Dr Jessica AllenDeputy Director

IHEwww.instituteofhealthequity.org

Health Inequalities

29 October 2014

• Social justice• Material,

psychosocial, political empowerment

• Creating the conditions for people to have control of their lives

www.who.int/social_determinants

Key principles

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

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

Fair Society: Healthy Lives: 6 Policy Objectives

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

• 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/indicator-set-the-impact-of-the-economic-downturn-and-policy-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

0.5 1 1.5 2 2.5 3 3.5 4 4.5 54045505560657075808590

Life expectancy and healthy life expectancy at birth females 2010-12, by IMD deprivation

quintile

Healthy life expectancy at birth - femalesLinear (Healthy life expectancy at birth - females)Female LE at birthLinear (Female LE at birth)

Deprivation level

Best performing local authority-females

Healthy life expectancy at birth- females

1 – most deprived

Greenwich 63.3

2 Brighton and Hove 66.53 Kensington and Chelsea 67.54 Barnet 69.95 – least deprived

Wokingham 71

0 1 2 3 4 540.045.050.055.060.065.070.075.080.085.0

Life expectancy and healthy life expectancy at birth, males, 2010-2012, by IMD depriva-

tion quintile

Life expectancy ar birth -malesLinear (Life expectancy ar birth -males)Healthy life expectancy at birth - males 2010-12 yearsLinear (Healthy life expectancy at birth - males 2010-12 years)

Deprivation Best performing local authority-males

Healthy life expectancy at birth- males

1 – most deprived

Brent 63.2

2 Enfield 64.43 Kensington and Chelsea 66.74 Barnet 68.95 – least deprived

Richmond Upon Thames 70

Learn from best performing local authorities by deprivation level.

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 ActAct 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