Social Determinants of Health          in Europe      Michael Marmot
Key principles• Social justice• Material, psychosocial,  political empowerment• Creating the conditions  for people to hav...
MACROLEVEL CONTEXT           WIDER SOCIETY                                  SYSTEMS                             LIFE COURS...
Life expectancy in countries in the WHO  European Region, 2010 (or latest available)Source: WHO Health for all database, 2...
Years of life spent free of disability, women in selectedEuropean countries 2009 Source: EC health indicators
MACROLEVEL CONTEXT           WIDER SOCIETY                                  SYSTEMS                             LIFE COURS...
Early child care and education• Parenting and family support  – Perinatal services  – Care before and during pregnancy  – ...
Children aged 36-59 months that do not attend any formof early education programme in selected CIS and CEEcountries       ...
Differences in PISA scores by attending preschool for morethan one year before and after accounting for socioeconomicbackg...
Iceland                                    Norway                                  Denmark                                ...
MACROLEVEL CONTEXT           WIDER SOCIETY                                  SYSTEMS                             LIFE COURS...
Work and employment are of critical importance for population health and health inequalities• Participation in, or exclusi...
Psychosocial environment of workStress arises from:• Demand-control imbalance• Effort-reward imbalance• Organisational inj...
Psychosocial stress and occupational classWahrendorf, Dragano and Siegrist , 2011   SHARE -11 European Countries
Wider Society• Social exclusion• Social protection across the life course• Communities
Welfare generosity and non employment byeducation in 26 European countriesPredicted                                       ...
Macrolevel context:Economic IssuesSustainability and environment
Social Protections Help…  Each 100 USD per  capita greater  social spending  reduced the effect  on suicides by:  0.38%, a...
MACROLEVEL CONTEXT           WIDER SOCIETY                                  SYSTEMS                             LIFE COURS...
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Social Determinants of Health in Europe

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  • http://www.who.int/about/regions/euro/en/index.html
  • . In every country shown in Fig.3.10 women live longer than men but spend more years in poor health. However there was no strong link between the size of these gaps across countries. For life expectancy, it varied from four years in several countries shown in Fig. 2.10 to 11 years in Lithuania while the gap in years in ill health varied from under three years in the United Kingdom to more than eight years in Portugal. Consequently the gender gap in years spent in good health, which is numerically equal to the gap in life expectancy minus the gap in years in poor health – did not favour either sex consistently. In 22 out of the 30 countries shown in Fig.3.10 women spent more years than men in good health, varying from a year or less in nine countries to close to four years more in Poland, Estonia and Lithuania. in the remaining eight of the 30 countries shown women spent fewer years in good health than men - the largest differences - over one and a half years - were in Portugal and the Netherlands In particular, Healthy Life Years (HLY) is a composite indicator of health that takes into account both mortality and ill-health, providing more information on burden of diseases in the population than life expectancy alone. The indicator “Healthy life years at birth”, shown in Fig.3.9, is an EU Structural Indicator and one of the EU Sustainable Development Indicators. It is calculated as life expectancy from which is subtracted the expected number of years lived with long-term activity limitations, currently obtained from EU-SILC.b
  • Values are all statistically significantSource: OECD PISA 2009 database, Table II.5.5.
  • Spending on welfare has different impacts on groups depending on their educational level.  Figure 5.2 shows the association between increase in social spending (welfare generosity) and decline in probability of non-employment for those with longstanding limiting illness (left hand graph), and those without (right hand graph).  Higher amounts of welfare spending benefit all groups, but the effect is greater among ill people than among healthy people, and greater among those with only primary level education, and least among those with tertiary level education (484;485). Those with lower education levels are more likely to be unemployed (see also Chapter 3). Fig. 5.2 shows that more generous welfare spending acts to reduce social inequalities in non-employment, and therefore has a clear potential to contribute to the reduction of health inequities.  Fig 5.2 Welfare generosity* and non employment** by education in 26 European countriesPredicted probabilities from multilevel regression analyses. The model controls for GDP and business cycle in addition to individual level variables Source:  van der Wel, Dahl & Thielen 2011 data from EU SILC (2005)Note*Welfare generosity - social expenditure data from Eurostat in purchasing power standards per capita, divided on the non-employment rate ( the inverse of Eurostat employment rates in the age group 15-64) in each country.**Non-employment: the category includes unemployed, early retirement/given up business, permanently disabled or unfit for work. Fulfilling domestic tasks and care responsibilities, other inactivity
  • Social Determinants of Health in Europe

    1. 1. Social Determinants of Health in Europe Michael Marmot
    2. 2. Key principles• Social justice• Material, psychosocial, political empowerment• Creating the conditions for people to have control of their liveswww.who.int/social_determinants
    3. 3. MACROLEVEL CONTEXT WIDER SOCIETY SYSTEMS LIFE COURSE STAGES Accumulation of positive and negative effects on health and wellbeingPrenatal Early Years Working Age Older Ages Family building Perpetuation of inequities
    4. 4. Life expectancy in countries in the WHO European Region, 2010 (or latest available)Source: WHO Health for all database, 2012
    5. 5. Years of life spent free of disability, women in selectedEuropean countries 2009 Source: EC health indicators
    6. 6. MACROLEVEL CONTEXT WIDER SOCIETY SYSTEMS LIFE COURSE STAGES Accumulation of positive and negative effects on health and wellbeingPrenatal Early Years Working Age Older Ages Family building Perpetuation of inequities
    7. 7. 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
    8. 8. Children aged 36-59 months that do not attend any formof early education programme in selected CIS and CEEcountries Tajikistan Bosnia and Herzegovina TFYR Macedonia* Kazakhstan Uzbekistan Montenegro Kyrgyzstan Serbia Georgia Albania Ukraine Belarus 0 20 40 60 80 100 Richest 20% Poorest 20%Source: Unicef/MICS 2007
    9. 9. Differences in PISA scores by attending preschool for morethan one year before and after accounting for socioeconomicbackground Slovenia Ireland Netherlands TFYR Montenegro Serbia Lithuania Turkey United Kingdom Denmark Switzerland Italy France Belgium Israel 0 20 40 60 80 100 120 140 Before accounting for socioeconomic background After accounting for socioeconomic backgroundOECD PISA 2009 database
    10. 10. Iceland Norway Denmark Slovenia CyprusChild poverty rates <60% Finland Swedenmedian before and after Czech Republic Austriasocial transfers 2009 Germany Netherlands Belgium France Slovakia Ireland Switzerland Estonia Malta United Kingdom Hungary Luxembourg Portugal Poland Spain Greece Italy Lithuania Bulgaria Latvia Romania 0 10 20 30 40 50 60 Poverty rateSource: EU SILC Before social transfers After social transfers
    11. 11. MACROLEVEL CONTEXT WIDER SOCIETY SYSTEMS LIFE COURSE STAGES Accumulation of positive and negative effects on health and wellbeingPrenatal Early Years Working Age Older Ages Family building Perpetuation of inequities
    12. 12. Work and employment are of critical importance for population health and health inequalities• Participation in, or exclusion from the labour market determines a range of life chances• Wages and salaries provide the major component of the income of most people in employment• Exposure to hazards at work, demanding or dangerous work, long or irregular hours, shift work, and prolonged sedentary work can all adversely affect health• Psychological and socio-emotional demands and threats evolving from an adverse psychosocial work environment have become more widespread
    13. 13. Psychosocial environment of workStress arises from:• Demand-control imbalance• Effort-reward imbalance• Organisational injustice• Employment precariousness
    14. 14. Psychosocial stress and occupational classWahrendorf, Dragano and Siegrist , 2011 SHARE -11 European Countries
    15. 15. Wider Society• Social exclusion• Social protection across the life course• Communities
    16. 16. Welfare generosity and non employment byeducation in 26 European countriesPredicted Predicted Longstanding limiting illness No Longstanding Limiting Illnessprobabilities probabilitiesof0.8 0.8 ofnonemploy nonemployment0.7 ment 0.70.6 0.60.5 0.50.4 Primary 0.4 Primary0.3 Secondary 0.3 Secondary Tertiary Tertiary0.2 0.20.1 0.1 0 0 Wefare generosity Welfare generosity van der Wel, Dahl & Thielen 2011
    17. 17. Macrolevel context:Economic IssuesSustainability and environment
    18. 18. Social Protections Help… 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 Spending> 190 USD no effect of 0.09%,unemployment unemployment on suicide benefitsSource: Stuckler et al 2009 Lancet
    19. 19. MACROLEVEL CONTEXT WIDER SOCIETY SYSTEMS LIFE COURSE STAGES Accumulation of positive and negative effects on health and wellbeingPrenatal Early Years Working Age Older Ages Family building Perpetuation of inequities

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