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Strategic Review of Health Inequalities in England Post 2010 (Marmot Review)

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kevin
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Download Fair Society, Healthy Lives< - The Marmot Review Final Report (25Mb)*

Download Fair Society, Healthy Lives< - The Marmot Review Executive Summary (8Mb)

Go to the Documents Section< for individual chapters, background documents and press documents.*

 

You can view videos from the launch conference held on Friday 12 Fbruary at www.marmot-review.org.uk<.

The Review followed the publication of the global Commission on Social Determinants of Health<, also chaired by Sir Michael Marmot and published by the WHO<. The CSDH advocated that national governments develop and implement strategies and policies suited to their particular national context aimed at improving health equity. The English review is a response to that recommendation and to the government's commitment to reducing health inequalities in England.

 

The aim of the Review was to propose an evidence based strategy for reducing health inequalities from 2010. The strategy includes policies and interventions that address the social determinants of health inequalities.

The Review had four tasks:

(i) identify, for the health inequalities challenge facing England, the evidence most relevant to underpinning future policy and action

(ii) show how this evidence could be translated into practice

(iii) advise on possible objectives and measures, building on the experience of the current PSA target on infant mortality and life expectancy

(iv) publish a report of the review's work that will contribute to the development of a post-2010 health inequalities strategy

It is anticipated that the Review will also have relevance for other countries developing strategies aimed at tackling health inequalities, following the recommendations of the CSDH.

You can find further details in the documents section<.

*Erratum: In the first 1000 hard copies and electronic copies on USB sticks on pp. 141, 142 and 149, on each page "0.05 per cent of GDP" should read "0.5 per cent of GDP".

http://www.ucl.ac.uk/gheg/marmotreview/<

http://www.marmot-review.org.uk/<

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Inequality in living standards since 1980: evidence from expenditure data

Download full version (PDF 551 KB)<

http://www.ifs.org.uk/publications/4759<

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To improve the health of local populations requires World Class Commissioning that is relevant, sensitive and accessible. This Guide has been developed by the Royal Society for Public Health in partnership with the National Social Marketing Centre, with funding from the English Department of Health. It will assist Commissioners to make the most of the best methods of promoting health, using the latest understanding of how we can support people to make healthy choices as individuals within the social and environmental contexts in which they live. The Guide will also be of value to Providers in giving insight into the Commissioning process.

 “This Guide will help people do good work more efficiently and will prevent a waste of resources, I strongly recommend Primary Care Trusts should not take action without reading the Guide first.”

Sir Muir Gray, Director of the National Knowledge Service

 

 Browse some of the most useful models, flow charts and diagrams in the Guide for World Class Commissioners ><

 

http://www.rsph.org.uk/en/policy-and-projects/projects/commissioning-too...<

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kevin
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Following the WHO Commission's 2008 report on social determinants of health, the UK Government commissioned Professor Marmot, director of the International Institute for Society and Health, to lead a strategic review of health inequalities in England.

Delegates heard the findings of Fair society, healthy lives  claimed that social and economic arrangements are at the root of health inequalities, and that a review of these arrangements must be made across society as a whole, not just focused on ‘the poorest of the poor.’

Three dimensions

Professor Marmot said that the three dimensions of health inequalities are material, psychosocial and political empowerment.

He stated his belief that economic policy would ‘hit the buffers’ unless both the implications of high mortality rates and implications on disability-free life expectancy, particularly as a consequence of policies to ease pressure on the pension burden, were addressed across all income groups.

Budget

When asked about his views on yesterday’s Budget announcements, Professor Marmot replied that he was "nervous", and that the question asked should not be "how much could you take from benefits? but what will be the effect on people’s lives?" He emphasised concerns about whether the changes to tax, specifically VAT would prove to be regressive.

In response to questions about the likelihood of the report being ‘buried’, Professor Marmot indicated that there had been private assurances from Government and that there was also very good local take up, with 30 areas already developing plans for implementing the report’s recommendations.

Professor Marmot concluded: “We have an ideology of a fair a society, but the review delivers practical means of achieving the goal of reducing inequality through a fairer society.”

Download the Marmot report, Fair society, healthy lives<

http://www.nhsconfed.org/OurWork/latestnews/Pages/MarmotCallsForFairness...<

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kevin
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Doctors should focus on tackling health inequalities as part of their everyday practice, a report< by the Royal College of Physicians (RCP) concludes.

Despite an increase in rates of life expectancy in recent years, there is evidence to suggest that health inequalities are still rife across the UK. In Canning Town, a deprived district in the East End of London, the average male life expectancy is 73 years, compared with 79 years in the affluent London borough of Westminster.

The report, published yesterday and developed in partnership with other Royal Colleges as well as with the NHS, identifies how doctors can take account of social inequalities in every area of their work.

Recommendations include refocusing resources towards prevention rather than the treatment of ill-health, identifying opportunities to help patients from disadvantaged backgrounds to manage their health, and encouraging patients to engage in healthy activities such as cycling. Doctors could also persuade local authorities to supply the resources and green spaces to support more active lifestyles.

NICE has published guidance to help doctors achieve a number of the recommendations set out in the report, and is committed to helping drive down health inequalities across Britain.

The Institute has already had a major impact on improving life expectancy rates in England, and is set to play a key role in continuing to reduce health inequalities, according to the commissioners of the Marmot Review< - a major body of work that outlines the most effective ways of reducing health inequalities in England from 2010.

Just last month, NICE published draft guidance< on the provision of contraceptive services for socially disadvantaged young people, such as teenage parents, young people living in areas with high levels of deprivation, some minority ethnic groups, and young offenders.

Current evidence suggests that socially disadvantaged young people find it difficult to access contraceptive services, for a variety of reasons, including lack of knowledge about service opening times and locations, and concerns about service confidentiality. Consequently, the draft guidance focuses on socially disadvantaged young people to ensure they receive culturally sensitive, confidential, non-judgemental and empathic advice and support tailored to their individual needs.

There are also a number of guidelines that promote the need for exercise and healthy living, as well as a suite of guidance designed to encourage doctors to offer preventative measures, such as prescribing statins to patients who are at risk of developing heart disease.

Professor Ian Gilmore, president of the RCP, described the launch of the report as a “watershed moment” in the way that doctors practice that fits in with the agenda of the new government.

“At present, many doctors and other health professionals do their best to treat the patient in front of them, but they do not always look beyond the symptoms presented, and address the patients’ social and economic background.

“This becomes a vicious cycle, where people are treated for an illness, go back into the community and fall ill again, because doctors have not been able to address the reason they were unwell in the first place.”

Sir Michael Marmot, director of the International Institute for Society and Health at University College London, warned that the cost of doing nothing about health inequalities is so large that it is simply not an option, and called on doctors to “put their house in order” by improving access to care and by becoming advocates of polices to reduce health inequalities.

http://www.nice.org.uk/newsroom/news/DrsShouldUseNICEGuidanceToTackleHea...<

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Forty four per cent of five-year-olds in England are falling behind in their development, according to the Marmot Review which also found serious inequalities in children's development across the country. In Hackney in London, for example, the figure was 58 per cent while in Solihull in the West Midlands and Richmond upon Thames, west London, it was 31 per cent.

Called 'The Marmot Review: Fair Society, Healthy Lives', the report said that in England the people who are currently dying prematurely each year as a result of health inequalities would otherwise have enjoyed a combined total of between 1.3m and 2.5m extra years of life. And it said there was a social gradient in health – the lower a person's social position, the worse his or her health. In other words, health inequalities resulted from social inequalities.

Action taken to reduce health inequalities will benefit society in many ways, the review said, including economic benefits by cutting losses from illness associated with health inequalities. These currently account for productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs.

Health inequalities can reduced in six ways, the review said – by giving every child the best start in life, enabling all children, young people and adults to maximise their capabilities and have control over their lives, creating fair employment and good work for all, ensuring a healthy standard of living for all, creating and developing healthy and sustainable places and communities, and strengthening the role and impact of ill health prevention.

The review said: "Delivering these policy objectives will require action by central and local government, the NHS, the third and private sectors and community groups. National policies will not work without effective local delivery systems focused on health equity in all policies. Effective local delivery requires effective participatory decision-making at local level. This can only happen by empowering individuals and local communities."

Review author Sir Michael Marmot said: "We need to [make sure] that local authorities invest money and expertise to ensure long-term reductions in health inequalities."

http://www.publicservice.co.uk/news_story.asp?id=15476<

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kevin
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The papers are littered with stories of public sector doom and gloom – job and service cuts, threats to the Big Society, and Ken Clarke’s recent warning that real effects will start to be felt in middle England this year.<

The economic justification for this is ‘pain today and gain tomorrow’. The government argues that the deficit is unsustainable, raising borrowing costs and feeding a bloated and inefficient state, which in turn stifles the private sector and civil society. Public spending must be cut to get back on track and create the right conditions to deliver growth and innovation in the private sector, and in turn, the jobs and well-being that we all want.

But how will this affect health and well-being? Sir Michael Marmot’s review, Fair Society, Healthy Lives<, and the rich resources and analysis that support it, provides evidence of how state intervention and spending affect our life chances and health: from the importance of early childhood development to our  access to green spaces. 

But this sort of evidence does not  tell us how health and well-being are affected by the overall dynamics of economic growth and decline, or how and at what level governments choose to tax, and spend the revenue they collect.  

In general, economic growth is good for objective measures of health, but once we get past a certain level of income we don’t seem to get much  happier – the effects of economic growth on our well-being tail off once our basic needs are met. Clearly recessions lead to unemployment and anxiety, and there is strong evidence this is not good for the physical or long-term mental health of those affected or their families. Strangely though, and particularly in rich countries such as the UK, recessions  are sometimes associated with a reduction in health inequalities. Recessions tend to affect everyone in society to some degree – not just the poorest. In the presence of decent welfare safety nets, those on higher incomes  therefore fall further before hitting that net. Over time, this can be reflected in a reduction in inequalities in mortality and other indicators of health.

As a nation this points to our future health being driven by the approach to economic policy: the relative health effects of cuts in the welfare safety net versus greater growth, led by the private sector. Whilst we cannot be sure how this will pan out in the UK, an innovative recent study< does give some clues. Using data from the Organisation for Economic Co-operation and Development (OECD), the authors – David Stuckler, Sanjay Basu and Martin McKee – looked at how responsive various measures of mortality are to non-health government spending across 15 EU countries between 1980-2005. Overall, they found that the effect of a given change in social welfare spending on overall mortality is seven times greater than an equivalent increase in GDP. 

This was an average finding across all countries, it doesn’t unbundle social welfare spending into its component parts and it ignores the fact that economic growth has more benefits than health alone – including creating the pot from which welfare spending comes. Nonetheless, it’s a timely and salutary warning that cuts in social welfare spending need to be carefully thought through, since GDP growth needs to work hard to counteract the effects of falling social welfare spending. The implications for health inequalities are less clear.

We urgently need more studies like this in the UK that look closely at which elements of welfare spending are most important for mortality and broader measures of health. The Sub-Committee on Public Health would then have far better evidence on which to base their decisions, as would the Treasury as Budget day nears.

This blog also appears on the Public Finance website<.

http://www.kingsfund.org.uk/blog/how_will_the_budget.html<

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anonymous (not verified)
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Figures to mark the second anniversary of the publication of the Marmot Review (‘Fair Society Healthy Lives’) were published in February 2012.

Main Findings include:

Life expectancy figures 2008-10 have increased for most local authority areas. However, inequalities within local authorities have also increased in most areas. In fact the amount by which the gap in life expectancy varies between the wealthiest neighbourhoods and the most deprived has risen for both men and women in the majority of 150 local authorities that will take over responsibility for public health in April 2013.

The number of children achieving a good level of development at age five has improved on last year’s figures, as has the number of young people not in Employment, Education or Training (NEETs). However, this is only measured up to age 19, and the NEETs figure for those over 19 has risen dramatically in the last months of 2011.

Finally, this year’s figures also show a reduction in the percentage of people in households on means tested benefits, and, in England as a whole, inequalities in the percentage in receipt of means-tested benefits between neighbourhoods with different levels of income deprivation decreased.

Click here< for press release

Click here< for details of the Marmot Review

http://www.edf.org.uk/blog/?p=16739<

anonymous (not verified)
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‘Why Inequality Matters’ by members of My Fair London in association with The Equality Trust was published in September 2013.

The pamphlet presents the key findings of the book ‘The Spirit Level – Why Equality is Better for Everyone’.

It shows that benefits of great equality are not confined to the least well off and the differences are huge, and can’t be explained by levels of poverty within each country, or by the health and behaviour of minority groups. In fact, the vast majority of the population do better in more equal societies. Too much inequality on the other hand results in the familiar signs of ‘broken societies’. Central to these problems is the loss of cohesion in more unequal societies.

Click here< for link

Click here< for The Equality Trust website

http://www.edf.org.uk/blog/?p=20935<

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