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Mental Health and Inequality


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Mental Health and Inequality

  1. 1. Mental health and inequalities: what’s happening to thesoci(et)al determinants of health? Lynne Friedli Socialist Health Association Health Inequality in England and Scotland Edinburgh 9th June 2012
  2. 2. The paradox.... As material inequalities grow, the pursuit of non material explanations proliferatesPicture source: Sleeping with spirit #2 Bradley Guiboche courtesy determinants?whats happening to social
  3. 3. I own, therefore I am.... Source: Banksie – grafitti, London, Englandwhats happening to social determinants?
  4. 4. Nussbaum’s capabilities Life Bodily health Bodily integrity Sense, imagination, thought Emotions Practical reason Affiliation Other species Play Control over environment: a) Political b) Material Source: NussbaumWhat can capabilities contribute?
  5. 5. Commission on the Social Determinants of Health Some living conditions deliver to people a life that is worthy of the human dignity that they possess, and others do not. Dignity can be like a cheque that has come back marked „insufficient funds‟ Martha Nussbaum Freedom to • material requisites live a valued life • psycho-social (control over lives) Amartya Sen • political voice (participation in decision making) Status Control Relatednesswhats happening to social determinants?
  6. 6. Meta analysis: comparative oddsof decreased mortality The relative value of social support/ social integration whats happening to social determinants? Source: Holt-Lundstad et al 2010
  7. 7. Social Epigenesis: biological embedding * In 2012 there‟s no talk of getting out. It‟s more important to be somebody where they live, than to be nobody outside. Status and respect are valued above everything Lisa McKenzie 2012 Status Control Relatedness “The most effective interventions will require a deeper understanding of how common social risks “get under the skin” to affect human biology and influence the causal pathways to disease”whats happening to social determinants?
  8. 8. Relative importance of early social and biological risk factors (PAR %) ag Social risk factors e Clinical risk factorswhats happening to social determinants? Source: Jutte, Brownell, Roos, Schippers, Boyce, Syme, 2010
  9. 9. Reasons to be concerned? I knew about inequality, how unfair life could be. But I thought it was something to do with me, with my family, what we‟d done..... Lisa McKenzie ‘Thinking • allowed’ An analysis of injustice? Who/what creates inequalities? • Are Scotland’s problems psychological & cultural? • Stigmatising dependency and need? • Avoiding the hard questions?whats happening to social determinants?
  10. 10. Myth No 1: „What we‟ve tried, though wellmeaning, hasn‟t worked....‟ Nearly a third of workers in Scotland - 4% of public sector 28% of private sector - earn less than a living wage (£7.20 perwhats happening to social determinants? hour) (ASHE 2010)
  11. 11. Trends by political leader or ‘30 years of brutal global capitalism’Source: Brewer M, Goodman A, Muriel A, Sibieta L. Poverty and Inequality in the UK:2007. Institute of Fiscal Studies, London.whats happening to social determinants?
  12. 12. UK Inequalities well above OECD average„If the rich could hire others to die for them, we, the poor, would allmake a nice living‟ 0.42 Fiddler onTrends in inequality of disposable income the Roof 0.40 Gini coefficient of income 0.38 0.36 inequality 0.34 0.32 0.30 0.28 0.26 0.24 0.22 1975 1980 1985 1990 1995 2000 2005 2010 Source: OECD 2011 Divided We Stand whats happening to social determinants?
  13. 13. Persistence of intergenerational earningswhats happening to social determinants?
  14. 14. Ideas that massacre the welfare state: Myth No 2: ‘dependency’ „an assets rather than a deficits approach to tackling poverty and inequality..... moving from welfare to wellbeing and from dependency to self determination.‟ Scottish Government 2011 • Deficit approach of public services A man goes to work full time and still has to get the social • Culture of dependency because wages is so low; folks haven‟t a clue how the he needed that money to rest of us are having to keep his kids make ends meetwhats happening to social determinants? Source: Dundee Equally Well/ONS Fairness & Wellbeing
  15. 15. Holding on to an inequalities analysisImage: Banksy; whats happening to social determinants?
  16. 16. Declaration of Intent of the Mental Patients Union•We proclaim the dignity of societys so-called mental patients•We challenge repressive psychiatric practice and its ill-definedconcepts of Mental illness•We state that the present appalling situation in Mental healthprimarily arises from the acute problems inhousing, unemployment and social inequality•Mental patients in determinants? are treated as people with no whats happening to social our society lynne.friedli@btopenworld.comhuman The Survivors’ History Group Pageant of Survivor History Source: rights
  17. 17. Mental health and deprivation Not ‘every family in the land’ Findings from 9 large scale population based studies: • Material and relative deprivation • Childhood socio-economic position • Low educational attainment • Unemployment • Environment: poor housing, poor resources, violence • Adverse life events • Poor support networks (Melzer et al 2004; Rogers & Pilgrim 2003; Stansfeld et al 2008; APMS 2007) Cycle of invisible barriers:whats happening to social determinants? • Poverty of hope, self-worth, aspirations
  18. 18. Explaining the social gradient: mental illness journeys... Most of the experiences that cause mental distress are directly linked to a lack of money....... powerlessness linked to poverty Peter Campbell Beyond the Water Tower • Adverse childhood experiences/stressful life 2005 events • Racism and other forms of discrimination • Contact with criminal justice system • Socio economic status – parental income, tenure, education, occupation • Institutional care inwhats happening to social determinants? childhood
  19. 19. Mental health of children by parentalincome 25% Percentage of children with a mental disorder 20% 15% 10% 5% 0% under £100-£199 £200-£299 £300-£399 £400-£499 £500-£599 £600-£770 Over £770 £100 Gross weekly household income Source: Meltzer et al 2000 Mental health of children and adolescents in Great Britainwhats happening to social determinants?
  20. 20. Mental health and the social gradient “Infants develop the attachment behaviours that optimally enhance their survival in their own characteristic environments.” Crittenden, 2000 Source: Fair Society, Healthy Lives: Marmot Review 2010whats happening to social determinants?
  21. 21. Rates of poor social/emotional adjustment by father’s social class at birthwhats happening to social determinants?
  22. 22. Low levels of (adult) mental wellbeing by concerns about income 45% Source: NW Wellbeing Survey Percentage with a low level of wellbeing 40% 35% 30% 25% 20% 15% 10% 5% 0% Living comfortably on Coping on present Finding it difficult on Finding it very difficult present income income present income on present incomewhats happening to social determinants?
  23. 23. Austerity rhetoricwhats happening to social determinants?
  24. 24. Austerity solutions....whats happening to social determinants?
  25. 25. Big fish/little fish: questions of power are unavoidable Source: happening to social determinants?
  26. 26. whats happening to social determinants?
  27. 27. Return to the social.... And what I shall endure, you shall endure For every atom belonging to me as good belongs to you...... Walt Whitman Solidarity Equity and Freedom and the Social to live a core Justice valued life economy I am, because we are...whats happening to social determinants?
  28. 28. Select bibliography Beckfield J and Krieger N (2009) Epi + demos + cracy: A Critical Review of Empirical Research Epidemiologic Reviews 31(1):152-177 Birn Anne-Emanuelle (2009) Making it politic(al): Closing the Gap in a Generation: health equity through action on the social determinants of health Social Medicine 4:3 p166-182 Christie C (2011) Report on the Future Delivery of Public Services by the Commission chaired by Dr Campbell Christie CSDH (2008) Closing the gap in a generation: health equity through action on the social determinants of health Final Report of Commission on Social Determinants of Health Geneva: World Health Organization. Friedli L (2009) Mental health, resilience and inequalities WHO Europe London/ Copenhagen Nussbaum M (2011) Creating capabilities: the human development approach Belknap Harvardwhats happening to social determinants?
  29. 29. Select bibliography Mair C, Zdeb K and Markie K (2011) Making better places: making places better the distribution of positive and negative outcomes in Scotland Improvement Service making-places-better-distribution-of-positive-and-negative-outcomes- in-scotland/ McKendrick et al 2011 Poverty in Scotland Child Poverty Action Group People First Scotland report.pdf OECD 2011 Divided we stand: why inequality keeps rising,3746,en_2649_33933_49147827 _1_1_1_1,00.html Stuckler D, Basu S, Suhrcke M et al (2011) Effects of the 2008 recession on health: a first look at European data The Lancet Vol. 378, Issue 9786, Pages 124-125 happening to social Board: A Summary of the Evidence Tackling Poverty determinants?
  30. 30. whats happening to social determinants?
  31. 31. Variation of growth of genetically identical marbled crayfish in an aquarium: how well would epidemiologists be able to predict outcomes? Source: Davey Smith G (2012) picture: Journal of Experimental Biologywhats happening to social determinants?