the global burden of non-communicable disease and the policy challenge
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The global burden of non-communicable disease and the policy challenge. Professor Sir Michael Marmot. NCDs in high, middle and low income countries Health inequalities and the social gradient in health Policy challenge: national and local. - PowerPoint PPT PresentationTRANSCRIPT
• NCDs in high, middle and low income countries
• Health inequalities and the social gradient in health
• Policy challenge: national and local
Source: WHO, 2008
Projected deaths by cause for high-, middle, and low-income countries
CVD
Cancer
OtherNCDs
• NCDs in high, middle and low income countries• Health inequalities and the social gradient in
health• Policy challenge: national and local
HEALTH DIFFERENCES BETWEEN ENGLAND AND THE US 55-64 year olds
0
5
10
15
20
25
England US England US England US
Low income Middle income High Income
Heart disease Diabetes CancerSource: Banks, Marmot, Oldfield and Smith; JAMA 2006
% Prevalence
Cardiovascular deaths of people aged 45 - 64 and social inequalities: Porto Alegre, Brazil
050
100150200250300350400
High Mediumhigh
Mediumlow
Low ALL
CVD deaths Attributable CVD deaths
CVD deathsper 100,000inhabitants
Socioeconomic level of districts
(Source: Bassanesi, Azambuja & Achutti, Arq Bras Cardiol, 2008)
Age standardised circulatory disease death rates at ages under 75, by local ward deprivation level, 1999 and 2001-2003:England
Obesity prevalence according to educational attainment, averaged across 19 EU Member States
(Source: Eurothine 2007 reported in Robertson et al 2007)
Social patterning of diabetes by education and by monthly income, Buenos Aires, Argentina
Fleisher et al 2008
Occupational stress in European countries
0
10
20
30
40
50
Very low Low High Very high
Effort rewardimbalance
Low control
Per cent
Occupational class
ALCOHOL CONSUMPTION RELATIVE TO ITS PRICE: UK
0
2
4
6
8
10
12
Litr
es o
f alc
oh
ol p
er p
erso
n
aged
15+
0
50
100
150
200
250
Pri
ce r
elat
ive
to in
com
e
alcohol Price
Tighe, 2003
• NCDs in high, middle and low income countries• Health inequalities and the social gradient in
health• Policy challenge: national and local
• Fairness at the heart of all policies.
• Health inequalities result from social inequalities – requires action on all the social determinants.
• Focusing solely on the most disadvantaged will not reduce inequalities sufficiently – action is needed across the social distribution.
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
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
Country clusters by level of policy response
• Cluster 1: Relatively positive and active response to health inequalities. – At least one national response to HIs or
comprehensive regional HI policy responses.
• Cluster 2: Variable response to health
inequalities. – No explicit national policy on HIs, but at least
one explicit regional response or a number of
other policies with some focus on health
inequalities.
• Cluster 3: Relatively undeveloped response to health inequalities. – No focused national or regional responses to
health inequalities, no explicit health inequality
reduction targets (though there may be
targeted actions on the social determinants of
health).Source: Report on Health Inequalities in the EU
LOCAL ACTION:• Local authorities
– 75% of local authorities have been significantly influenced by Marmot, evidence by their Health and Well-being Strategies and JSNAs (joint Strategic Needs Assessments)
– We have worked directly with 40 plus local authorities
• English Partnership Local government partnership between IHE and 7-8 local authorities until 2014/15 – intensive working to develop SDH approach to health inequalities. Disseminate findings
Priorities agreed by 65 Health and Well-being Boards – Local Government England
Kings Fund 2013
Prevention Inequality Ageing Mental health
Unhealthy behaviours
Marmot Principles
0
10
20
30
40
50
60
5 7 9
2328
49
Keeping Vulnerable Communities Safe
• over 80 years are 4 X more likely to die from fire
• Smoking materials contributory factor in 49% of fatal fires
• Alcohol or drugs were present in 47% of fatal fires
• The householder known to mental health or social care providers in 39% of fire deaths
• 70% of accidental house fires take place in the lower quintile of Super Output Area (WMFS)
• 72% of house fires caused by arson take place in the lower quintile of Super Output Areas (WMFS)
WMFS
Malmö, Sweden
• Commission for a Socially Sustainable Malmo, chaired by Sven-Olof Isaacson, March 2011
• to translate the findings of the CSDH into a form suitable to address social determinants and health inequalities in Malmo
• Report March 2013
Malmö:Six areas for action
• Children and young people´s livings conditions
• Living environment and urban planning• Education• Income and employment• Health services’• Changes in processes for socially
sustainable development
Action to tackle health inequalities
• “Every sector a health sector”
• Empower individuals and communities – create the conditions for people to take responsibility