Transcript Review on Social Determinants of Health and the Health

Health Inequalities
29 October 2014
Dr Jessica Allen
Deputy Director
IHE
www.instituteofhealthequity.org
Key principles
• Social justice
• Material,
psychosocial, political
empowerment
• Creating the
conditions for people
to have control of their
lives
www.who.int/social_determinants
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
Fair Society: Healthy Lives:
6 Policy Objectives
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
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
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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
www.instituteofhealthequity.org/projects/indicatorset-the-impact-of-the-economic-downturn-andpolicy-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
- 19-24 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
Learn from best performing local authorities by
deprivation level.
Life expectancy and healthy life expectancy at
birth females 2010-12, by IMD deprivation
quintile
Life expectancy and healthy life expectancy
at birth, males, 2010-2012, by IMD
deprivation quintile
90
85
80
75
70
65
60
55
50
45
40
90.0
80.0
70.0
60.0
50.0
40.0
0
0
1
2
3
Healthy life expectancy at birth - females
4
5
Best performing local
authority-females
1 – most
deprived
2
3
4
5 – least
deprived
Greenwich
Healthy life
expectancy at
birth- females
63.3
Brighton and Hove
Kensington and Chelsea
Barnet
Wokingham
66.5
67.5
69.9
71
2
3
4
5
Life expectancy ar birth -males
Female LE at birth
Deprivation
level
1
Healthy life expectancy at birth - males 2010-12 years
Deprivation
Best performing local
authority-males
1 – most
deprived
2
3
4
5 – least
deprived
Brent
Healthy life
expectancy at
birth- males
63.2
Enfield
Kensington and Chelsea
Barnet
Richmond Upon Thames
64.4
66.7
68.9
70
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
www.instituteofhealthequity.org