Pain delayed but not avoided
• Despite falls in GDP and employment, average
take-home incomes continued to grow in 2009-10
mainly driven by growth in income from benefits
and tax credits;
• “In 2011–12 and beyond, the coalition
government’s cuts to benefits and tax credits are
likely to reduce household incomes, all else being
equal”
Source: Poverty and Inequality in the UK: 2011
IFS Commentary 13th May 2011
Odds ratios (OR) for risk of mental illness in
people with increasing numbers of debts:GB
unadjusted (♦),
adjusted for income (■)
adjusted for income and key sociodemographic variables (age, ethnicity, marital status,
household size, household tenure, education, social class,employment status,
urban or rural, and region ( ).
Source: Jenkins et al 2008
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
Published by Friends of the Earth and
Marmot Review Team
Parliamentary Launch 12th May 2011
Direct health impacts - Mortality
• Excess winter deaths are almost three times higher in the
coldest quarter of housing than in the warmest quarter
• 40% excess winter deaths attributable to cardio-vascular
diseases
• 33% excess winter deaths attributable to respiratory
diseases
Direct health impacts - Morbidity
• Children living in cold homes more than twice as likely to
suffer from respiratory problems than children living in
warm homes
• More than 1 in 4 adolescents living in cold housing are at
risk of multiple mental health problems, compared to 1 in
20 adolescents in warm housing
• Cardio-vascular and respiratory diseases
• Mental health
• Colds and flu, exacerbates existing conditions such as
arthritis and rheumatisms
Indirect health and social impacts
• Cold housing negatively affects:
– children’s educational attainment, emotional well-being
and resilience
– family dietary opportunities and choices
– dexterity; and increases the risk of accidents and
injuries in the home
• Investing in the energy efficiency of housing can
help stimulate the labour market and economy, as
well as creating opportunities for skilling up the
construction workforce
We can do better –
international comparisons
Countries with more energy efficient housing have lower
excess winter deaths
Coefficient
of seasonal
variation in
mortality
Cavity wall Roof
Floor
Double
insulation insulation insulation glazing (%
(% houses) (% houses) (% houses) houses)
Finland
0.10
100
100
100
100
Germany
0.11
24
42
15
88
Netherlands 0.11
47
53
27
78
Sweden
0.12
100
100
100
100
Norway
0.12
85
77
88
98
Denmark
0.12
65
76
63
91
Belgium
0.13
42
43
12
62
France
0.13
68
71
24
52
Austria
0.14
26
37
11
53
Greece
0.18
12
16
6
8
UK
0.18
25
90
4
61
Ireland
0.21
42
72
22
33
Portugal
0.28
6
6
2
3
(Healy 2003)
Greener living environments: lower
Deaths from inequalities,
circulatory disease
health
England
Income group 4 is most deprived
Source: Mitchell & Popham, Lancet 2008
Marmot Review: 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
• Only 4 per cent of NHS funding is spent on
prevention
Average weekly alcohol consumption by
sex and socioeconomic class, GB: 2008
Mean number
of units a week
ONS General Lifestyle Survey 2008
Alcohol-attributable hospital admissions by
small area deprivation quintile in England,2006-07
Action on the wider determinants - to tackle
health inequalities
•
“Every sector a health sector”
•
Local authorities, Health and Social Services,
Voluntary Sector have a key role to play at local
level
•
Empower individuals and communities – create
the conditions for people to take responsibility
www.marmotreview.org
Marmot Review: recommended targets
Across the social gradient:
• Life expectancy
• Healthy life expectancy
• Readiness for school
• Young people not in education, employment or
training
Target that progressively increases:
• Proportion of households that have an income,
after tax and benefits that is sufficient for healthy
living
Public Health White Paper recognises:
• that disadvantage accumulates over lifetime;
• the need to address the wider determinants of
health;
• and approved the use of proportionate
universalism as in Fair Society Healthy Lives
• role of local authorities in leading on public health
in partnership with the NHS
But:
• Giving local communities control is challenging
when they face budget cuts of 20-25%;
• “responsibility deals”
– Evidence from history suggests that public health
advances – clean water, reduction of air pollution,
healthier working conditions, reduction in drink-driving –
have come to greater degree from action by local and
central government than by voluntary agreements with
industry.
• While the White Paper picked up five of the six
domains of recommendations from the Marmot
Review it was silent on ensuring a healthy
standard of living for all
Cost-Related Access Problems in the Past Year, by Income
(Adjusted) percent
experienced at least one
of three problems**
Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—
insurance status.
* Indicates significant within-country differences with below-average income (p < 0.05).
** Did not fill/skipped prescription, did not visit doctor with medical problem, and/or did not get recommended care.
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Percentage shares of equivalised total gross and post-tax income,
by quintile groups for all households, 1978 – 2007/8
Trends in income share among top income
decile, US: 1913-2007
Source: Piketty and Saez (2003), series updated to 2007 by Saez in 2009
International comparisons of income mobility
Higher score = lower intergenerational mobility
Source: Blanden (2009) in NEP 2010.
Good Society?
1. Health inequalities
Health and the distribution of health as social
accountant
2. The causes of the causes
Every Minister a Health Minister
3. Fundamental drivers
• Health inequalities are not inevitable or immutable
Age standardised mortality rates by socioeconomic (NS SEC) in
the North East and South West regions, men aged 25-64, 2001-03
SMRs by cause, all ages:
Glasgow relative to Liverpool & Manchester
All ages, both sexes: cause-specific standardised mortality ratios 2003-07, Glasgow relative
to Liverpool & Manchester, standardised by age, sex and deprivation decile
Calculated from various sources
350
300
248.5
229.5
Standardised mortality ratio
250
200
168.0
150
126.7
112.2
111.9
All cancers
(malignant
neoplasms)
Circulatory system
131.7
100
50
0
Lung cancer
External causes
Suicide (inc.
undetermined intent)
Alcohol
Drugs-related
poisonings
Source: Walsh D, Bendel N., Jones R, Hanlon P. It’s not ‘just deprivation’: why do equally deprived UK cities experience different health outcomes? Public Health, 2010
from H Burns, CMO, Scotland
Health improvement in difficult times
• A major element of the excess risk of
premature death seen in Scotland is
psychosocially determined
• Study evidence of low sense of control,
self efficacy and self esteem in
population in these areas
Source: H. Burns, CMO Scotland
A Fair Society
Conditions in which
individuals &communities:
Have control over their
lives
and
Participate fully in society
Website www.marmotreview.org