This document summarizes a presentation by Professor Sir Michael Marmot on social determinants of health and nutrition. The presentation discusses: 1) How health is influenced by social factors and the need for a society to promote the well-being of its people. 2) Evidence that health inequalities exist both between and within countries. 3) Marmot's definition of a "fair society" as one where health is evenly distributed and not determined by social position or economic status. 4) Marmot's six policy objectives to reduce health inequalities, including giving children a good start, enabling individuals to maximize their capabilities, ensuring fair employment and healthy living standards.

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3. Dr. Pandav is the National President of Indian Public
Health Association and a Professor and Head of
Centre for Community Medicine at the All India
Institute of Medical Sciences (AIIMS). He is a
Physician, Medical Scientist, Public Health Specialist,
Dr C S Pandav Epidemiologist and Health Economist. Dr Pandav has
Professor & Head, worked as a consultant for the WHO, UNICEF,
Centre for Community ICCIDD, PAMM and MI at the global, regional
Medicine, AIIMS
(including China, Africa) levels for over 50 countries,
and also at the national level in India for the last 30
years.
SESSION MODERATOR

4. Demystifying Social Determinants
in
Health & Nutrition

5. Professor Sir Michael G. Marmot
MBBS, MPH, PhD, FRCP, FFPHM, FMedSci, FBA
Director, UCL Institute of Health Equity (Marmot Institute)
Chair, European Review on the Social Determinants of Health and the
Health Divide
Director: International Institute for Society and Health;
MRC Research Professor of Epidemiology and Public Health, University
College London
He was a member of the Royal Commission on Environmental Pollution for six years, and
served as President of the British Medical Association (BMA) in 2010-2011. He is a Fellow of
the Academy of Medical Sciences, an Honorary Fellow of the British Academy, and an
Honorary Fellow of the Faculty of Public Health of the Royal College of Physicians.
In 2000 he was knighted by Her Majesty The Queen, ‘for services to Epidemiology and the
understanding of health inequalities’. Internationally acclaimed, Professor Marmot is a Foreign
Associate Member of the Institute of Medicine (IOM), and a former Vice President of the
Academia Europaea.
He was Chair of the Commission on Social Determinants of Health (CSDH) , which was set up
by the World Health Organization in 2005, and produced the report entitled: ‘Closing the Gap in
a Generation’.

6. AGENDA
SECTION I – Need of Society for Quality Life of its People
SECTION II – Status
SECTION III- Definition of a Fair Society
SECTION IV – Marmot Review: 6 Policy Objectives
SECTION V - Conclusion
Questions and Answers

7. • Social justice
• Material, psychosocial, po
litical empowerment
• Creating the conditions
for people to have control
of their lives
www.who.int/social_determinants

8. AGENDA
SECTION I – Need of Society for Quality Life of its People
SECTION II – Status
SECTION III- Definition of a Fair Society
SECTION IV – Marmot Review: 6 Policy Objectives
SECTION V - Conclusion
Questions and Answers

9. Inequalities in health within and between
countries

10. Inequalities between countries
Glasgow men(Lenzie) 82 *
Glasgow men (Calton) 54
National data WHO 2009, Glasgow data: Hanlon et al. 2006

11. Under 5 mortality per 1000 live births by wealth quintile
Average U5M for high income countries is 7/1000
India Peru
2005/6 2000
Source: DHS

12. AGENDA
SECTION I – Need of Society for Quality Life of its People
SECTION II – Status
SECTION III- Definition of a Fair Society
SECTION IV – Marmot Review: 6 Policy Objectives
SECTION V - Conclusion
Questions and Answers

13. What is a ‘fair society’?
• Health as a measure of how well we are doing as a
society;
• Distribution of health across society;
• Health inequalities – the social gradient

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

15. AGENDA
SECTION I – Need of Society for Quality Life of its People
SECTION II – Status
SECTION III- Definition of a Fair Society
SECTION IV – Marmot Review: 6 Policy Objectives
SECTION V - Conclusion
Questions and Answers

16. Marmot Review: 6 Policy Objectives
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

17. 6 Policy Objectives
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

18. Moderate and severe stunting rates for children under age 5 by national
wealth (GNP per capita), 2008
EFA 2011

19. Reading levels in grade 3 students: regional variation India
EFA 2011

20. Marmot Review: 6 Policy Objectives
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

21. Share of workers in vulnerable employment by sex, selected
countries in South Asia
ILO

22. Marmot Review: 6 Policy Objectives
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

23. Minimum standards (or income) for health
living
• To live a live of dignity

24. Marmot Review: 6 Policy Objectives
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

25. Empowering communities: SEWA Case Study: The
Parivartan Programme
• Improve the basic physical infrastructure within the slums and in
the homes;
• Community development;
• City-level organisation for environmental upgrading of the slums
SEWA Case Study 2008

26. SEWA: slum upgrading in India
• Slum upgrading in Ahmadabad, India, cost only US$
500/household.
• Community contributions of US$ 50/household.
• Following the investment in these slums, there was
improvement in health
– decline in waterborne diseases,
– children started going to school,
– women were able to take paid work, no longer having to
stand in long lines to collect water.

27. MELADI NAGAR
Before After

28. Marmot Review: 6 Policy Objectives
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

29. Social patterning of cigarette smoking among men in Mumbai,
India
1.8
1.7
Adjusted odds ratio*
1.6
1.5
1.4
1.3
1.2
1.1
1
College Secondary Middle Primary None/illiterate
(reference)
Sorensen et al.2005 AJPH

30. Global projections for the number of people with diabetes
(aged 20-79), 2010 - 2030
Source: IDF 2009

31. • Social justice
• Tackling the inequitable
distribution of
power, money, and
resources
• Improving the conditions
in which people are
born, grow, live, work and
age;
• Monitoring, measuring and
www.who.int/social_determinants
research

32. Socioeconomic development AND
equity oriented policies

33. •

37. AGENDA
SECTION I – Need of Society for Quality Life of its People
SECTION II – Status
SECTION III- Definition of a Fair Society
SECTION IV – Marmot Review: 6 Policy Objectives
SECTION V - Conclusion
Questions and Answers

38. A world where
social justice is
taken seriously

39. AGENDA
SECTION I – Need of Society for Quality Life of its People
SECTION II – Status
SECTION III- Definition of a Fair Society
SECTION IV – Marmot Review: 6 Policy Objectives
SECTION V - Conclusion
Questions and Answers

40. Questions & Answers
To submit a question for Sir Michael G. Marmot,
please message Dr. C. S. Pandav via the chat

41. Closing Remarks