Embed Size (px)
Citation preview
Social Determinants of Healthin Europe
Michael Marmot
• Social justice• Material, psychosocial,
political empowerment • Creating the conditions
for people to have control of their lives
www.who.int/social_determinants
Key principles
Prenatal Early Years Working Age Older Ages
Family building
Accumulation of positive and negative effects on health and wellbeing
LIFE COURSE STAGES
MACROLEVEL CONTEXT
WIDER SOCIETY SYSTEMS
Perpetuation of inequities
Life expectancy in countries in the WHO European Region, 2010 (or latest available)
Source: WHO Health for all database, 2012
Years of life spent free of disability, women in selected European countries 2009
Source: EC health indicators
Prenatal Early Years Working Age Older Ages
Family building
Accumulation of positive and negative effects on health and wellbeing
LIFE COURSE STAGES
MACROLEVEL CONTEXT
WIDER SOCIETY SYSTEMS
Perpetuation of inequities
Early child care and education
• Parenting and family support– Perinatal services– Care before and during pregnancy– Help for new mothers
• Pre-school education and care• Primary, secondary and tertiary education and
training
Children aged 36-59 months that do not attend any form of early education programme in selected CIS and CEE countries
0 20 40 60 80 100
Belarus
Ukraine
Albania
Georgia
Serbia
Kyrgyzstan
Montenegro
Uzbekistan
Kazakhstan
TFYR Macedonia*
Bosnia and Herzegovina
Tajikistan
Richest 20% Poorest 20%
Source: Unicef/MICS 2007
Differences in PISA scores by attending preschool for more than one year before and after accounting for socioeconomic background
OECD PISA 2009 database
Israel
Belgium
France
Italy
Switzerland
Denmark
United Kingdom
Turkey
Lithuania
Serbia
TFYR Montenegro
Netherlands
Ireland
Slovenia
0 20 40 60 80 100 120 140
Before accounting for socioeconomic backgroundAfter accounting for socioeconomic background
0 10 20 30 40 50 60
Romania Latvia
Bulgaria Lithuania
Italy Greece
Spain Poland
Portugal Luxembourg
Hungary United Kingdom
Malta Estonia
Switzerland Ireland
Slovakia France
Belgium Netherlands
Germany Austria
Czech Republic Sweden Finland Cyprus
Slovenia Denmark
Norway Iceland
Poverty rate
Before social transfers After social transfers
Child poverty rates <60% median before and after social transfers 2009
Source: EU SILC
Prenatal Early Years Working Age Older Ages
Family building
Accumulation of positive and negative effects on health and wellbeing
LIFE COURSE STAGES
MACROLEVEL CONTEXT
WIDER SOCIETY SYSTEMS
Perpetuation of inequities
Work and employment are of critical importance for population health and health inequalities
• Participation in, or exclusion from the labour market determines a range of life chances
• Wages and salaries provide the major component of the income of most people in employment
• Exposure to hazards at work, demanding or dangerous work, long or irregular hours, shift work, and prolonged sedentary work can all adversely affect health
• Psychological and socio-emotional demands and threats evolving from an adverse psychosocial work environment have become more widespread
Psychosocial environment of work
Stress arises from:
• Demand-control imbalance
• Effort-reward imbalance
• Organisational injustice
• Employment precariousness
Psychosocial stress and occupational class
SHARE -11 European CountriesWahrendorf, Dragano and Siegrist , 2011
Wider Society
• Social exclusion• Social protection across the life course• Communities
Welfare generosity and non employment by education in 26 European countries
Minimum Maximum0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8 Longstanding limiting illness
Primary
Secondary
Tertiary
Predictedprobabilities
of nonemploy
ment
Wefare generosity Minimum Maximum0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8No Longstanding Limiting Illness
Primary
Secondary
Tertiary
Predictedprobabilities
of nonemploy
ment
Welfare generosity
van der Wel, Dahl & Thielen 2011
Macrolevel context:
Economic Issues
Sustainability and environment
Social Protections Help…
Each 100 USD per capita greater social spending reduced the effect on suicides by:0.38%, active labour market programmes
0.23%, family support
0.07%, healthcare
0.09%,unemployment benefits
Spending> 190 USD no effect of unemployment on suicide
Source: Stuckler et al 2009 Lancet
Prenatal Early Years Working Age Older Ages
Family building
Accumulation of positive and negative effects on health and wellbeing
LIFE COURSE STAGES
MACROLEVEL CONTEXT
WIDER SOCIETY SYSTEMS
Perpetuation of inequities
