1. Health Inequalities in the New Public Health System
28th February 2012
Dr Jessica Allen
Deputy Director
Marmot Review Team
Institute of Health Equity
UCL

2. New Public Health System
Move to local authorities
Money?
Focus – health services or SDH?
Leadership
CCGs?
Population focus? – registration
Funding?
Health inequalities?
NHS Workforce?

3. Health and Wellbeing Throughout Life
Empowering Local Government and Communities
Taking a life course approach
Giving every child the best start in life
Making work pay
Designing communities for active aging and sustainability.
Collaborative working with business and the voluntary sector
A new public health system with strong local and national leadership.
Minimum Income for Health Living?

5. Approach for new public health system tackling health inequalities

6. Fair Society, Healthy Lives (The Marmot Review)
Health inequalities are not inevitable or immutable
Health inequalities result from social inequalities - ‘causes of the causes’ – the social determinants
Focusing solely on most disadvantaged will not be sufficient - need ‘proportionate universalism’
Reducing health inequalities vital to economy - cost of inaction

8. Strategic Drivers: 6 key policy objectives of Fair Society, Healthy Lives.
Give every child the best start in life
Enable all children, young people and adults to maximise their capabilities and have control over their lives
Create fair employment and good work for all
Ensure healthy standard of living for all
Create and develop healthy and sustainable places and communities
Strengthen the role and impact of ill health prevention

9. Policy Development and delivery – all levels
Cross government and cross-sectoral
Proportionate universal
Health equity in all policies
International, national and local – multi levelled approach
Partnership working
Involving communities
Public health leadership

10. Interventions and strategies

11. X Framework Early Years Prevention and Regulation
E.g. Smoking ban in public places.
Standard of Living
E.g. Tackling debt problems.
Employment and Work
E.g. Address stress at work.
Communities and Places
E.g. Reducing environmental inequalities.
Delivery system
E.g. BLT Strategy
E.g. Advertising campaigns
E.g. Free NRT
Delivery system
E.g. Feeling good about where you live
Education and Skill Development
E.g. Reduce the number of NEETs.
E.g. Weight management programmes
Delivery system
E.g. Swansea and Wrexham
E.g. 5-a-day campaign X
E.g. Stop smoking programmes
E.g. School educational programmes
Delivery system
E.g. Birmingham Brighter Futures
Downstream interventions
Equity
E.g. Reducing population groups’ differences in PPHCs
Early Years
E.g. Increase children and family services.
Framework

12. The risk of fuel poverty according to household income, England 2009

13. Resilience 13

14. Educational attainment is a predictor of health outcomes.
Higher educational attainment is associated with healthier behaviour.
There is a gradient in limiting illness by level of educational attainment.
There is a gradient in mortality by educational attainment.
Education and Skills

16. Local government approach

17. Local Government
Complex, disparate and diverse systems of Local Government.
Focus on needs of local population and place.
Differing capacities to orchestrate action to address the social determinants of health.

18. How? Whole System Leadership. Involving elected members
Public health in all sectors - Links with other sector
Areas of focus – early years, transport, planning, education, fuel poverty etc.
Co-production
Increasing participation and empowering communities.

19. Creating conditions in which individuals and communities have control over their health and lives and participate fully in society.