1. Social determinants, mental health and development Michael Marmot UCL Sept 16 th 2010 New York

2. Health inequalities matter Social Justice Empowerment Material Psychosocial political Creating conditions for people to lead flourishing lives

3. Early child development and education Healthy Places Fair Employment Social Protection Universal Health Care Health Equity in all Policies Fair Financing Good Global Governance Market Responsibility Gender Equity Political empowerment – inclusion and voice CSDH – Areas for Action

4. Risk factors for depression Level of evidence Low socioeconomic positionVery convincing Low educationVery convincing Unemployment and under employment Very convincing Food insecurity and early nutrition deficiency Strong Gender inequityStrong Low incomeStrong WHO CSDH PPHC KN 2007

5. Odds ratio for depressive symptoms by presence of social deprivation at different phases of life course: Eastern European countries From Nicholson et al J Affective Disorders 2008

6. Early life Early child development and education

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

8. Long term outcomes associated with childhood behavioural problems (New Zealand study) OR Source: L. Friedli & M. Parsonage (2007) Mental health promotion: Building an economic case. Based on: Fergusson et al (2005) J. Child Psychl & Psych 46 (8): 837-849

9. Healthy Places Urban design – good urban design can encourage social cohesion – exercise - benefits for mental health – green spaces

10. Gender Equity Higher risk of depression in women – Multiple responsibilities with no financial gain – Caring responsibilities – Lack of support – Gender based violence – Access to health care – Poor physical health – Level of education – Autonomy in decision making – Migration

11. ODDS OF DEPRESSION BY CONTROL AT WORK & AT HOME WITHIN GRADE - WOMEN WHITEHALL II odds ratios EMPLOYMENT GRADE Griffin et al, Soc Sci Med, 2002 High Medium Low

12. Fair employment Employment conditions – Stress in the workplace increases the risk of disease.

13. DEPRESSION AND EFFORT-REWARD IMBALANCE: RUSSIA, POLAND, CZECH *Adjusted for age, sex and centre (Pikhart et al. Soc Sci Med, 2004 58:1475-82) Quartiles of effort-reward ratio

14. Older ages

15. Loneliness by wealth % often/some of the time (except for Feel in tune with people around where % refers to hardly ever/never)

16. Social Protection

17. Minimum income for healthy living – Morris et al. –Diet –Physical activity/body and mind –Psychosocial relations/social connections/active minds –Getting about –Medical care –Hygiene –Housing Morris et al 2007

18. www.who.int/social_determinants/en