Health Inequalities in the New Public Health System

28th February 2012

Dr Jessica Allen

Deputy Director

Marmot Review Team

Institute of Health Equity

UCL

New Public Health System

• Move to local authorities– Money?– Focus – health services or SDH?– Leadership

• CCGs?– Population focus? – registration– Funding?– Health inequalities?

• NHS Workforce?

Health and Wellbeing Throughout Life

• Empowering Local Government and Communities

• Taking a life course approach• Giving every child the best start in

life• Making work pay• Designing communities for active

aging and sustainability.• Collaborative working with business

and the voluntary sector• A new public health system with

strong local and national leadership.

Approach for new public health system tackling health inequalities

Fair Society, Healthy Lives (The Marmot Review)

• Health inequalities are not inevitable or immutable

• Health inequalities result from social inequalities - ‘causes of the causes’ – the social determinants

• Focusing solely on most disadvantaged will not be sufficient - need ‘proportionate universalism’

• Reducing health inequalities vital to economy - cost of inaction

Strategic Drivers: 6 key policy objectives of Fair Society, Healthy Lives.

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

Policy Development and delivery – all levels

• Cross government and cross-sectoral• Proportionate universal• Health equity in all policies• International, national and local – multi levelled

approach• Partnership working• Involving communities• Public health leadership

Interventions and strategies

X

Early Years

E.g. Increase children and

family services.

Employment and WorkE.g. Address

stress at work.

Standard of Living

E.g. Tackling debt

problems.

Education and Skill

Development

E.g. Reduce the number of NEETs.

Communities and Places

E.g. Reducing

environmental

inequalities.

Prevention and

RegulationE.g. Smoking ban in public

places.

Delivery system

E.g. Swansea

and Wrexham

Delivery system

E.g. Birmingham Brighter

Futures

E.g. Advertising campaigns

E.g. Free NRT

E.g. Stop smoking

programmes

E.g. School educational programmes

Delivery systemE.g. BLT Strategy

Framework

E.g. 5-a-day campaign

E.g. Weight management programmes

Delivery system

E.g. Feeling

good about where you

live

Downstream

interventions EquityE.g.

Reducing population

groups’ differences in PPHCs

The risk of fuel poverty according to household income, England 2009

Education and Skills

• Educational attainment is a predictor of health outcomes.

• Higher educational attainment is associated with healthier behaviour.

• There is a gradient in limiting illness by level of educational attainment.

• There is a gradient in mortality by educational attainment.

Local government approach

Local Government

• Complex, disparate and diverse systems of Local Government.

• Focus on needs of local population and place.• Differing capacities to orchestrate action to

address the social determinants of health.

How?• Whole System Leadership.• Involving elected members• Public health in all sectors - Links with other

sector• Areas of focus – early years, transport, planning,

education, fuel poverty etc.• Co-production• Increasing participation and empowering

communities.

Creating conditions in which individuals and communities have control over their health and lives and participate fully in society.