The global burden of non-communicable disease and the policy challenge Professor Sir Michael Marmot

NCDs in high, middle and low income countries Health inequalities and the social gradient in health Policy challenge: national and local

Source: WHO, 2008 Projected deaths by cause for high-, middle, and low-income countries CVD Cancer Other NCDs

NCDs in high, middle and low income countries Health inequalities and the social gradient in health Policy challenge: national and local

HEALTH DIFFERENCES BETWEEN ENGLAND AND THE US year olds Heart diseaseDiabetesCancer Source: Banks, Marmot, Oldfield and Smith; JAMA 2006 % Prevalence

Cardiovascular deaths of people aged and social inequalities: Porto Alegre, Brazil CVD deaths per 100,000 inhabitants Socioeconomic level of districts (Source: Bassanesi, Azambuja & Achutti, Arq Bras Cardiol, 2008)

Age standardised circulatory disease death rates at ages under 75, by local ward deprivation level, 1999 and :England

Life expectancy at age 25 by education, men Source: Health inequalities in the EU 2013

Life expectancy at age 25 by education, women Source: Health inequalities in the EU 2013

Obesity prevalence according to educational attainment, averaged across 19 EU Member States (Source: Eurothine 2007 reported in Robertson et al 2007)

Social patterning of diabetes by education and by monthly income, Buenos Aires, Argentina Fleisher et al 2008

Occupational stress in European countries

ALCOHOL CONSUMPTION RELATIVE TO ITS PRICE: UK Tighe, 2003

NCDs in high, middle and low income countries Health inequalities and the social gradient in health Policy challenge: national and local

The causes of the causes

Fairness at the heart of all policies. Health inequalities result from social inequalities – requires action on all the social determinants. Focusing solely on the most disadvantaged will not reduce inequalities sufficiently – action is needed across the social distribution.

Social determinants of health across the lifecourse

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

The Commission on Social Determinants of Health (CSDH) – Closing the gap in a generation Strategic Review of Health Inequalities in England: The Marmot Review – Fair Society Healthy Lives Review of Social Determinants of Health and the Health Divide in the WHO Euro Region

Country clusters by level of policy response Cluster 1: Relatively positive and active response to health inequalities. –At least one national response to HIs or comprehensive regional HI policy responses. Cluster 2: Variable response to health inequalities. –No explicit national policy on HIs, but at least one explicit regional response or a number of other policies with some focus on health inequalities. Cluster 3: Relatively undeveloped response to health inequalities. –No focused national or regional responses to health inequalities, no explicit health inequality reduction targets (though there may be targeted actions on the social determinants of health). Source: Report on Health Inequalities in the EU

LOCAL ACTION: 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 English Partnership Local government partnership between IHE and 7-8 local authorities until 2014/15 – intensive working to develop SDH approach to health inequalities. Disseminate findings

Priorities agreed by 65 Health and Well-being Boards – Local Government England Kings Fund 2013

West Midlands Fire Service Supporting Young People into Employment and Training

Keeping Vulnerable Communities Safe over 80 years are 4 X more likely to die from fire Smoking materials contributory factor in 49% of fatal fires Alcohol or drugs were present in 47% of fatal fires The householder known to mental health or social care providers in 39% of fire deaths 70% of accidental house fires take place in the lower quintile of Super Output Area (WMFS) 72% of house fires caused by arson take place in the lower quintile of Super Output Areas (WMFS) WMFS

Malmö, Sweden Commission for a Socially Sustainable Malmo, chaired by Sven-Olof Isaacson, March 2011 to translate the findings of the CSDH into a form suitable to address social determinants and health inequalities in Malmo Report March 2013

Malmö: Six areas for action Children and young people´s livings conditions Living environment and urban planning Education Income and employment Health services’ Changes in processes for socially sustainable development

Action to tackle health inequalities “Every sector a health sector” Empower individuals and communities – create the conditions for people to take responsibility

A world where social justice is taken seriously