardized) for all causes of
death by deprivation twentieth, ages 15-64,
1999-2003, England and Wales
males
men
females
women
The dashed lines are average mortality rates for
men and women in England and Wales
Romeri et al 2006
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The Review will cover

• Strategic what sort of society we want
• Mechanisms of delivery across government and
  locally
• Specific areas for policies
• Metrics and targets
• Need for evidence

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Task Groups Areas for Action

• Early Childhood development and education.
• Employment and work conditions
• Social Protection
• Built environment
• Sustainable development
• Social exclusion and social mobility
• Priority public health conditions
• Economic analysis
• Delivery systems

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Emerging conceptual framework

• Create an enabling society which maximises
  individual and community capabilities
• Equity from the start
• Fair employment decent work
• Chances to develop skills and opportunities to
  control lives
• Reshape our society around social justice and
  equity.
• Make health equity part of all policies, systems
  and programmes.
• Effective delivery of the social gradient based
  on the evidence.
• Positive action to tackle discrimination to
  ensure equity for all.
• Ensure adequate living standards.
• Build community assets and tackle neighbourhood
  deprivation.
• Prioritise health and wellbeing as much as
  wealth.
• Strengthen the role and impact of prevention on
  the social gradient.
• Work towards healthier and more sustainable
  environment and food policies.

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Create an enabling society that maximises
individual and community capabilities

• Equity from the start
• Education to maximise potential
• Chances to update life skills
• Good, flexible, balanced work

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Inequality in Early Cognitive Development of
British Children in the 1970 Cohort, 22 months to
10 years
High SES Low SES
High Q at 22m
Low Q at 22m
Source Feinstein, L. (2003) Inequality in the
Early Cognitive Development of British Children
in the 1970 Cohort, Economica (70) 277, 73-97
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Per cent achieving 5 A - C grades inc Maths and
English at GCSE by IDACI decile of pupil
residence England 2007
achieving 5 A-C GCSEs inc Maths and English
Most deprived
Income Deprivation Affecting Children Index
(IDACI)
Least deprived
Source DCFS 2009
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Trends in percentage of pupils achieving 5 A-C
GCSE including English and Maths
(2003-2007)England
Source DCSF 2009
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Mortality of men aged 16-64 by social class and
employment status at the 1981 census
Employed in 1981 Unemployed in 1981
Standardised Mortality Rate
I II IIIN IIIM IV V
I II IIIN IIIM IV V Social
Class
1981 LS Cohort. England Wales mortality
1981-92
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Prevalence of poor mental health in manual
workers by type of contract Spain

Source Artazcoz et al 2005
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Trends in unemployment rates for young people in
UK (seasonally adjusted) 1992 - 2009
Unemployment rates at 29.3 for ages 16 and 17
Office for National Statistics
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Reshape our society around social justice and
equity

• Health equity at the heart of all policies
• Focus on social and material inequalities
• Building community assets and tackle
  neighbourhood disadvantage

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Life expectancy at birth for selected London
electoral wards, 2002-06
Haringey Tottenham Green LE for men 71 years
Kensington Chelsea Queens Gate ward LE for
men 88 years.
(data from London Health Observatory)
Areas in blue are known as Spearhead Authorities
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Proportion of homes measured as non-decent by
tenure England
Source www.poverty.org.uk from English House
Condition Survey
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Living environment by neighbourhood income
England
Index poor housing, air quality and road traffic
accidents
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Prioritise health and wellbeing as much as wealth

• Strengthen the role and impact of prevention on
  the social gradient
• Work towards healthier and more sustainable
  environmental and food policies

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Prioritise health

• Sustainability
• Prioritise prevention over amelioration /cure
• address
• Give due weigh to maximising wellbeing.
• Low level stress key indicator
• Isolation
• Social network and capital impact

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Some cross-cutting challenges for the Review

• Reducing the gradient
• Beyond mortality Inequalities in being well
  and well being
• The role of resilience
• Breaking down national and local silos

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United Nations, ECOSOC meeting July 2009

• Yet, inequities in health outcomes persist
  within and among countries. Most of the
  difference is attributable to the conditions in
  which people are born, grow, live, work and age.

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• Thank you
• For further information, please visit
• www.ucl.ac.uk/gheg/marmotreview