Are social inequalities affecting the health of young people: taking a life course approach to

health outcomes

Peter Goldblatt

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

• Social justice• Material, psychosocial,

political empowerment • Creating the conditions

for people to have control of their lives

www.who.int/social_determinants

Key principles

A. Give every child the best start in lifeB. Enable all children, young people and adults to

maximise their capabilities and have control over their lives

C. Create fair employment and good work for allD. Ensure healthy standard of living for allE. Create and develop healthy and sustainable places

and communitiesF. Strengthen the role and impact of ill health

prevention

Fair Society: Healthy Lives: 6 Policy Objectives

Prenatal Early Years Working Age Older Ages

Family building

Accumulation of positive and negative effects on health and wellbeing

LIFE COURSE STAGES

MACROLEVEL CONTEXT

WIDER SOCIETY SYSTEMS

Perpetuation of inequities

Prenatal Early Years Working Age Older Ages

Family building

Accumulation of positive and negative effects on health and wellbeing

LIFE COURSE STAGES

MACROLEVEL CONTEXT

WIDER SOCIETY SYSTEMS

Perpetuation of inequities

Prenatal Early Years Working Age Older Ages

Family building

Accumulation of positive and negative effects on health and wellbeing

LIFE COURSE STAGES

MACROLEVEL CONTEXT

WIDER SOCIETY SYSTEMS

Perpetuation of inequities

Gaps in school readiness at 3 and 5 years by family income: UK

Ave

rage

per

cent

ile s

core

Waldfogel & Washbrook 2008

0 10 20 30 40 50 60

Romania Latvia

Bulgaria Lithuania

Italy Greece

Spain Poland

Portugal Luxembourg

Hungary United Kingdom

Malta Estonia

Switzerland Ireland

Slovakia France

Belgium Netherlands

Germany Austria

Czech Republic Sweden Finland Cyprus

Slovenia Denmark

Norway Iceland

Poverty rate

Before social transfers After social transfers

Child poverty rates <60% median before and after social transfers 2009

Source: EU SILC

A) Give every child the best start in life.

Priority objectives

1. Reduce inequalities in the early development of physical and emotional health, and cognitive, linguistic, and social skills.

2. Ensure high quality maternity services, parenting programmes, childcare and early years education to meet need across the social gradient.

3. Build the resilience and well-being of young children across the social gradient.

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

Differences in PISA scores by attending preschool for more than one year before and after accounting for socioeconomic background

OECD PISA 2009 database

IsraelBelgium

FranceItaly

SwitzerlandDenmark

United Kingdom

TurkeyLithuania

SerbiaTFYR Montenegro

NetherlandsIreland

Slovenia

0 20 40 60 80 100 120 140

Before accounting for socioeconomic backgroundAfter accounting for socioeconomic background

Children achieving a good level of development at age five, local authorities 2011: England

0 30 60 90 120 15040

45

50

55

60

65

70

75

80

Local authority rank - based on Index of Multiple Deprivation

Good level of development

at age 5%

Source: LHO (2012)

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.

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

%

B) Enable all children, young people and adults to maximise their capabilities and have control over

their lives.

Priority objectives

1. Reduce the social gradient in skills and qualifications.

2. Ensure that schools, families and communities work in partnership to reduce the gradient in health, well-being and resilience of children and young people.

3. Improve the access and use of quality lifelong learning across the social gradient.

Life expectancy (at age 30) trends in Sweden 2000-2010, by education, women

Trends in probability of survival in men by education: Russian Federation

0.4

0.45

0.5

0.55

0.6

0.65

0.7

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

Calendar year

45 p

20

45 p20 = probability of living to 65 yrs when aged 20 yrs

University

Less than secondary

Source: Murphy et al 2006

Absolute inequality in males death rates by level of education

Mackenbach et al 2008

Prenatal Early Years Working Age Older Ages

Family building

Accumulation of positive and negative effects on health and wellbeing

LIFE COURSE STAGES

MACROLEVEL CONTEXT

WIDER SOCIETY SYSTEMS

Perpetuation of inequities

Per cent not in education employment or training by local authority: England

0

5

10

15

20

Not in Education Employment or Training

Local authorities

Per cent NEET

Further information

www.instituteofhealthequity.org