1. A perspective on health inequalities: health inequalities are everybody’s business. Dr Angela Donkin

2. 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

3. Health, Work-force, Pensions Costs and productivity

4. Policy Objectives: The Social Determinants of Health 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 a 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

5. A. Every child has the best start in life. Good level of development by IMD, 2011 figures.

6. Socio-emotional difficulties at age 3 and 5: Millennium Cohort Study Age 3Age 5 Kelly et al, 2010 Fully adjusted = for parenting activities and psychosocial markers

7. State of Play – early years + Importance of early years re-iterated by Frank Field and Graham Allen Reviews Focus has kept early years on the agenda despite lack of ring fenced grant Most children’s centres remain open Further extension of free childcare for children from lower income families Extension of national FNP and increase in numbers of health visitors - EYFS scores not good, in 2013 only 52% achieved a good level of development Increased targeting of resources yet significant issue across the social gradient and high levels of inequality Council spending cuts remain a risk

8. What can you do? An Equal Start – sets out those outcomes to chase and how to measure them Also Briefing from PHE on parenting coming out in the summer. DFE site and EIF. Ensure good UNIVERSAL provision – good parenting information for all, support for those in need. Ensure health visitors are knowledgeable regarding early intervention, attachment, reading, regular bedtimes etc. Reduce maternal stress Ensure companies have family friendly working practices Ensure adequate provision of good quality childcare

9. B. Enable all children and adults to have control over their lives. NEET levels in Wales, Swansea and Wrexham, 2005 - 2012.

10. What can I do? Briefing on building resilience in schools and NEETs coming out in the summer. Identify issues early Apprenticeship schemes for all Fair and open recruitment Raise standard of schools. London is a good example here.

11. FAIR EMPLOYMENT AND GOOD WORK FOR ALL AND A MINIMUM INCOME FOR HEALTHY LIVING

12. 6.7 million of the 13 million people in poverty are in working households, UK 2011/12 (JRF 2013 using DWP data)

13. State of play + After fall during the recession, employment rates are picking up Little change in level of low income, and maybe even a decrease in distance between top and bottom 10% (bottom 10% have nowhere to go to) _ Concern re. long term unemployed employment rates Adequacy of income has been dropping given benefit stagnation/wage restraint and inflation- 2008/9 – 2011/12 -Among the 20 million households whose minimum needs are calculated (JRF) the number falling short of an acceptable standard of living has increased by a fifth since 2008/9 - from 3.8 million to 4.7 million households. 28% of couple households with children; 42% of under 35s living alone; 67% of lone parent families. 9% of pensioners. Concern over quality of new work – zero hour contracts/self employment

14. What can you do? Understand your situation – use recession indicators Briefing regarding living wage and quality of work out in the summer. Be a living wage employer… ensure living wage is seen as a minimum Treat staff well and comply with HSE stress management guidelines, including on all issues including autonomy, reward-effort balance etc. Spread the word. Integrate these expectations into procurement policies that utilise public money to meet the social value act requirements.

15. Procurement In Halton How Social Value will be Embed through Procurement Developing a Social Value Policy for the Council Creation of “Social Value Opportunity Assessment” part of Pre procurement processes (SOP) o Bespoke approach - Not all procurement can capture Social Value o Aspiration to include where appropriate - Social Value Outcome(s) o Ensure this can be measured through selection/award o Build Social Value outcomes into awarded contracts o Principles of EU Procurement Law - Transparency/fair/proportionate etc. (below EU) o Next steps:  Draft Outcomes and Output Indicators - consultation  Social, Economic and Environmental themes in the Outcomes  Developing all of the above principles with Sefton MBC

16. Create and develop healthy and sustainable places and communities Much work ongoing to develop asset based approaches which could work to build self esteem, and then reduce negative health behaviours. E.g. People’s Health Trust – 46m. Well London. Need to develop improvements in health with community involvement.

17. What can you do? Briefing out in the summer Develop community based approaches alongside other effective approaches Encourage exercise outside Encourage active travel (to work) Keep parks open and develop them to include opportunities for outside exercise/fun.

18. Strengthen the role and impact of ill-health prevention Work across sectors Take a proportionate universalism approach – universal provision with more support for those who need it. Tackling the social determinants will make it easier to achieve health gains, more difficult to reduce inequalities without this Create a vision, a system and lead by example

19. Research and resources IHE have a team of researchers. Majority of work from WHO, DH, PHE.. But also take smaller commissions, local authorities, UNICEF, 4 Children etc. WHO European review Working with health professionals An Equal Start. Outcomes and measures to improve early years. Monitoring the impact of the recession and economic downturn http://www.instituteofhealthequity.org/ Forthcoming June. What works: early years, home to school transition, building resilience in schools, improving quality of work, living wage, improving access to green space, NEETs, older people in the work force, homelessness, overcrowding.. And more. Summer. 4 years on data – monitoring impact against marmot objectives (2 years on data on website) SD of infectious disease SDH of Mental Health (WHO) – next few weeks. Research programme for the next year

20. A new way If you keep doing the same thing… you can’t expect a different result..

21. Thank you. Contact details a.donkin@ucl.ac.uk http://www.instituteofhealthequity.org/