Dr Mike Grady
Marmot Review Team.
UCL.
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
Give every child
the best start in
life.
Create fair
employment and
good work for
all.
Enable all
children, young
people and
adults to
maximise their
capabilities and
have control
over their lives.
Create and
develop healthy
and sustainable
places and
communities.
Ensure healthy
standard of
living for all.
Policy mechanisms
Equality and health equity in all policies.
Effective evidence-based delivery systems.
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 lean times
• In England, dying prematurely each year as a
result of health inequalities between 1.3 and 2.5
million extra years of life lost – the human cost200000 deaths of 30+.
• 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
– increased treatment costs well in excess of £5B.
Making it happen – A framework for delivery
• Increased disability free life expectancy and reduction in
inequalities across the gradient.
• Empowering people : securing community solutions.
• Intergovernmental action with dedicated leadership and
executive team.
• National Policies need effective local deliver focussed on
health equity in all policies.
• New model of civic and public sector leadership grounded in
democracy and whole system thinking
• Local Strategic Partnerships of Councils, NHS, 3rd Sector and
Private Sector creating the conditions where individuals and
communities take control.
• Comprehensive, systematic, scaled up,coproduced action
focussed on the social determinants of health.
Partnerships with individuals and communities
• Critical success factor in addressing health inequalities through
empowerment – creating the conditions in which people can take
control
– Bespoke individual responses
– Population focused approaches
• Asset based partnership – half full not half empty
–
–
–
–
Sharing power
Community led and long term
Shift in values and attitudes
Leadership and knowledge transfer.
• Shared aspirations in improving health and wellbeing
– Perceptions of local schools, health and social care service, housing
type,employment,safety and social cohesion.
• Balancing long-term gains and short-term pressures.
Evaluating partnerships
• Process issues
– Engagement of Senior
managers in
partnership
– Reorganisation impact
– Lack of financial and
human resources
– Information sharing
and best practice
– Coterminosity
– Need for quick wins
• Outcomes
– Health outcomes
– Monitoring and
evaluation problems
Perkins et al (2009) What counts is what works? New Labour and partnership in public health. Policy Press
Public Health Workforce
A Theory of Maturing Partnerships for Health Improvement
Process factors
No shared vision
Confidence in partners
Dominant partner
Shared identity
Top down
Project focussed
Quick wins
Funding constraints
Grant giving
Immature
Partnership
Gaining collaborative advantage
for health improvement
Maturing partnership
Little added
value
Shared vision
Mature
Partnership
Showing
Added value
Increasingly acting on social
determinants of health
Joint ownership
Alignment
Joint posts
Citizen engagement
Internal focus
Accountability
Individual ownership
Holistic
Health an NHS
issue
Health everyones
business.
Medical Model
External contextual factors
Adapted from Seymour M (2009) Do LSPs provide collaborative advantage for Health Improvement.
Addressing SDH
Action
•
Olympic Host 5 Boroughs Strategic Regeneration Plan. Recommendations made to be
incorporated into Stage 2 Plan to secure the Olympic legacy and convergence on health
inequalities.
•
Bolton Local Strategic Partnership LSP developing action plan based on Marmot
recommendations. To be submitted to marmot Team for comment.
•
Wakefield Council and PCT Working up a strategy for ratification by the LSP based on Marmot
principles.
•
Yorkshire and the Humber NHS Action Plan to be agreed at next Board Meeting. Consideration
being given to a 1 year dedicated post to oversee implementation of Marmot recommendations.
•
Coventry City Council and PCT Thematic Groups of the LSP to work up action plans on specific
recommendations from the Marmot review.
•
North West Region Continuing development of regional strategy based on Marmot principles.
•
Greater London Authority. Marmot Team to facilitate and support implementation April 2010
•
Health Lives/ Healthy Places 30 PCT sign up
Social determinants approach to obesity
Social Determinants
approach
Proximal Factors
Areas of action
Diet
Early Years
Skill Development
Employment & work
Communities & places
Standard of living
Prevention
Equality/health equity
Exercise
Metabolism
‘Living Well’
Statements
of intent to
build vision
of future
For further information
www.ucl.ac.uk/marmotreview