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Dr Mike Grady Marmot Review Team.UCL.
The Conceptual Framework
Reduce health inequalities and improve health and well-being for all.
Create an enabling society that maximises individual and community potential.
Ensure social justice, health and sustainability are at heart of policies.
Give every child the best start in
life.
Create fair employment and
good work for all.
Enable all children, young
people and adults to
maximise their capabilities and
have control over their lives.
Ensure healthy standard of living for all.
Create and develop healthy and sustainable
places and communities.
Strengthen the role and impact
of ill health prevention.
Equality and health equity in all policies.
Effective evidence-based delivery systems.
Policy objectives
Policy mechanisms
Key themes
Reducing health inequalities is a matter of fairness and social justice
Action is needed to tackle the social gradient in health – Proportionate universalism
Action on health inequalities requires action across all the social determinants of health
Reducing health inequalities is vital for the economy – cost of inaction
Beyond economic growth to well-being
Cost of Inaction in lean times
• In England, dying prematurely each year as a result of health inequalities between 1.3 and 2.5 million extra years of life lost – the human cost- 200000 deaths of 30+.
• Economic benefits in reducing losses from illness associated with health inequalities. Each year in England these account for:– productivity losses of £31-33B
– reduced tax revenue and higher welfare payments of £20-32B
– increased treatment costs well in excess of £5B.
Making it happen – A framework for delivery
• Increased disability free life expectancy and reduction in inequalities across the gradient.
• Empowering people : securing community solutions.• Intergovernmental action with dedicated leadership and
executive team.• National Policies need effective local deliver focussed on
health equity in all policies.• New model of civic and public sector leadership grounded in
democracy and whole system thinking• Local Strategic Partnerships of Councils, NHS, 3rd Sector and
Private Sector creating the conditions where individuals and communities take control.
• Comprehensive, systematic, scaled up,coproduced action focussed on the social determinants of health.
Partnerships with individuals and communities
• Critical success factor in addressing health inequalities through empowerment – creating the conditions in which people can take control– Bespoke individual responses– Population focused approaches
• Asset based partnership – half full not half empty– Sharing power– Community led and long term– Shift in values and attitudes– Leadership and knowledge transfer.
• Shared aspirations in improving health and wellbeing– Perceptions of local schools, health and social care service, housing
type,employment,safety and social cohesion.
• Balancing long-term gains and short-term pressures.
Evaluating partnerships
• Process issues– Engagement of Senior
managers in partnership
– Reorganisation impact– Lack of financial and
human resources– Information sharing
and best practice– Coterminosity– Need for quick wins
• Outcomes– Health outcomes– Monitoring and
evaluation problems
Perkins et al (2009) What counts is what works? New Labour and partnership in public health. Policy Press
Public Health Workforce
ImmaturePartnership
Little added value
MaturePartnership
Showing Added value
Gaining collaborative advantage for health improvement
Maturing partnership
Increasingly acting on social determinants of health
Process factors
External contextual factors
A Theory of Maturing Partnerships for Health Improvement
No shared vision
Dominant partner
Top down
Project focussed
Quick wins
Funding constraints
Grant giving
Internal focus
Individual ownership
Health an NHS issue
Medical Model
Confidence in partners
Shared identity
Shared vision
Joint ownership
Alignment
Joint posts
Citizen engagement
Accountability
Holistic
Health everyones business.
Addressing SDH
Adapted from Seymour M (2009) Do LSPs provide collaborative advantage for Health Improvement.
Action• Olympic Host 5 Boroughs Strategic Regeneration Plan. Recommendations made to be
incorporated into Stage 2 Plan to secure the Olympic legacy and convergence on health inequalities.
• Bolton Local Strategic Partnership LSP developing action plan based on Marmot recommendations. To be submitted to marmot Team for comment.
• Wakefield Council and PCT Working up a strategy for ratification by the LSP based on Marmot principles.
• Yorkshire and the Humber NHS Action Plan to be agreed at next Board Meeting. Consideration being given to a 1 year dedicated post to oversee implementation of Marmot recommendations.
• Coventry City Council and PCT Thematic Groups of the LSP to work up action plans on specific recommendations from the Marmot review.
• North West Region Continuing development of regional strategy based on Marmot principles.
• Greater London Authority. Marmot Team to facilitate and support implementation April 2010
• Health Lives/ Healthy Places 30 PCT sign up
Social determinants approach to obesitySocial Determinants approach
Proximal Factors
Areas of action Diet Exercise Metabolism
Early Years
Skill Development
Employment & work
Communities & places
Standard of living
Prevention
Equality/health equity
‘Living Well’
Statements of intent to build vision of future