The Marmot review final report – Fair Society, Healthy Lives –
proposes new ways to improve everyone's health and reduce inequalities that it describes as 'unfair and unjust'.
February 11, 2010
It concluded that, although health inequalities are normally associated with the poor, premature illness and death affects everyone below the wealthiest tier of English society.
Most people in
Website: http://www.ucl.ac.uk/gheg/marmotreview/Documents
“……People living in the most deprived neighbourhoods will on average die seven years earlier than people living in the richest neighbourhoods. Even more disturbing, people living in poorer areas not only die sooner, but spend more of their lives with disability – an average total difference of 17 years. The review has estimated the cost of health inequalities in
· Productivity losses of £31 – 33 billion every year
· Lost taxes and higher welfare payments in the range of £20 – 32 billion per year
· Additional NHS healthcare costs well in excess of £5.5 billion per year
The review also predicts an increase in the cost of treating the various illnesses that result from inequalities in obesity alone to rise from £2 billion per year to nearly £5 billion per year by 2025.
The review calls for health inequalities to sit alongside tackling climate change as one of society’s core priorities. Creating a sustainable future is, the review argues, compatible with action to reduce health inequalities: sustainable local communities, active transport, sustainable food production, and zero carbon houses will all have health benefits across society.
The six main recommendations of the review are:
· Giving every child the best start in life
· Enabling all children, young people and adults to maximize their capabilities and have control over their lives
· Creating fair employment and good work for all
· Ensuring a healthy standard of living for all
· Creating and developing sustainable places and communities
· Strengthening the role and impact of ill-health prevention
Professor Marmot, whose commission included the President of the Royal College of Physicians, Professor Ian Gilmore, and the Chief Executive of the Economic and Social Research Council, Professor Ian Diamond, said: "There will be those who say that our recommendations cannot be afforded, particularly in the current economic climate. We say that it is inaction that cannot be afforded, the economic and more importantly human costs are simply too high.
The health and wellbeing of today’s children, and of those children when they become adults, depend on us having the courage and imagination to do things differently, to put sustainability and well-being before a narrow focus on economic growth and bring about a more equal and fair society."
“…….Health Secretary Andy Burnham said the review would help the Government put in place a strategy to tackle health inequalities over the next decade.
“It is not right that where we live can dictate the state of our health. Everyone should have an equal chance at good health. I am passionate about getting to the heart of this issue and ensuring that young people can look forward to the same life expectancy regardless of where they are born. This report will help us make that historic achievement," Mr Burnham said….”…
From: David McDaid
The Marmot Review Final Report
| Fair Society, Healthy Lives Full Report (pdf, 25Mb) Fair Society, Healthy Lives Executive Summary (pdf, 8Mb) Fair Society, Healthy Lives Table of Contents (pdf, 60Kb) Fair Society, Healthy Lives Tables and Figures (pdf, 57Kb) Fair Society, Healthy Lives Chapter 1 - Introduction (pdf, 2Mb) Fair Society, Healthy Lives Chapter 2 - Health inequalities and the social determinants of health (pdf, 3Mb) Fair Society, Healthy Lives Chapter 3 - Lessons to be learnt from the current Health Inequalities Strategy, targets and indicators (pdf, 2Mb) Fair Society, Healthy Lives Chapter 4 - Policy objectives and recommendations (pdf, 8Mb) Fair Society, Healthy Lives Chapter 5 - Making it happen: a framework for delivering and monitoring reductions in health inequalities along the social gradient (pdf, 2Mb) Fair Society, Healthy Lives Chapter 6 - Key policies over the life course (pdf, 2Mb) Fair Society, Healthy Lives Annex 1 - Structure and organisation of the review (pdf, 60Kb) Fair Society, Healthy Lives Annex 2 - Framework for indicators to assess performance improvement in delivering Review recommendations (pdf, 120Kb) Fair Society, Healthy Lives Abbreviations (pdf, 50Kb) Fair Society, Healthy Lives References (pdf, 350Kb) Fair Society, Healthy Lives Index (pdf, 80Kb) |
Content:
Executive summary
Chapter 1 Introduction
1.1 The central themes for the Review
1.1.1 Health inequalities are a matter of social justice
1.1.2 There is a social gradient in health and health inequalities
1.1.3 Addressing health inequalities is a matter of fairness
1.1.4 The economic context
1.1.5 Tackling health inequalities involves tackling social inequalities
1.1.6 Tackling health inequalities means tackling climate change
1.2 Conceptual framework and action on the social determinants of health inequalities
1.2.1 A framework for the Review’s recommendations
1.2.2 Policy objectives and the life course
1.2.3 Policy objectives and the social gradient
1.2.4 Health and well-being
Chapter 2 Health inequalities and the social determinants of health
2.1 Health inequalities in
2.2 The current PSA target
2.3 Regional variation in mortality
2.4 Other indicators of health
2.5 Health risks
2.5.1 Smoking
2.5.2 Alcohol
2.5.3 Obesity
2.5.4 Drug use
2.6 The social determinants of health
2.6.1 Early years and health status
2.6.2 Education and health
2.6.3 Work, health and well-being
2.6.4 Income and health
2.6.5 Communities and health
2.7 Human and economic costs of inequalities
2.7.1 Loss of years of life
2.7.2 Loss of years of healthy life
2.7.3 Economic costs
Chapter 3 Lessons to be learned from the current health inequality strategy, targets and indicators
3.1 Introduction
3.2 Current health inequalities policy
3.3 Lessons learnt: policy designs and approach
3.3.1 The social determinants of health
3.3.2 Investing in prevention of ill health
3.3.3 Cross-cutting action and all-policy focus on health equity
3.3.4 Need to focus on the gradient in health inequalities
3.3.5 Small-scale policies and short timescales
3.3.6 The hunt for quick wins
3.4 Lessons learnt from delivery systems
3.4.1 Barriers to the national delivery system
3.4.2 Barriers to local-level delivery systems
3.5 Appropriateness of the targets
3.6 Issues in the construction of the targets
3.6.1 Not all dimensions of equality and inequality are covered
3.6.2 Being clear about outcomes
3.6.3 Use of national targets at local levels
3.6.4 Use of local area information to monitor inequalities
3.7 Monitoring progress in reducing health inequalities
3.7.1 Over-simplification
3.7.2 Problems arising from targeting
3.7.3 Absolute and relative inequalities
3.7.4 Unintended consequences and perverse incentives
3.7.5 The availability of monitoring information
3.8 Delivering across the whole system
Chapter 4 Policy objectives and recommendations
4.1 Introduction
A Policy Objective A: Give every child the best start in life
A.2 Recommendations
A.2.1 Increased investment in early years
A.2.2 Supporting families to develop children’s skills
A.2.3 Quality early years education and childcare
A.3 Policy Recommendations
B Policy objective B: Enable all children, young people and adults to maximize their capabilities and have control over their lives.
B.2.1 Reduce the social gradient in educational outcomes
B.2.2 Reduce the social gradient in life-skills
B.2.3 Ongoing skills development through lifelong learning
B.3 Policy Recommendations
C Policy Objective C: Create fair employment and good work for all work
D Policy Objective D: Ensure healthy standard of living for all
E Policy Objective E: Create and develop healthy and sustainable places and communities
F Policy Objective F: Strengthen the role and impact of ill health prevention
Chapter 5 Making it happen: a framework for delivering and monitoring reductions in health inequalities along the social gradient
5.1 Delivery systems
5.1.1 Taking a whole-system approach
5.1.2 Empowering people: securing community solutions
5.1.3 The role of national government
5.1.4 The National Health Service
5.1.5 The role of local government
5.1.6 The role of the third sector
5.1.7 The role of private sector employers
5.1.8 Enhancing partnerships
5.1.9 Partnerships for implementation
5.2 Framework for targets and indicators to assess performance improvement
5.2.1 The framework
5.2.2 Existing sets of indicators
5.2.3 Components of the framework
5.2.4 Selection of indicators
5.3 National targets
5.4 Issues in implementing the framework
5.4.1 What dimensions of inequality should be covered?
5.4.2 To what timescale should targets relate?
5.4.3 On what type of areas or individual characteristics should indicators and targets be based?
5.4.4 Measuring the social gradient in health
5.5 Data availability
5.5.1 Limitations of the data infrastructure, both nationally and at local level
5.5.2 Improving timeliness
5.6 Addressing the problems with area based measures
5.7 Evaluating the impact of interventions
5.7.1 The need for evaluation
5.7.2 Evaluating an impact on the social gradient
Chapter 6 Key polices over the life course
Annex 1 Structure and organisation of the review
Annex 2 Framework of indicators to assess performance improvement in delivering
Review recommendations
References
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