1. Fair society, Healthy Lives Michael Marmot UCL Institute of Health Equity Stockholm July 2012

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

3. The health sector acting alone cannot tackle health inequalities Action is needed across the whole of government and the whole of society Health is an issue for all social workers, not just those working in health settings Recipients of social care services are likely to be the most socially disadvantaged and most will have a long-term illness or disability… over 50s age group are largest users of health and social care (Marmot Review p 159)

4. Social determinants of health across the lifecourse

5. 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

6. 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

7. 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

8. Links between socioeconomic status and factors affecting child development, 2003-4 Source: Department for Children, Schools and Families

9. Gaps in school readiness at 3 and 5 years by family income: UK Average percentile score Waldfogel & Washbrook 2008

10. Country ranking: equality in child wellbeing - material, education, and health Source: UNICEF Report Card 9, ranking 24 OECD countries by their performance in each of three dimensions of inequality in child well-being ScoreCountry 8Denmark, Finland, Netherlands, Switzerland 7Iceland, Ireland, Norway, Sweden 6Austria, France, Germany, Poland, Portugal 5Belgium, Czech Republic, Hungary, Luxembourg, Slovakia, Spain, United Kingdom 3Greece, Italy

11. Children aged 36-59 months that do not attend any form of early education programme in selected CIS and CEE countries Source: Unicef/MICS 2007

12. 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

13. Unemployment in EU 27 countries, 2002 - 2011

14. Unemployment associated with poor mental and physical health

15. Mortality* of men aged 16-64 by social class and employment status at the 1981 census 1981 LS Cohort. *England & Wales: mortality 1981-92 * adjusted for age and salary Social class Standardised Mortality Rate I II IIIN IIIM IV V Employed in 1981 Unemployed in 1981

16. Unemployment and Mortality 1% rise in unemployment associated with: - 0.8% ↑Suicide - 0.8% ↑Homicide - 1.4% ↓Traffic death No effect on all- cause mortality Source: Stuckler et al 2009 Lancet

17. Changes in adult unemployment and in age- standardised suicide rates (age 0–64 years) in old (pre- 2004) and new European Union Member States (Stuckler et al Lancet 2011) 2007 is the index year, and y-axis values represent proportional change relative to that year Unemployment Suicides

18. Occupational stress in European countries

19. 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

20. Social protection policies make a difference Social and health benefits

21. 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

22. Copyright ©2010 BMJ Publishing Group Ltd. Stuckler, D. et al. BMJ 2010;340:c3311 Relation between social welfare spending and all cause mortality in 18 EU countries, 2000

23. Responses to economic crisis and child poverty: UK

24. Projected relative AHC income poverty rates under current policies and without the coalition government’s tax and benefits reforms: UK IFS 2010

25. Social protection policies can mitigate intergenerational effects

26. Child poverty rates (% living in households <60% median income) before and after social transfers 2009 Source: EU SILC

27. Health inequalities are not inevitable or immutable

28. SMRs by cause, all ages: Glasgow relative to Liverpool & Manchester Source: Walsh D, Bendel N., Jones R, Hanlon P. It’s not ‘just deprivation’: why do equally deprived UK cities experience different health outcomes? Public Health, 2010 from H Burns, CMO, Scotland

29. Health improvement in difficult times A major element of the excess risk of premature death seen in Scotland is psychosocially determined Study evidence of low sense of control, self efficacy and self esteem in population in these areas Source: H. Burns, CMO Scotland

30. Health inequalities and policy strategies Health inequalities are not inevitable; Not just a responsibility of the health care sector; Whole of society, whole of government

31. A Fair Society