Transcript Marmot in Practice - Social Services Research Group

Jim McManus,
Joint Director of Public Health
Birmingham City Council and NHS
The response to the JSNA took everyone
by surprise.....
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Introduction to context of Marmot
Relevance to Health & Social Care
Integration
Relevance to JSNA
Examples of use in Practice
Over to you
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The elements which make for a healthy
society are multi-faceted
Our frameworks and systems are not
JSNA has an almost impossible task
Everyone knows what they want the Health
and Wellbeing Strategy to do...nobody wants
to do it
Need to plan across the lifecourse
Forward
Comrades!
The JSNA has
solved all our
problems!
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1. Adopt the Outcomes
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Starting well
Developing well
Living well
Working well
Ageing well
2. Add an objective
“dying well”
3.Cut our JSNA and
Strategy across the
Lifespan
4. Use as “golden thread”
(still under construction)
Activities
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For Health Inequalities
Action
For JSNA
For Health and
Wellbeing Strategy
For Integration
As a lifecourse
approach to human
ecology
Framework
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Lifecourse approach
using Marmot
Early development
Mental health
problems onset
Tasks for each
lifestage
Community and Public
Sector tasks
Interdependencies
LGBT MENTAL HEALTH
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Use of Marmot
Framework across
lifecourse
Tasks for adult social
care and older adult
social care elucidated
Incorporation into third
sector contracts with
third sector
Preventive workstream
PREVENTION
Areas of action
Sustainable communities and places
Healthy Standard of Living
Early Years
Skills Development
Employment and Work
Prevention
Accumulation of positive and negative
effects on health and wellbeing
Prenatal
Pre-school
School
Training
Employment
Family building
Life course stages
Retirement
The Conceptual Framework
Reduce health inequalities and improve health and well-being for all.
Create an enabling society that
maximises individual and
community potential.
Ensure social justice, health and
sustainability are at heart of
policies.
Policy objectives
A.
Give every child the
best start in life.
C.
Create fair
employment and good
work for all.
B.
Enable all children,
young people and
adults to maximise
their capabilities and
have control over their
lives.
E.
Create and develop
healthy and
sustainable places
and communities.
D.
Ensure healthy
standard of living for
all.
Policy mechanisms
Equality and health equity in all policies.
Effective evidence-based delivery systems.
F.
Strengthen the role
and impact of ill
health prevention.
100
Socio Economic Status
High SES
Low SES
High Q at 22m
90
Average position in distribution
80
70
60
50
40
30
20
Low Q at 22m
10
0
22
26
30
34
38
42
46
50
54
58
62
66
70
74
78
82
86
90
94
98
102 106 110 114 118
months
Source: Feinstein, L. (2003) ‘Inequality in the Early Cognitive Development of British Children in the 1970 Cohort’, Economica (70) 277, 73-97
Average percentile score
Waldfogel & Washbrook 2008
Life expectancy and disability free life expectancy at birth, persons by
neighbourhood income level, England, 1999-2003
Age
85
80
75
70
65
60
55
Life expectancy
DFLE
50
Pension age increase
2026-46
Poly. (DFLE)
45
0
5
10
15
Source: ONS
20
25
30
35 40 45 50 55 60 65 70 Poly.
75 (Life
80 85
90 95 100
expectancy)
Neighbourhood Income Deprivation
(Population Percentiles)
Reducing health inequalities is a matter of fairness
and social justice – inequality is avoidable.
Action is needed to tackle the social gradient in health
– Proportionate universalism
Action on health inequalities requires action across all
the social determinants of health avoiding lifestyle
drift
Reducing health inequalities is vital for the economy –
cost of inaction
A move beyond economic growth to well-being of
society: sustainability and the fair distribution of
health
Each year, if all had the mortality rate of
1) those with university education:
 Prevent 202,000 people aged 30+ dying
prematurely (40 % of deaths);
 2.5 million life years gained ;
2) those in most affluent 10% of areas:
 2.8 million extra years of life free from
limiting illness or disability
Estimates calculated for Marmot Review based on ONS data
1) Give every child the best start in life.
Priority objectives
1. Reduce inequalities in the early development of physical and
emotional health, and cognitive, linguistic, and social skills.
2. Ensure high quality maternity services, parenting programmes,
childcare and early years education to meet need across the
social gradient.
3. Build the resilience and well-being of young children across the
social gradient.
Focus Group respondent – Single Parent in Manchester:
“I’m not mentally ok because I’m doing too much, but then
how am I helping my children?”
2) Enable all children, young people and adults to
maximise their capabilities and have control over their
lives.
Priority objectives
1. Reduce the social gradient in skills and qualifications.
2. Ensure that schools, families and communities work in
partnership to reduce the gradient in health, well-being and
resilience of children and young people.
3. Improve the access and use of quality lifelong learning across the
social gradient.
Focus Group Respondent ,Birmingham
“If there is no education, there are no jobs these days, so it really is
worrying. If your children don’t get a good education then what’s
going to happen to them”
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Life expectancy (Years of Life)
Health expectancy (quality of years)
Wellbeing. (when developed)
Readiness for School
Young People not in education or
unemployment.
Increase in proportion of households with
an income sufficient for healthy living.
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JSNA (Birmingham,
Lincolnshire, E Mids, Mcr)
Health Inequalities
Strategy (London,
Tracking Progress (LHO,
Wales)
Sustainable Community
Strategy (Birmingham)
Health and Wellbeing
Strategy (Bham)
An overview
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Pragmatism
What works for you
Bridging framework
Analysis tool
Outcomes tracker
Strategic Tool
A way to getting to
lifecourse
commissioning
Principles
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Marmot gives us the best possible statement
of evidence on the challenges of health
inequalities
Evidence appraisal leads to outcomes and
Policy Objectives
Marmot as Bridging Framework
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1. Adopt the Outcomes
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
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Starting well
Developing well
Living well
Working well
Ageing well
2. Add an objective
“dying well”
3.Cut our JSNA and
Strategy across the
Lifespan
4. Use as “golden thread”
(still under construction)
Activities





For Health Inequalities
Action
For JSNA
For Health and
Wellbeing Strategy
For Integration
As a lifecourse
approach to human
ecology
Framework
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Adoption of Framework by HWBB and LSP
The JSNA is constructed according to
outcomes
Prioritisation being developed according to
Marmot Outcomes
Health and Wellbeing Strategy using Marmot
Marmot Group – Joint NHS and LA Group on
the “what of health inequalities work”
Start Well
Adults &
High priority
Communitie parents in touch
s
with A & C
Develop Well
Age Well
Transition
Older Peoples’
offer from
prevention to
very high need
Homes &
Neighbourh
oods
Overcrowding and Decent Homes
infant mortality
Standard
Access, Trips,
Falls, Extreme
Weather,
Adaptability,
Developme
nt
Back to work
packages
Digital inclusion
Volunteering
and work
packages
Digital Inclusion
NHS
Infant Mortality
Conception
Back to work
packages for
parents
Digital Inclusion
Frail Elderly
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JSNA refresh in draft
HWBS in drafting process
Commissioning for older people
Prevention programme
LGBT Health Strategy
Faith Community Strategy
Joint Health Inequalities Plan
Vision for Public Health Reorganisation
Thank you!
[email protected]