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Professor Sir Michael Marmot's Charles Cully Lecture on health inequalities and cancer

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The Irish Cancer Society hosts the annual Charles Cully Lecture in memory of one of the Society's founding members. Professor Sir Michael Marmot, one of the world's leading international experts on health inequalities, was the recipient of the Charles Cully Medal and gave the 2013 lecture on health inequalities and cancer.

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Professor Sir Michael Marmot's Charles Cully Lecture on health inequalities and cancer

  1. 1. Fair Society Healthy Lives Annual Irish Cancer Society Charles Cully Memorial Lecture 2013 Michael Marmot
  2. 2. • Health inequalities: social gradient • Social determinants: the causes of the causes • Evidence into policy
  3. 3. 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
  4. 4. Deviation of life expectancy at birth from average life expectancy by deprivation ranking: Ireland Burke & Pentony, Eliminating Health Inequalities – A Matter of Life and Death —TASC 2011
  5. 5. Life expectancy by social class: Ireland Burke & Pentony, Eliminating Health Inequalities – A Matter of Life and Death —TASC 2011 years
  6. 6. Social distribution of cancer varies depending on type of cancer: Ireland
  7. 7. Social distribution of cancer varies depending on type of cancer: Ireland Source: Cancer incidence in men and women in Ireland 1994 - 2009
  8. 8. Social distribution of cancer varies depending on type of cancer: Ireland Source: Cancer incidence in men and women in Ireland 1994 - 2009
  9. 9. Social distribution of cancer varies depending on type of cancer: Ireland Source: Cancer incidence in men and women in Ireland 1994 - 2009
  10. 10. International comparison: prostate cancer incidence rate per 100,000 in 2008
  11. 11. Prostate cancer: smoothed relative risks: 2002-2007
  12. 12. • Cancer is the second major cause of death in Ireland, after cardiovascular disease, • An average of nearly 30,000 new cases of cancer are diagnosed each year. • The number of newly diagnosed cancers is increasing by 6-7% annually • Largely due to increasing proportion of elderly people Source: Healthy Ireland: a framework for improved health and wellbeing 2013-2025
  13. 13. • Clearly identified modifiable risk factors: smoking, unhealthy diet, physical inactivity, obesity • Need to look at the causes of the causes of the social and area distribution
  14. 14. Social determinants of health and health inequities Socioeconomic and political context Governance Policy Macroeconomic Social Health Cultural and societal norms and values Education Occupation Income Gender Ethnicity/race Social position Material circumstances Social cohesion Psychosocial factors Behaviours Biological factors Health care system Distribution of health and well-being CSDH Conceptual Framework
  15. 15. 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
  16. 16. Obesity prevalence according to educational attainment, averaged across 19 EU Member States (Source: Eurothine 2007 reported in Robertson et al 2007)
  17. 17. 0 10 20 30 Latvia Ireland Finland Spain Norway Portugal Italy Percent obese Overall prevalence of obesity Highest education Second Highest Second Lowest Lowest education 0 10 20 30 England Germany Hungary Sweden Denmark Estonia Percentobese Obesity and education level, females, Eurothine study Low High Source: Roskam et al.
  18. 18. Causes of the causes • A life course approach • Context matters
  19. 19. Prenatal Early Years Working Age Older Ages Family building Accumulation of positive and negative effects on health and wellbeing LIFE COURSE STAGES MACROLEVEL CONTEXT WIDER SOCIETY SYSTEMS Perpetuation of inequities
  20. 20. Taxation revenue (Including social contributions) as a percentage of GDP: Ireland and the EU Burke & Pentony, Eliminating Health Inequalities – A Matter of Life and Death —TASC 2011
  21. 21. Total state expenditure v. total tax revenue (including social contributions) in €ms: Ireland Burke & Pentony, Eliminating Health Inequalities – A Matter of Life and Death —TASC 201
  22. 22. The effect of tax and benefit reforms on relative child poverty to 2020: UK and Northern Ireland, incomes measured before housing costs Source: IFS Report R78, 2013
  23. 23. Impact of modelled tax and benefit reforms since Jan 2010, by income decile group (percentage points) Source: IFS Green Budget 2013, Ch 7 Fig 7.4
  24. 24. Prenatal Early Years Working Age Older Ages Family building Accumulation of positive and negative effects on health and wellbeing LIFE COURSE STAGES MACROLEVEL CONTEXT WIDER SOCIETY SYSTEMS Perpetuation of inequities
  25. 25. 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
  26. 26. Country comparison on average rank in four dimensions of child wellbeing – material, health, education, behaviours & risks, in early 2000s and late 2000s UNICEF 2013 Report Card 11
  27. 27. Differences in PISA scores by attending preschool for more than one year before and after accounting for socioeconomic background OECD PISA 2009 database
  28. 28. 0 10 20 30 40 50 60 Romania Latvia Bulgaria Lithuania Italy Greece Spain Poland Portugal Luxembourg Hungary United Kingdom Malta Estonia Switzerland Ireland Slovakia France Belgium Netherlands Germany Austria Czech Republic Sweden Finland Cyprus Slovenia Denmark Norway Iceland Poverty rate Before social transfers After social transfers Child poverty rates <60% median before and after social transfers 2009 Source: EU SILC
  29. 29. Children achieving a good level of development at age five, local authorities 2011: England Source: LHO (2012)
  30. 30. Areas for improving outcomes: • Child Development – Cognitive – Communication & language – Social & emotional – Physical • Parenting – Safe and healthy environment – Active learning – Positive parenting • Parent’s lives – Mental wellbeing – Knowledge & skills – Financially self-supporting
  31. 31. Birmingham Brighter Futures • Aims to improve the lives of all the city's children and young people; • Focus on improving children’s physical health, literacy and numeracy, behaviour, emotional health, social literacy, and job skills. • Specific programmes relevant to early years include: Family Nurse Partnership (FNP), Incredible Years Parenting Programme, Promoting Alternative Thinking Strategies (PATHS), Triple P Parenting Programme.
  32. 32. Per cent 5 year olds achieving ‘good development score’,* Birmingham LA, West Midlands & England *in personal, social and emotional development and communication, language and literacy Source: Department for Education: preliminary data %
  33. 33. Prenatal Early Years Working Age Older Ages Family building Accumulation of positive and negative effects on health and wellbeing LIFE COURSE STAGES MACROLEVEL CONTEXT WIDER SOCIETY SYSTEMS Perpetuation of inequities
  34. 34. Occupational stress in European countries 0 10 20 30 40 50 Very low Low High Very high Effort reward imbalance Low control Per cent Occupational class
  35. 35. Unemployment rates by education and country of origin in selected countries Source: Eurostat database
  36. 36. Evidence from previous economic downturns suggests that population health will be affected: • More suicides and attempted suicides; possibly more homicides and domestic violence • Fewer road traffic fatalities • An increase in mental health problems, including depression, anxiety and lower levels of wellbeing • Worse infectious disease outcomes such as TB + HIV • Negative longer-term mortality effects • Health inequalities are likely to widen
  37. 37. Trends in the numbers of suicides and unemployment claimants in England, 2000-10, by sex. Barr B et al. BMJ 2012;345:bmj.e5142©2012 by British Medical Journal Publishing Group
  38. 38. Social Protections: unemployment and suicide 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
  39. 39. Income, employment, housing and health • Unemployment, low incomes and poor housing contribute to worse health; • These problems are more likely to occur among particular groups within the population and among those already on low incomes.
  40. 40. Neighbourhoods affordable to housing benefit recipients in 2011 and 2016
  41. 41. Rough sleeping counts and estimates by London and rest of England Housing Statistical Release Autumn 2012 DCLG Number
  42. 42. We can do better: • Political prioritisation of health equity – Advocacy – Leadership • Development of effective interventions • Measure and monitor
  43. 43. www.instituteofhealthequity.org A Fair Society Creating conditions in which individuals and communities have control over their lives

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