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The Commission on Social
Determinants of Health
(CSDH) – Closing the gap
in a generation 2008
Strategic Review of Health
Inequalities in England:
The Marmot Review – Fair
Society Healthy Lives 2009
European
Review of Health
Inequalities and
the Health Divide
2010-2012
Life expectancy and disability free life expectancy at birth, persons by
neighbourhood income level, England, 1999-2003
45
50
55
60
65
70
75
80
85
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
Neighbourhood Income Deprivation
Source: ONS (Population Percentiles)
Age
Life expectancy
DFLE
Pension age increase
2026-46Poly. (DFLE)
Poly. (Life expectancy)
2
Inequality in Early Cognitive Development of British Children in the 1970 Cohort, 22 months to 10 years
0
10
20
30
40
50
60
70
80
90
100
22 26 30 34 38 42 46 50 54 58 62 66 70 74 78 82 86 90 94 98 102 106 110 114 118
months
Av
era
ge
po
sit
ion
in
dis
trib
uti
on
High Q at 22m
Low Q at 22m
Source: Feinstein, L. (2003) ‘Inequality in the Early Cognitive Development of British Children in the 1970 Cohort’, Economica (70) 277, 73-97
High SES
Low SES
3
Gaps in school readiness at 3 and 5 years by family income: UK
Avera
ge p
erc
entile
score
Waldfogel & Washbrook 2008 4
Per cent of children achieving a good level of
development by local authority: England
0
20
40
60
80
100
Per cent achieving a
good level of development
Local authorities
Children achieving a Good level of development
Per cent achieving 5+ A* - C grades inc Maths and English at GCSE by IDACI decile of pupil residence: England 2007
25.329.9
34.239.2
44.749.5
53.857.8
61.968.4
0
10
20
30
40
50
60
70
80
0-10% 10-
20%
20-
30%
30-
40%
40-
50%
50-
60%
60-
70%
70-
80%
80-
90%
90-
100%
% achieving 5+ A*-C GCSEs inc Maths and English
Income Deprivation Affecting Children Index (IDACI) Least
deprivedSource: DCFS 2009
Most
deprived6
7
Recommendations : Fair Society ,Healthy Lives
Give every child the best start in life.
Enable all to maximise their capabilities and have control over their
lives
Create fair employment and good work for all.
Ensure a healthy standard of living for all
Create and develop healthy and sustainable communities.
Strengthen the role and impact of ill-health prevention.
Local Democratic legitimacy
• Community Leadership in giving people voice.
• Place shaping building sustainable communities promoting health wellbeing and resilience.
• Extending participation and co-production of services
• Orchestrating local partnership working.
• Directors of Public Health leading local public health
• Use Council’s role as Commissioner, Service Provider and Employer.
People and Places
• Critical linkage of health, wellbeing and resilience.
• Evidence of linkage of low level stress, depression, isolation especially in communities of multiple deprivation with significant barriers to participation.
“ You can see the deprivation, all you have to do is look outside. Its in your face every day, litter everywhere, rats and rubbish. It’s a dump……it feels like people around you have no meaning to life.I keep my curtains closed at times……….It doesn’t give you a purpose to do anything” (Focus group participant)
• Many excluded areas are characterised by lack of mutual trust, isolation and under developed social cohesion.
“I feel safe but there I places I don’t go” (focus group participant)
Developing Communities: building resilience
• Evidence participation and improving life skills ameliorates impact of health inequalities through developing social support networks. (Bynner and
Parsons 2006)
• Impact of personal support critical“ I know I have got back up and that is a big thing” (Mari 2006)
• Learning and skill development impact positively and fosters community action. “ It was just getting worse and worse. The group then decided that we ought to be lobbying people that could help us MPs, local councillors, local members and the Police.” (Shirley)
• Social networks create the conditions in which people thrive“I don’t know what makes other people healthier. I know what makes me healthier and that’s being happy and having friends” (Suzanne 2006)
INDEX OF HEALTH AND SOCIAL PROBLEMS PLOTTED BY INCOME INEQUALITY
Wilkinson R and Pickett K.(2009) The Spirit Level; Why more equal societies almost always do better.Penguin Books London.
Impact of changes to tax and benefit system on net
income in 2014 -2015 by decile: UK
Source: IFS 2011
YORK ALL AGE: ALL CAUSE MORTALITY RATES
Creating the conditions
for individuals and
communities to take
control over their health
and lives and have
political voice.
www.ucl.ac.uk/marmotreview