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Transcript of York city council presentation
The Commission on Social Determinants of Health (CSDH) – Closing the gap in a generation 2008
Strategic Review of Health Inequalities in England:
The Marmot Review – Fair Society Healthy Lives 2009
European Review of Health Inequalities and
the Health Divide
2010-2012
Life expectancy and disability free life expectancy at birth, persons by neighbourhood income level, England, 1999-2003
45
50
55
60
65
70
75
80
85
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
Neighbourhood Income DeprivationSource: ONS (Population Percentiles)
Age
Life expectancy
DFLE
Pension age increase2026-46Poly. (DFLE)
Poly. (Life expectancy)
2
Life course
Prenatal Pre-school
School Training Employment Retirement
Family building
PreventionEarly Years Skills Development Employment and Work
Accumulation of positive and negative effects on health and wellbeing
Healthy Standard of Living
Sustainable communities and places
Life course stages
Areas of action
3
Inequality in Early Cognitive Development of British Children in the 1970 Cohort, 22 months to 10 years
0
10
20
30
40
50
60
70
80
90
100
22 26 30 34 38 42 46 50 54 58 62 66 70 74 78 82 86 90 94 98 102 106 110 114 118
months
Ave
rag
e p
osi
tio
n in
dis
trib
uti
on
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
High SES Low SES
4
Gaps in school readiness at 3 and 5 years by family income: UK
Ave
rage
per
cent
ile s
core
Waldfogel & Washbrook 2008 6
Per cent achieving 5+ A* - C grades inc Maths and English at GCSE by IDACI decile of pupil residence: England 2007
25.329.9
34.239.2
44.749.5
53.857.8
61.968.4
0
10
20
30
40
50
60
70
80
0-10% 10-20%
20-30%
30-40%
40-50%
50-60%
60-70%
70-80%
80-90%
90-100%
% achieving 5+ A*-C GCSEs inc Maths and English
Income Deprivation Affecting Children Index (IDACI) Least deprived
Source: DCFS 2009
Most deprived
7
8
The Conceptual Framework
Reduce health inequalities and improve health and well-being for all.
Create an enabling society that maximises individual and
community potential.
Ensure social justice, health and sustainability are at heart
of policies.
A. Give every
child the best start in life.
C. Create fair
employment and good work for all.
B. Enable all children, young people and adults to maximise
their capabilities and have control over their lives.
D. Ensure healthy
standard of living for all.
E. Create and develop
healthy and sustainable places and communities.
F. Strengthen the role
and impact of ill health prevention.
Equality and health equity in all policies.
Effective evidence-based delivery systems.
Policy objectives
Policy mechanisms
9
Key Messages
• Major health inequalities within and between countries.
• Social gradient in health• Health inequalities driven by
social inequalities • Action is needed across the
whole system ,health systems alone cannot reduce health inequalities.
• Systematic , sustained and universal action on the social determinants of health proportionate to disadvantage.
• Collate the evidence, develop capacity, build political commitment.
Local Democratic legitimacy
• Community Leadership in giving people voice.
• Place shaping building sustainable communities promoting health wellbeing and resilience.
• Extending participation and co-production of services
• Orchestrating local partnership working.
• Directors of Public Health leading local public health
• Use Council’s role as Commissioner, Service Provider and Employer.
Local determinants of health and wellbeing
Barton H and Grant M 2008
People and Places
• Critical linkage of health, wellbeing and resilience.• Evidence of linkage of low level stress, depression,
isolation especially in communities of multiple deprivation with significant barriers to participation.
“ You can see the deprivation, all you have to do is look outside. Its in your face every day, litter everywhere, rats and rubbish. It’s a dump……it feels like people around you have no meaning to life.I keep my curtains closed at times……….It doesn’t give you a purpose to do anything” (Focus group participant)• Many excluded areas are characterised by lack of
mutual trust, isolation and under developed social cohesion.
“I feel safe but there I places I don’t go” (focus group participant)
Developing Communities: building resilience
• Evidence participation and improving life skills ameliorates impact of health inequalities through developing social support networks. (Bynner and Parsons 2006)
• Impact of personal support critical“ I know I have got back up and that is a big thing” (Mari 2006)
• Learning and skill development impact positively and fosters community action. “ It was just getting worse and worse. The group then decided that we ought to be lobbying people that could help us MPs, local councillors, local members and the Police.” (Shirley)
• Social networks create the conditions in which people thrive“I don’t know what makes other people healthier. I know what makes me healthier and that’s being happy and having friends” (Suzanne 2006)
INDEX OF HEALTH AND SOCIAL PROBLEMS PLOTTED BY INCOME INEQUALITY
Wilkinson R and Pickett K.(2009) The Spirit Level; Why more equal societies almost always do better.Penguin Books London.
Impact of changes to tax and benefit system on net income in 2014 -2015 by decile: UK
Source: IFS 2011
YORK ALL AGE: ALL CAUSE MORTALITY RATES
Creating the conditions for individuals and communities to take control over their health and lives and have political voice.
www.ucl.ac.uk/marmotreview