Dr Jessica Allen Deputy Director IHE Health Inequalities 29 October 2014

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

Health inequalities Social justice – the worst inequality of all. Material, psychosocial, political empowerment Creating the conditions for people to have control of their lives the conditions in which we are born, grow, live, work and age

A.Give every child the best start in life B.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 all 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 Fair Society: Healthy Lives: 6 Policy Objectives

Cost of Inaction Action taken to reduce health inequalities will benefit society in many ways. It will have economic benefits in reducing losses from illness associated with health inequalities. Each year in England these account for: –productivity losses of £31-33B –reduced tax revenue and higher welfare payments of £20-32B and –increased treatment costs well in excess of £5B.

Making the case and getting prioritisation 75% of local authorities have Marmot principles central in public health strategic direction

But, number of obstacles to further prioritisation and implementation We don’t know what to do Its not our role and remit (health care sector, national government role) Investment is difficult, no money available Difficult to prioritise – not high on the political or public agenda No clear accountability, incentives, enforcements Cross cutting work difficult

To prioritise politically and ensure implementation Evidence Practical Cost efficacy Public support Wider system and cross government support Measurement and monitoring Accountability Leadership

EG EARLY YEARS Evidence of inequalities lead to poor health Evidence of positive intervention impacts Evidence of cost efficacy Continue to build evidence

Report on impact of demographic change, recession and welfare reform on health inequalities in London and production of indicators to monitor and measure impact.

Evidence from previous economic downturns suggests that population health will be affected: More suicides and attempted suicides; possibly more homicides and domestic violence Fewer road traffic fatalities An increase in mental health problems, including depression, anxiety and lower levels of wellbeing Worse infectious disease outcomes such as TB + HIV Negative longer-term mortality effects Health inequalities are likely to widen

Recession indicators Piloted in 4 boroughs in London Report and analysis set-the-impact-of-the-economic-downturn-and- policy-changes-on-health-inequalities-in-london 4 Domains EMPLOYMENT INCOME AND MIGRATION OF VULNERABLE FAMILIES HOUSING HEALTH AND WELLBEING

Marmot indicators Accountability, evidence and prioritisation

2014 indicators in a spine chart format, - Healthy life expectancy at birth - males and females - Life expectancy at birth - males and females - Inequality in life expectancy at birth - males and females - People reporting low life satisfaction - Good level of development at age 5 - Good level of development at age 5 with free school meal status - GCSE achieved (5A* - C including English and Maths) - GCSE achieved (5A* - C including English and Maths) with free school meal status year olds who are not in employment, education or training - Unemployment % (ONS model-based method) - Long-term claimants of Jobseeker's Allowance - Work-related illness - Households not reaching Minimum Income Standard - Fuel poverty for high fuel cost households - Percentage of people using outdoor places for exercise/health reasons

Deprivation level Best performing local authority-females Healthy life expectancy at birth- females 1 – most deprived Greenwich63.3 2Brighton and Hove66.5 3Kensington and Chelsea67.5 4Barnet – least deprived Wokingham71 DeprivationBest performing local authority-males Healthy life expectancy at birth- males 1 – most deprived Brent63.2 2Enfield64.4 3Kensington and Chelsea66.7 4Barnet – least deprived Richmond Upon Thames70 Learn from best performing local authorities by deprivation level.

Levers - legislation Equalities Inequalities Social value

Health Inequalities legislation Legal duties to reduce health inequalities for the first time Platform for joining up health services, social care services and health-related services at local level

Social Value Act Act 2012 public bodies in England and Wales must consider: How what is being proposed to be procured might improve the economic, social and environmental well-being of the relevant area, and How, in conducting the process of procurement, it might act with a view to securing that improvement”

Thank you