NATIONAL SYMPOSIUM ON AGEING RESEARCH

Canberra24 September, 2003

“Linking research, policy and practice”

Michael MarmotInternational Centre for Health and Society

UCL

TRANSLATING RESEARCH EVIDENCE INTO POLICY

SUCCESSES AND FAILURES

TRANSLATING RESEARCH EVIDENCE INTO POLICY

SUCCESSES

00.10.20.30.40.50.60.70.80.9

11.11.21.31.41.51.61.71.81.9

2

Admin

Prof/Exec

Clerical

Other

All Cause Mortality by Grade of EmploymentWhitehall Men 25 year Follow-up

Marmot and Shipley, 1996

40-64yrs 64-69yrs 70-89yrs

Rel

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e ra

te

Independent Inquiry into

Inequalities in Health

REPORT

CHAIRMAN: SIR DONALD ACHESON

GENERAL RECOMMENDATIONS

1. Health Inequalities Impact Assessment All policies to favour the less well-off.

2. High priority to women of childbearing age, expectant mothers and young children.

3. Further steps to reduce income inequalities and improve living standards of poor households.

Independent Inquiry into Inequalities in Health

AREAS FOR FUTURE POLICY DEVELOPMENT (1)

POVERTY & INCOME HOUSING AND ENVIRONMENT EDUCATION MOBILITY, TRANSPORT, POLLUTION EMPLOYMENT NUTRITION NATIONAL HEALTH SERVICE

Independent Inquiry into Inequalities in Health

AREAS FOR FUTURE POLICY DEVELOPMENT (2)

MOTHERS AND FAMILIES OLDER PEOPLE ADULTS OF WORKING AGE GENDER ETHNICITY

Independent Inquiry into Inequalities in Health

Tackling Health Inequalities

Summary of the 2002

Cross-Cutting Review

HM TREASURY

National Targets for Tackling Health Inequalities

Infant Mortality (Deaths in the first year of life) “Starting with children under one year, by 2010 to reduce by at least 10% the gap in mortality between routine and manual groups and the population as a whole”

Expectation of Life “Starting with local authorities, by 2010 reduce by at least 10% the gap between the fifth of areas with the lowest life expectancy at birth and the population as a whole.”

TRANSLATING RESEARCH EVIDENCE INTO POLICY

FAILURES?

STRATEGIES FOR BUILDING RESEARCH CAPACITY

WHY DO WE NEED INTERDISCIPLINARY RESEARCH?

Social structure

Social Environment

Work

Health Behaviours

Patho-physiologicalchangesOrgan impairment

Well-beingMortalityMorbidity

Genes

Early Life

Culture

BrainNeuro-endocrine and immune

Psychological

Material factors

EPIDEMIOLOGY STATISTICS SOCIOLOGY SOCIAL PSYCHOLOGY PSYCHOBIOLOGY NEURENDOCRINOLOGY ECONOMICS MOLECULAR GENETICS

FUNDING INTERDISCIPLINARY RESEARCH

FUNDING INTERDISCIPLINARY RESEARCH?

RESEARCH INTO AGEING

Ageing as a lifelong process

Needs of older people

THE NATIONAL RESOURCE OF LARGE LONG-TERM COHORT STUDIES

Study Year of birth Sample size

Location of data

ELSA* 1900-1951 (N=16,000)

UCL

Whitehall 2* 1930-50

(N=10,308) UCL

NSHD* 1946

(N= 5,362) UCL

NCDS* 1958

(N=17,414) IOE

BCS70 1970

(N=17,198) IOE

ALSPAC* 1991-2

(N=14,000) Bristol

Millennium 2000-1

(N=20,000) IOE

Birth 1-5 years 6-16 years Early Adulthood 17-30 yrs Early & Middle Adulthood 31-45 years

Later Middle Adulthood 46-65 years

Later Life 66+

• has or is about to collect DNA

data collection period

1946 cohort: www.nshd.mrc.ac.uk1958, 1970 & Millennium cohorts: www.cls.ioe.ac.ukALSPAC: www.alspac.bristol.ac.ukELSA & Whitehall: www.ucl.ac.uk

RESEARCH INTO AGEING

The English Longitudinal Study of Ageing

(ELSA)

General Background

Research team International Centre for Health and Society, UCL Institute for Fiscal Studies and UCL National Centre for Social Research plus researchers from Cambridge, Oxford,

Nottingham

Funding from NIA and UK government

The English Longitudinal Study of Ageing (ELSA)

Key Research Areas Health trajectories, disability and healthy life expectancy The relationship between economic position and health The determinants of economic position in older age The timing of retirement, and post retirement labour

market activity The nature of social networks, support and participation Household and family structure, and the transfer of

resources

Broad questionnaire coverage

Demographics Health Social participation Housing Employment and earnings Pensions and retirement

Broad questionnaire coverage (cont)

Income and assets Cognitive function Psychosocial Expectations Measurements Self completion (social support, GHQ12, Beck

depression inventory)

Collaboration with UK panel studies

1946 birth cohort

Whitehall II– Testing of explanations for inequalities in

health– Cohort growing older and retiring

Collaboration with UK panel studies

1946 birth cohort

Whitehall II

BHPS– Full age cross-section– Focus on older people in 2002 wave– Sharing of topics and measures

Comparative issues Ex-ante policy evaluation difficult Understanding causal relationships difficult Comparative data can:

– Help understand differences between countries– Expand sources of variation available to researchers (conditional

on enough observables to make the comparison valid)– Help examine role of institutions directly

Principal international comparators: Health and Retirement Study (HRS), SHARE

ELSA will look quite like HRS Two-yearly frequency Exit interview (post mortality, with proxy) Modular structure + core content Unfolding brackets Financial respondent Expectations But with some differences:

– biomedical health data– cognitive function– psychosocial factors– Face to face waves 1 and 2 (plus nurse visit wave 2)

FUTURE DIRECTIONS FOR AUSTRALIA?