Dr Jessica AllenDeputy Director,UCL Institute of Health Equity

Jessica.allen@ucl.ac.uk

Fair Society, Healthy Lives

Building Action

Action on inequalities depends on:

Political Leadership

Sector Leadership

– Evidence– Financial case– Delivery and implementation– Levers and accountabilities– Advocacy and persistence

Political leadership

• WHO• Health system• National governments• Local governments• Individuals – health system and beyond

• Social justice• Material, psychosocial,

political empowerment • Creating the conditions

for people to have control of their lives

www.who.int/social_determinants

Key principles

commissionedby labour

implementedby coalition govt

Cross party support

2010

Evidence

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

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 England, dying prematurely each year as a result of

health inequalities, between 1.3 and 2.5 million extra years of life.

• Cost of doing nothing• 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.

• Lots of reports and building cost evidence where possible.– European Review

– Reports about fuel poverty, green spaces, hospitals, heath professionals, children centres

– And evidence for local action (phe)

Delivery and implementation

Areas for action – the life course.

Do something... do more... do better

• Where there is very little in place in terms of policies on social determinants of health, “some” action matters.

• Where policies do exist, they can be improved ��to deal with large and persistent health inequities

• There is scope to do better on inequities even ��in the richest areas.

LOCAL IMPACT: DH remit

• Local authorities –75% of local authorities have been

significantly influenced by Marmot, evidence by their Health and Well-being Strategies and JSNAs (joint Strategic Needs Assessments)

–We have worked directly with 40 plus local authorities

National advice

• advisory roles

• Select committees

• Working with core DH teams

• Advocacy – Ministerial and cross departments

Accountabilities and levers

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”

Marmot indicators for local authorities

• Male and female life expectancy • Slope indices of inequality (SII) for male and female life

expectancy• Slope indices of inequality (SII) for male and female disability-

free life expectancy• Children achieving a good level of development at age 5• Young people who are not in education, employment or training

(NEET)• People in households in receipt of means-tested benefits• Slope index of inequality for people in households in receipt of

means-tested benefits

• Lancashire 2012

Context – economic downturn, recession, austerity – uneven growth

A. Give every child the best start in life

- Funding issues, child poverty

B. Enable all children, young people and adults to maximise their capabilities and have control over their lives

- Skills training, NEETS, whole school approaches

C. Create fair employment and good work for all

- Youth unemployment, contract workers, insecure employment, involuntary part-time working, ALMP policies

D. Ensure healthy standard of living for all

- Minimum income standard, minimum wages, benefit caps

E. Create and develop healthy and sustainable places and communities

- Green policies, social isolation, housing

F. Strengthen the role and impact of ill health prevention

- Cost inflation, resource allocation, demographic pressures

Fair Society: Healthy Lives: some areas for concern

• 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

Advoacy and persistence

• Lots of it!

Thank you

www.instituteofhealthequity.org