The Commission on Social

Determinants of Health

(CSDH) – Closing the gap

in a generation 2008

Strategic Review of Health

Inequalities in England:

The Marmot Review – Fair

Society Healthy Lives 2009

European

Review of Health

Inequalities and

the Health Divide

2010-2012

Life expectancy and disability free life expectancy at birth, persons by

neighbourhood income level, England, 1999-2003

45

50

55

60

65

70

75

80

85

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

Neighbourhood Income Deprivation

Source: ONS (Population Percentiles)

Age

Life expectancy

DFLE

Pension age increase

2026-46Poly. (DFLE)

Poly. (Life expectancy)

2

Inequality in Early Cognitive Development of British Children in the 1970 Cohort, 22 months to 10 years

0

10

20

30

40

50

60

70

80

90

100

22 26 30 34 38 42 46 50 54 58 62 66 70 74 78 82 86 90 94 98 102 106 110 114 118

months

Av

era

ge

po

sit

ion

in

dis

trib

uti

on

High Q at 22m

Low Q at 22m

Source: Feinstein, L. (2003) ‘Inequality in the Early Cognitive Development of British Children in the 1970 Cohort’, Economica (70) 277, 73-97

High SES

Low SES

3

Gaps in school readiness at 3 and 5 years by family income: UK

Avera

ge p

erc

entile

score

Waldfogel & Washbrook 2008 4

Per cent of children achieving a good level of

development by local authority: England

0

20

40

60

80

100

Per cent achieving a

good level of development

Local authorities

Children achieving a Good level of development

Per cent achieving 5+ A* - C grades inc Maths and English at GCSE by IDACI decile of pupil residence: England 2007

25.329.9

34.239.2

44.749.5

53.857.8

61.968.4

0

10

20

30

40

50

60

70

80

0-10% 10-

20%

20-

30%

30-

40%

40-

50%

50-

60%

60-

70%

70-

80%

80-

90%

90-

100%

% achieving 5+ A*-C GCSEs inc Maths and English

Income Deprivation Affecting Children Index (IDACI) Least

deprivedSource: DCFS 2009

Most

deprived6

7

Recommendations : Fair Society ,Healthy Lives

Give every child the best start in life.

Enable all to maximise their capabilities and have control over their

lives

Create fair employment and good work for all.

Ensure a healthy standard of living for all

Create and develop healthy and sustainable communities.

Strengthen the role and impact of ill-health prevention.

Local Democratic legitimacy

• Community Leadership in giving people voice.

• Place shaping building sustainable communities promoting health wellbeing and resilience.

• Extending participation and co-production of services

• Orchestrating local partnership working.

• Directors of Public Health leading local public health

• Use Council’s role as Commissioner, Service Provider and Employer.

People and Places

• Critical linkage of health, wellbeing and resilience.

• Evidence of linkage of low level stress, depression, isolation especially in communities of multiple deprivation with significant barriers to participation.

“ You can see the deprivation, all you have to do is look outside. Its in your face every day, litter everywhere, rats and rubbish. It’s a dump……it feels like people around you have no meaning to life.I keep my curtains closed at times……….It doesn’t give you a purpose to do anything” (Focus group participant)

• Many excluded areas are characterised by lack of mutual trust, isolation and under developed social cohesion.

“I feel safe but there I places I don’t go” (focus group participant)

Developing Communities: building resilience

• Evidence participation and improving life skills ameliorates impact of health inequalities through developing social support networks. (Bynner and

Parsons 2006)

• Impact of personal support critical“ I know I have got back up and that is a big thing” (Mari 2006)

• Learning and skill development impact positively and fosters community action. “ It was just getting worse and worse. The group then decided that we ought to be lobbying people that could help us MPs, local councillors, local members and the Police.” (Shirley)

• Social networks create the conditions in which people thrive“I don’t know what makes other people healthier. I know what makes me healthier and that’s being happy and having friends” (Suzanne 2006)

INDEX OF HEALTH AND SOCIAL PROBLEMS PLOTTED BY INCOME INEQUALITY

Wilkinson R and Pickett K.(2009) The Spirit Level; Why more equal societies almost always do better.Penguin Books London.

Impact of changes to tax and benefit system on net

income in 2014 -2015 by decile: UK

Source: IFS 2011

YORK ALL AGE: ALL CAUSE MORTALITY RATES

Creating the conditions

for individuals and

communities to take

control over their health

and lives and have

political voice.

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