FROM RESEARCH TO POLICY ON INEQUALITIES IN HEALTH Michael Marmot International Centre for Health and Society University College London LONDON PUBLIC HEALTH NETWORK Tackling Health Inequalities Special Event 25th February 2003

Metaphorical Male Height UK 1960s-1990s Height (cms) V IV IIIm IIInm II I V IV IIIm IIInm II I SOCIAL CLASS 1960s 1990s

LIFE EXPECTANCY BY SOCIAL CLASS I & V, MALES & FEMALES ENGLAND & WALES Years MALES FEMALES Health Statistics Quarterly,

SOCIAL DETERMINANTS OF HEALTH THE SOLID FACTS WHO EUROPE HEALTHY CITIES, HEALTH FOR ALL INTERNATIONAL CENTRE FOR HEALTH AND SOCIETY, UCL

Social Gradient u People’s social and economic circumstances affect health throughout life, so health policy must be linked to the social and economic determinants of health.

Stress u Stress harms health

Early Life u The effects of early development last a life-time: a good start in life means supporting mothers and young children.

Youth Literacy Scores (16-25 Years) and Parents’ Education Literacy score Parents’ Education (Years) Willms 1997

Social Exclusion u Social exclusion creates misery and costs lives.

SOCIAL COHESION AND TRUST u People here willing to help neighbours u This is a close-knit neighbourhood u People in this neighbourhood can be trusted u People here don’t get along u People don’t share the same values (Sampson, Science 1997)

Work u Stress in the workplace increases the risk of disease.

Unemployment u Job security increases health, wellbeing and job satisfaction.

Social Support u Friendship, good social relations and strong supportive networks improve health at home and in the community.

Addiction u Individuals turn to alcohol, drugs and tobacco and suffer from their use. Use is influenced by the wider social setting.

Food u Healthy food is a political issue.

Transport u Healthy transport means reducing driving and encouraging more walking and cycling, backed up by better public transport.

Independent Inquiry into Inequalities in Health REPORT CHAIRMAN: SIR DONALD ACHESON

GENERAL RECOMMENDATIONS u 1. Health Inequalities Impact Assessment All policies to favour the less well-off. u 2. High priority to women of childbearing age, expectant mothers and young children. u 3. Further steps to reduce income inequalities and improve living standards of poor households. Independent Inquiry into Inequalities in Health

AREAS FOR FUTURE POLICY DEVELOPMENT (1) u POVERTY & INCOME u HOUSING AND ENVIRONMENT u EDUCATION u MOBILITY, TRANSPORT, POLLUTION u EMPLOYMENT u NUTRITION u NATIONAL HEALTH SERVICE Independent Inquiry into Inequalities in Health

AREAS FOR FUTURE POLICY DEVELOPMENT (2) u MOTHERS AND FAMILIES u OLDER PEOPLE u ADULTS OF WORKING AGE u GENDER u ETHNICITY Independent Inquiry into Inequalities in Health

National Targets for Tackling Health Inequalities u Infant Mortality (Deaths in the first year of life) “Starting with children under one year, by 2010 to reduce by at least 10% the gap in mortality between routine and manual groups and the population as a whole” u Expectation of Life “Starting with local authorities, by 2010 reduce by at least 10% the gap between the fifth of areas with the lowest life expectancy at birth and the population as a whole.”

Tackling Health Inequalities Summary of the 2002 Cross-Cutting Review HM TREASURY

Context of Government Action on Health Inequalities Key programmes in addressing poverty and disadvantage: *The Child Poverty Strategy *Quality Local Services - White Paper *The NHS Plan and Saving Lives - White Paper *Schools Achieving Success - White Paper

Context of Government Action on Health Inequalities Further key programmes in addressing poverty and disadvantage: *The National Strategy for Neighbourhood Renewal - Action Plan *The National Housing Strategy *The UK Fuel Poverty Strategy *Securing Our Future Health: Taking a Long-Term View - The Wanless report

Key Government Strategies in Tackling Inequalities in Health Breaking the cycle of health inequalities *Reducing poverty (especially child poverty) through tax and benefit systems *Raising the educational attainment of disadvantaged children *Reducing smoking among pregnant women *Reducing the number of teenage pregnancies

Breaking the cycle of health inequalities (further strategies) *Providing high quality antenatal, maternal and child care services with greater focus on low income groups *Improving educational, social and emotional development of children (0- 5 years) from disadvantaged backgrounds *Improving rates of breastfeeding and maternal and infant nutrition

Key Government Strategies in Tackling Inequalities in Health Tackling the major killers *promoting smoking cessation and tobacco education in manual socioeconomic groups *improving access to health services for CHD and cancer among disadvantaged groups *improving diet and nutrition of children and disadvantaged groups

Key Government Strategies in Tackling Inequalities in Health Tackling the major killers *promoting greater physical activity among children and disadvantaged groups *reducing work related ill health and injury *reducing illness and death by accidental injury especially among children in low income families

CHANGE IN INCOME FOR RICH AND POOR - UK BUDGETS Gain % income Poorest Richest 10% Institute for Fiscal Studies, 2002

Delivery Plans?