Transcript No Slide Title

NATIONAL SYMPOSIUM ON AGEING
RESEARCH
Canberra
24 September, 2003
“Linking research, policy and practice”
Michael Marmot
International Centre for Health and Society
UCL
TRANSLATING RESEARCH
EVIDENCE INTO POLICY
SUCCESSES AND FAILURES
TRANSLATING RESEARCH
EVIDENCE INTO POLICY
SUCCESSES
All Cause Mortality by Grade of Employment
Whitehall Men 25 year Follow-up
Relative rate
Admin
2
1.9
1.8
1.7
1.6
1.5
1.4
1.3
1.2
1.1
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
Prof/Exec
Clerical
Other
40-64yrs
64-69yrs
Marmot and Shipley, 1996
70-89yrs
Independent Inquiry into
Inequalities in Health
REPORT
CHAIRMAN: SIR DONALD ACHESON
GENERAL RECOMMENDATIONS
1.
Health Inequalities Impact Assessment
All policies to favour the less well-off.
 2. High priority to women of childbearing
age, expectant mothers and young children.
3. Further steps to reduce income
inequalities and improve living standards of
poor households.
Independent Inquiry into Inequalities in Health
AREAS FOR FUTURE POLICY
DEVELOPMENT (1)
 POVERTY &
INCOME
 HOUSING AND ENVIRONMENT
 EDUCATION
 MOBILITY, TRANSPORT, POLLUTION
 EMPLOYMENT
 NUTRITION
 NATIONAL HEALTH SERVICE
Independent Inquiry into Inequalities in Health
AREAS FOR FUTURE POLICY
DEVELOPMENT (2)
 MOTHERS AND
FAMILIES
 OLDER
PEOPLE
 ADULTS OF WORKING AGE
 GENDER
 ETHNICITY
Independent Inquiry into Inequalities in Health
Tackling Health Inequalities
Summary of the 2002
Cross-Cutting Review
HM TREASURY
National Targets for Tackling
Health Inequalities
Infant Mortality (Deaths in the first year of life)
“Starting with children under one year, by 2010
to reduce by at least 10% the gap in mortality
between routine and manual groups and the
population as a whole”
 Expectation of Life “Starting with local
authorities, by 2010 reduce by at least 10% the
gap between the fifth of areas with the lowest life
expectancy at birth and the population as a
whole.”

TRANSLATING RESEARCH
EVIDENCE INTO POLICY
FAILURES?
STRATEGIES FOR BUILDING
RESEARCH CAPACITY
WHY DO WE NEED
INTERDISCIPLINARY RESEARCH?
Material
factors
Social
structure
Work
Social
Environment
Psychological
Brain
Neuroendocrine and
immune
Health
Behaviours
Patho-physiological
changes
Organ impairment
Early
Life
Genes
Culture
Well-being
Mortality
Morbidity
EPIDEMIOLOGY
 STATISTICS
 SOCIOLOGY
 SOCIAL PSYCHOLOGY
 PSYCHOBIOLOGY
 NEURENDOCRINOLOGY
 ECONOMICS
 MOLECULAR GENETICS

FUNDING INTERDISCIPLINARY
RESEARCH
FUNDING INTERDISCIPLINARY
RESEARCH?
RESEARCH INTO AGEING
 Ageing
 Needs
as a lifelong process
of older people
THE NATIONAL RESOURCE OF LARGE
LONG-TERM COHORT STUDIES
Study
Year of birth
Sample size
Location of data
ELSA*
1900-1951
(N=16,000)
UCL
Whitehall 2*
1930-50
(N=10,308)
UCL
NSHD*
1946
(N= 5,362)
UCL
NCDS*
1958
(N=17,414)
IOE
BCS70
1970
(N=17,198)
IOE
ALSPAC*
1991-2
(N=14,000)
Bristol
Millennium
2000-1
(N=20,000)
IOE
Birth
1-5 years
6-16 years
Early Adulthood 17-30 yrs
Early & Middle Adulthood
31-45 years
Later Middle Adulthood
46-65 years
Later Life 66+
• has or is about to collect DNA

data collection period
1946 cohort:
1958, 1970 & Millennium cohorts:
ALSPAC:
ELSA & Whitehall:
www.nshd.mrc.ac.uk
www.cls.ioe.ac.uk
www.alspac.bristol.ac.uk
www.ucl.ac.uk
RESEARCH INTO AGEING
The English Longitudinal
Study of Ageing
(ELSA)
General Background
The English Longitudinal Study
of Ageing (ELSA)
Research team
 International Centre for Health and
Society, UCL
 Institute for Fiscal Studies and UCL
 National Centre for Social Research
 plus researchers from Cambridge,
Oxford, Nottingham
Funding from NIA and UK government
 Health
Key Research Areas
trajectories, disability and healthy life
expectancy
 The relationship between economic position and
health
 The determinants of economic position in older
age
 The timing of retirement, and post retirement
labour market activity
 The nature of social networks, support and
participation
 Household and family structure, and the transfer
of resources
Broad questionnaire coverage
 Demographics
 Health
 Social
participation
 Housing
 Employment and earnings
 Pensions and retirement
Broad questionnaire coverage (cont)
 Income
and assets
 Cognitive function
 Psychosocial
 Expectations
 Measurements
 Self completion (social support, GHQ12, Beck
depression inventory)
Collaboration with UK panel
studies
 1946
birth cohort
 Whitehall
II
– Testing of explanations for inequalities in
health
– Cohort growing older and retiring
Collaboration with UK panel
studies
 1946
birth cohort
 Whitehall
II
 BHPS
– Full age cross-section
– Focus on older people in 2002 wave
– Sharing of topics and measures
Comparative issues
 Ex-ante
policy evaluation difficult
 Understanding causal relationships difficult
 Comparative data can:
– Help understand differences between countries
– Expand sources of variation available to
researchers (conditional on enough observables to
make the comparison valid)
– Help examine role of institutions directly
 Principal
international comparators: Health
and Retirement Study (HRS), SHARE
ELSA will look quite like HRS
 Two-yearly
frequency
 Exit interview (post mortality, with proxy)
 Modular structure + core content
 Unfolding brackets
 Financial respondent
 Expectations
 But with some differences:
–
–
–
–
biomedical health data
cognitive function
psychosocial factors
Face to face waves 1 and 2 (plus nurse visit wave 2)
FUTURE DIRECTIONS FOR
AUSTRALIA?