Monday, June 13, 2011

[EQ] Health Inequalities - A Challenge for Local Authorities

Health Inequalities – A Challenge for Local Authorities


Marmot Review Fair Society, Healthy Lives 2011


Available online at:

“…..The Marmot Review team therefore commissioned the London Health Observatory to provide charts showing key indicators for monitoring health inequalities and the social determinants of health for all ‘upper tier’ local authorities in England – those which will take over the responsibility for public health (3).

The indicators at local authority level are:
- life expectancy at birth;
- children reaching a good level of development at age five;
- young people not in employment,
- education or training (NEET); and,
- percentage of people in households receiving means tested benefits.

In addition there is an index showing the level of social inequalities within each local authority area for: life expectancy at birth; disability free life expectancy at birth, and percentage of people in households receiving means tested benefits. The higher the value of the index the greater the inequality (4).

Commenting, eminent public health specialist and author of Fair Society, Health Lives, Professor Sir Michael Marmot said:

‘Health inequalities are a tragic waste of life and health and cost this country tens of billions of pounds every year in lost productivity, welfare payments and costs to the NHS from ill health (10). The evidence is very clear: investing in pre-school years pays most dividends.

We already know that by the age of 10 a child from a poorer background will have lost any advantage of intelligence indicated at 22 months; whereas a child from an affluent family will have improved his or her cognitive scores purely because of his/her advantaged background.

We now have the baseline measurements for tackling health inequalities, using a social determinants approach. The Coalition Government is working in the right direction by transferring the responsibility of preventing ill health to local authorities. We need to ensure that local authorities invest money and expertise to ensure long-term reductions in health inequalities.’

 Healthy Lives, Healthy People: Our Strategy for Public Health in England was published by the Coalition Government in November 2010. The White Paper sets out the Government’s long-term vision for the future of public health in England. It responds to the Marmot Review, adopting a life course framework for tackling the social determinants of health. The aim is to create a ‘wellness’ service (Public Health England) and to strengthen both national and local leadership

Main policy recommendations from Fair Society, Health Lives:

1. Giving every child the best start in life (highest priority recommendation) – what happens during early years (starting in the womb) has lifelong effects on many aspects of health and well-being from obesity, heart disease and mental health, to educational achievement and economic status. Later interventions, although important, are considerably less effective where good early foundations are lacking. That is why the Review proposes a rebalancing of public spending towards the early years, more parenting support programmes, a well-trained early years work force and high quality early years care.

2. Enabling all children, young people and adults to maximize their capabilities and have control over their lives – educational achievement brings with it a whole range of achievements including better employment, income and physical and mental health. Evidence suggests it is families rather than schools that have the most influence on educational attainment therefore building closer links between schools, the family, and the local community are important to reducing educational inequalities.

3. Creating fair employment and good work for all – being in employment is protective of health; conversely unemployment contributes to poor health. Jobs need to offer a decent living wage, opportunities for in-work development, good management practices, the flexibility to enable people to balance work and family life, and protection from adverse working conditions that can damage health.

4. Ensuring a healthy standard of living for all – having insufficient money to lead a healthy life is a highly significant cause of health inequalities. Standards for a minimum income for healthy living  (MIHL) need to be developed and implemented – the calculation includes the level of income needed for adequate nutrition, physical activity, housing, individual and community interactions, transport, medical care and hygiene.

5. Creating and developing sustainable places and communities – many policies which would help mitigate climate change would also help reduce health inequalities – for instance more walking, cycling and green spaces. The Review proposes common policies to reduce the scale and impact of climate change and health inequalities. Good quality neighbourhoods can make a significant difference to quality of life and health – this relates both to the physical environment and to the social environment. Social support, within and between communities is critical to physical and mental well-being.

6. Strengthening the role and impact of ill-health prevention - many of the key health behaviours important for the development of chronic disease follow the social gradient: smoking, obesity, lack of physical activity, unhealthy nutrition and drug misuse. The Review argues for more funding to prevent ill health (currently it is only four percent of the NHS budget) and action to treat drug misuse as a medical problem. The NHS alone cannot tackle the social causes of ill health, action must come from families, schools, employers and government.



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