Source: Slide 17 of ‘Personal tax and benefit changes’, presentation by James Browne at the 2011 IFS Post-BudgetBriefing, downloadable from http://www.ifs.org.uk/budgets/budget2011/budget2011_jb.pdf.
York city council presentation
European Review of Health Inequalities and the Health Divide 2010-2012The Commission on Social Strategic Review of HealthDeterminants of Health Inequalities in England:(CSDH) – Closing the gap The Marmot Review – Fairin a generation 2008 Society Healthy Lives 2009
Life expectancy and disability free life expectancy at birth, persons byAge neighbourhood income level, England, 1999-200385807570656055 Life expectancy DFLE50 Pension age increase 2026-4645 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
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 wellbeingPrenatal Pre- School Training Employment Retirement school Family building Life course stages 3
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
Gaps in school readiness at 3 and 5 years by family income: UKAverage percentile score Waldfogel & Washbrook 2008 6
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 7Source: DCFS 2009
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 andchild 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
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.
Local Democraticlegitimacy• 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.
Local determinants of health and wellbeingBarton H and Grant M 2008
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 lookoutside. Its in your face every day, littereverywhere, rats and rubbish. It’s a dump……it feels likepeople around you have no meaning to life.I keep mycurtains closed at times……….It doesn’t give you apurpose 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 groupparticipant)
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)
INDEX OF HEALTH AND SOCIAL PROBLEMS PLOTTED BY INCOME INEQUALITYWilkinson R and Pickett K.(2009) The Spirit Level; Why more equal societies almost always do better.Penguin Books London.
Impact of changes to tax and benefit system on netincome in 2014 -2015 by decile: UKSource: IFS 2011