1. European
Review of Health
Inequalities and
the Health Divide
2010-2012
The Commission on Social Strategic Review of Health
Determinants of Health Inequalities in England:
(CSDH) – Closing the gap
The Marmot Review – Fair
in a generation 2008
Society Healthy Lives 2009

2. Life expectancy and disability free life expectancy at birth, persons by
Age neighbourhood income level, England, 1999-2003
85
80
75
70
65
60
55 Life expectancy
DFLE
50
Pension age increase
2026-46
45 Poly. (DFLE)
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 Poly. (Life 85 90 95 100
75 80 expectancy)
Neighbourhood Income Deprivation
Source: ONS (Population Percentiles)
2

3. Areas of action
Sustainable communities and places
Healthy Standard of Living
Early Years Skills Development Employment and Work Prevention
Accumulation of positive and negative effects
on health and wellbeing
Prenatal Pre- School Training Employment Retirement
school
Family building
Life course stages
3

4. Inequality in Early Cognitive Development of British Children in the 1970
Cohort, 22 months to 10 years
100
High SES
90 High Q at 22m Low SES
80
Average position in distribution
70
60
50
40
30
20
10 Low Q at 22m
0
22 26 30 34 38 42 46 50 54 58 62 66 70 74 78 82 86 90 94 98 102 106 110 114 118
months
Source: Feinstein, L. (2003) ‘Inequality in the Early Cognitive Development of British Children in the 1970 Cohort’, Economica (70) 277, 73-97
4

6. Gaps in school readiness at 3 and 5 years by
family income: UK
Average percentile score
Waldfogel & Washbrook 2008 6

7. Per cent achieving 5+ A* - C grades inc Maths and English at GCSE by
IDACI decile of pupil residence: England 2007
% achieving 5+ A*-C GCSEs inc Maths and English
80
68.4
70 61.9
57.8
60 53.8
49.5
50 44.7
39.2
40 34.2
29.9
30 25.3
20
10
0
0-10% 10- 20- 30- 40- 50- 60- 70- 80- 90-
20% 30% 40% 50% 60% 70% 80% 90% 100%
Most
Least
deprived Income Deprivation Affecting Children Index (IDACI) deprived
7
Source: DCFS 2009

8. 8

9. The Conceptual Framework
Reduce health inequalities and improve health and well-being for all.
Create an enabling society that Ensure social justice, health
maximises individual and and sustainability are at heart
community potential. of policies.
Policy objectives
A. C.
E.
Create and develop
Give every Create fair
healthy and
child the best employment and
sustainable places
good work for all.
start in life. and communities.
B.
Enable all D. F.
children, young Ensure healthy Strengthen the role
people and adults standard of living and impact of ill
to maximise their for all. health prevention.
capabilities and
have control over Policy mechanisms
their lives.
Equality and health equity in all policies.
Effective evidence-based delivery systems.
9

10. Key Messages
• Major health inequalities within
and between countries.
• Social gradient in health
• Health inequalities driven by
social inequalities
• Action is needed across the
whole system ,health systems
alone cannot reduce health
inequalities.
• Systematic , sustained and
universal action on the social
determinants of health
proportionate to disadvantage.
• Collate the evidence, develop
capacity, build political
commitment.

11. Local Democratic
legitimacy
• Community Leadership in
giving people voice.
• Place shaping building
sustainable communities
promoting health wellbeing
and resilience.
• Extending participation and co-
production of services
• Orchestrating local partnership
working.
• Directors of Public Health
leading local public health
• Use Council’s role as
Commissioner, Service Provider
and Employer.

12. Local determinants of health and wellbeing
Barton H and Grant M 2008

13. People and Places
• Critical linkage of health, wellbeing and resilience.
• Evidence of linkage of low level
stress, depression, isolation especially in communities
of multiple deprivation with significant barriers to
participation.
“ You can see the deprivation, all you have to do is look
outside. Its in your face every day, litter
everywhere, rats and rubbish. It’s a dump……it feels like
people around you have no meaning to life.I keep my
curtains closed at times……….It doesn’t give you a
purpose to do anything” (Focus group participant)
• Many excluded areas are characterised by lack of
mutual trust, isolation and under developed social
cohesion.
“I feel safe but there I places I don’t go” (focus group
participant)

15. Developing Communities: building resilience
• Evidence participation and improving life skills ameliorates impact of
health inequalities through developing social support networks. (Bynner and
Parsons 2006)
• Impact of personal support critical
“ I know I have got back up and that is a big thing” (Mari 2006)
• Learning and skill development impact positively and fosters community
action.
“ It was just getting worse and worse. The group then decided that we
ought to be lobbying people that could help us MPs, local
councillors, local members and the Police.” (Shirley)
• Social networks create the conditions in which people thrive
“I don’t know what makes other people healthier. I know what makes me
healthier and that’s being happy and having friends” (Suzanne 2006)

16. INDEX OF HEALTH AND SOCIAL PROBLEMS PLOTTED BY INCOME INEQUALITY
Wilkinson R and Pickett K.(2009) The Spirit Level; Why more equal societies almost always do better.
Penguin Books London.

18. Impact of changes to tax and benefit system on net
income in 2014 -2015 by decile: UK
Source: IFS 2011

19. YORK ALL AGE: ALL CAUSE MORTALITY RATES

21. Creating the conditions
for individuals and
communities to take
control over their health
and lives and have
political voice.
www.ucl.ac.uk/marmotreview