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.

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.

Ensure healthy standard of living for all.

Create and develop healthy and sustainable

places and communities.

Strengthen the role and impact

of ill health prevention.

Equality and health equity in all policies.

Effective evidence-based delivery systems.

Policy objectives

Policy mechanisms

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 cost- 200000 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

ImmaturePartnership

Little added value

MaturePartnership

Showing Added value

Gaining collaborative advantage for health improvement

Maturing partnership

Increasingly acting on social determinants of health

Process factors

External contextual factors

A Theory of Maturing Partnerships for Health Improvement

No shared vision

Dominant partner

Top down

Project focussed

Quick wins

Funding constraints

Grant giving

Internal focus

Individual ownership

Health an NHS issue

Medical Model

Confidence in partners

Shared identity

Shared vision

Joint ownership

Alignment

Joint posts

Citizen engagement

Accountability

Holistic

Health everyones business.

Addressing SDH

Adapted from Seymour M (2009) Do LSPs provide collaborative advantage for Health Improvement.

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 obesitySocial Determinants approach

Proximal Factors

Areas of action Diet Exercise Metabolism

Early Years

Skill Development

Employment & work

Communities & places

Standard of living

Prevention

Equality/health equity

‘Living Well’

Statements of intent to build vision of future

For further information

www.ucl.ac.uk/marmotreview