Fair Society, Healthy Lives
Building Action
Dr Jessica Allen
Deputy Director,
UCL Institute of Health Equity
Jessica.allen@ucl.ac.uk
Action on inequalities depends on:
Political Leadership
Sector Leadership
– Evidence
– Financial case
– Delivery and implementation
– Levers and accountabilities
– Advocacy and persistence
Political leadership
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WHO
Health system
National governments
Local governments
Individuals – health system and beyond
Key principles
• Social justice
• Material, psychosocial,
political empowerment
• Creating the conditions
for people to have
control of their lives
www.who.int/social_determinants
2010
commissioned
by labour
implemented
by coalition govt
Cross party support
Evidence
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
Key themes
Reducing health inequalities is a matter of fairness and
social justice
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
Reducing health inequalities is vital for the economy –
cost of inaction
Beyond economic growth to well-being
Cost of Inaction
• In England, dying prematurely each year as a result of
health inequalities, between 1.3 and 2.5 million extra
years of life.
• Cost of doing nothing
• 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.
• Lots of reports and building cost evidence where
possible.
– European Review
– Reports about fuel poverty, green spaces, hospitals,
heath professionals, children centres
– And evidence for local action (phe)
Delivery and implementation
Areas for action – the life course.
Do something... do more... do better
• Where there is very little in place in terms of
policies on social determinants of health,
“some” action matters.
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Where policies do exist, they can be improved
to deal with large and persistent health
inequities
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There is scope to do better on inequities even
in the richest areas.
LOCAL IMPACT: DH remit
• Local authorities
–75% of local authorities have been
significantly influenced by Marmot,
evidence by their Health and Wellbeing Strategies and JSNAs (joint
Strategic Needs Assessments)
–We have worked directly with 40 plus
local authorities
National advice
• advisory roles
• Select committees
• Working with core DH teams
• Advocacy – Ministerial and cross
departments
Accountabilities and levers
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”
Marmot indicators for local authorities
• Male and female life expectancy
• Slope indices of inequality (SII) for male and female life
expectancy
• Slope indices of inequality (SII) for male and female disabilityfree life expectancy
• Children achieving a good level of development at age 5
• Young people who are not in education, employment or training
(NEET)
• People in households in receipt of means-tested benefits
• Slope index of inequality for people in households in receipt of
means-tested benefits
• Lancashire 2012
Context – economic downturn, recession,
austerity – uneven growth
Fair Society: Healthy Lives: some areas for concern
A. Give every child the best start in life
- Funding issues, child poverty
B. Enable all children, young people and adults to maximise their
capabilities and have control over their lives
- Skills training, NEETS, whole school approaches
C. Create fair employment and good work for all
- Youth unemployment, contract workers, insecure employment,
involuntary part-time working, ALMP policies
D. Ensure healthy standard of living for all
- Minimum income standard, minimum wages, benefit caps
E. Create and develop healthy and sustainable places and
communities
- Green policies, social isolation, housing
F. Strengthen the role and impact of ill health prevention
- Cost inflation, resource allocation, demographic pressures
• 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:
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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
Advoacy and persistence
• Lots of it!
Thank you
www.instituteofhealthequity.org