Panelist

Sir Michael MarmotProfessor of Epidemiology and Public Health

University College London

Distribution of lifestyle risk factors 

• Tobacco use

• Obesity• Diet

• Physical activity

• Alcohol

Comparison of smoking prevalence between low and high socioeconomic groups

0123456789

10

India(Delhi)

China Brazil Cuba SouthAfrica

Hungary

Smoking rate ratio between low  and

 high

 Socioecon

omic group

s

Bobak et al in ‘Tobacco control in developing countries’ ed: Jha & Chaloupka, 2000

0%

5%

10%

15%

20%

25%

30%

35%

40%

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Percen

tage

 obe

se (B

MI ≥

30)

Year

Female obesity (aged 16+ years) prevalence by social class 1997‐2007: Health Survey for England

Alcohol Consumption Relative To Its Price: UK

0

2

4

6

8

10

12

1960

1964

1968

1972

1976

1980

1984

1988

1992

1996

2000Li

tres

of a

lcoh

ol p

er p

erso

n ag

ed 1

5+

0

50

100

150

200

250

Pric

e re

lativ

e to

inco

me

alcohol Price

Tighe, 2003

Social distribution of health outcomes

• Education

• Wealth/income

• Gender

Mackenbach et al 2008

Absolute inequality in males death rates 

by level of education

Cardiovascular deaths of people aged 45 ‐ 64 and social inequalities: Porto Alegre, Brazil

050

100150200250300350400

High Mediumhigh

Mediumlow

Low ALL

CVD deaths Attributable CVD deaths

CVD

dea

ths

per 1

00,0

00in

habi

tant

s

Socioeconomic level of districts

Bassanesi, Azambuja & Achutti, Arq Bras Cardiol, 2008

Social patterning of diabetes by education and by monthly income, Buenos Aires, Argentina

Fleisher et al 2008

Life course

Prenatal Pre-school School Training Employment Retirement

Family building

Accumulation of positive and negative effects on health

and wellbeing

Life course stages

• Disaggregate outcome and lifestyle indicators by sex, socioeconomic variables

• Need to develop simple indicators of social determinants of health at key points in life

Monitoring social determinants of health 1• Early years

• An indicator of early child development across the interconnected domains of physical, social/behavioural and cognitive/language

• Youth• An indicator of involvement in education and/or employment during adolescence

• Adult life• An indicator of resources to live a life with dignity and participate in society

Monitoring social determinants of health 2

• A composite  indicator of the quality of the living environment e.g. access to clean water, sanitation, air, healthy food etc. 

Thank you