Keynote speech on social determinants of health, 6 December 2021, more information at www.oecd.org/wise/well-being-and-mental-health.htm

1. Social Determinants of Health
Michael Marmot
@MichaelMarmot
http://www.instituteofhealthequity.org/about-our-work/latest-updates-from-
the-institute/build-back-fairer
OECD Wellbeing and Mental Health Conference
December 2021

2. Why treat people and send them back
to the conditions that made them sick?

3. HEALTH EQUITY IN ENGLAND:
THE MARMOT REVIEW 10
YEARS ON
3

4. Increases in life expectancy at birth stalling in England
4

5. Differences in life expectancy by deprivation widen in
England’s regions
5
Least
deprived
Most
deprived
London
Women

6. 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

7. Public sector expenditure (% of GDP) declined in the UK
7
Expenditure
by service

8. Proportionate Universalism

9. Levelling–up the social gradient in health

10. Council spending per person decreased the most in
more deprived areas
10

11. 11

12. Children living in poverty before and after housing costs
in England
12

13. The UK 2020: the poor poorer
13
IFS Deaton Review
2020

14. 14

15. After a small dip, violence increased the most for those
in more deprived areas
15
Most deprived
Least deprived

16. Social Determinants & Mental Health
16

17. What our communities have told us….

18. Proportion of people aged 16 – 64 assessed as at risk of mental
illness by income quintile: England
%
Source: Health Survey for England, DH;
the data is the average over 2008 and 2009; England; updated Mar 2011

19. ‘Gene map for depression' sparks hopes
of new generation of treatments
“Clinical depression is a debilitating condition the causes of which are still
largely unknown.”
Guardian 27 April 2018

20. Risk factors for depression
Level of evidence
Low socioeconomic position Very convincing
Low education Very convincing
Unemployment and under
employment
Very convincing
Food insecurity and early
nutrition deficiency
Strong
Gender inequity Strong
Low income Strong
WHO CSDH PPHC KN 2007

21. The mind is gateway by which social determinants affect ill-
health.
•Mental illness and well-being.
•Psychosocial pathways to physical illness
• Behaviours
• Stress pathways

22. Child poverty (<60% median income)
UNICEF Report Card 14

23. Public spending early child education and care
23
OECD Family Database

24. ACEs by income England 2013

25. Adverse Childhood Experiences: England
Bellis et al., 2014

26. Suicide Rate per 100,000 adolescents aged 15-19
Unicef, WHO
0 2 4 6 8 10 12 14 16 18 20
Lithuania
New Zealand
Canada
United States
Switzerland
Netherlands
United Kingdom
Greece
Rate per 100,000

27. Number of deaths by suicide per 100,000 persons
at different ages in Canada
27
0
10
20
30
40
50
60
70
80
90
1 to 14 years 15 to 24 years 25 to 34 years 35 to 44 years 45 to 54 years 55 years or older
Rate
per
100,000
First Nations males living on reserve Non-Indigenous males in Canada
Statistics Canada,
2016

28. Rate of suicide deaths among Māori and non-
Māori aged 15-24 years, 2009–2019
28
New Zealand Mortality Collection, NZ MoJ

29. BUILD BACK FAIRER: THE
COVID-19 MARMOT
REVIEW
The Pandemic,
Socioeconomic and Health
Inequalities in England
29

30. Male age-standardised mortality rates from all causes,
COVID-19 and other causes (per 100,000), by deprivation
deciles in England
30
ONS. Deaths involving COVID-19 by
local area and socioeconomic
deprivation, 2020

31. UK – miserly on unemployment
31
New Statesman 28 July 2021

32. Increase in percentage of children or young people with probable
mental disorder between 2017 and 2020, and again in boys between
2020 and 2021
Source: NHS Mental Health of Children
and Young People

33. Pandemic wasn’t all bad in the USA
33
• From March 18 2020 to October 2021, America’s billionaires
increased from 614 to 745
• Their wealth increased by $2.1 trillion. Get that? $2,100 billion
• Growth of 70%. From $3 trillion to $5 trillion
• That is 60% of the $3.5 trillion 10 year cost of Biden’s Build Back
Better plan.
• $5 trillion is two thirds more than the wealth of the bottom half of
the US Population
Institute for Policy Studies October 18, 2021

34. HEALTH AS A MEASURE OF SOCIETAL SUCCESS
Pre-Pandemic. LE stalling, inequalities increasing, LE for
poorest people falling
Slow down in LE nearly slowest of rich countries.
Pandemic. Highest excess mortality
Link?
• Poor governance and political culture
• Social and economic inequalities increasing
• Reduction in spending on public services – we are ill-
prepared
• England was unhealthy coming in to the pandemic
34