Sir Michael Marmot - Insecurity and Social Determinants of Health

Insecurity and Social Determinants of Health
Click to edit Master subtitle style Michael Marmot April 2012
Conflict and insecurity

Threaten health Threaten human dignity Threaten psychosocial wellbeing; Threaten access to and availability of services, including health care, education, food, water Exacerbate health inequities avoidable inequalities in health outcomes
Commission on Human Security 2003
Freedom from fear; Freedom from want
Conflict and deprivation are interconnected. Deprivation has many causal links to violence, although these have to be carefully examined. Conversely, wars kill people, destroy trust among them, increase poverty and crime, and slow down the economy. Addressing such insecurities effectively demands an integrated approach.
Social justice Empowerment material, psychosocial, political Creating the conditions for people to take control of their lives
www.who.int/social_determinants/e n
Inequalities in health within and between countries
Inequity in infant mortality rates between countries and within countries by mothers education
CSDH Final Report 2008
Under 5 mortality per 1000 live births by wealth quintile

Average U5M for high income countries is 7/1000
India 2005/6
Peru 2000
Source: DHS
Conflict-affected countries
Source: Global Burden of Armed Violence Report, Geneva Declaration Secretariat 2008
EMR countries in conflict
Source: Watts, Siddiqi, Shukrullah,Karim,Serag report to CSDH, 2007
Social determinants of maternal mortality in Afghanistan

92% of maternal deaths in rural areas Mean age at marriage is 15 years 94% of respondents had less than 1 year education Women report barriers to seeking health care Low use of available health care (only 11% prenatal care, less than 1% reported trained health care worker at delivery)
Amowit 2002 reported in Watts et al, report to CSDH 2007
Social disruption
Death rates in Russia 1980-2007

both genders, per 100,000
Gorbatchev elected Coup against Gorbatchev, breakup of USSR Rouble crisis
Click icon to add chart
3M extra deaths (Men et al, BMJ,2003)
Causes of the causes
CSDH three principles of action

Structural drivers of those conditions at global, national and local level
Conditions in which people are born, grow, live, work and age
Monitoring, Training, Research
CSDH three Linked Areas for Action

Structural drivers of those conditions at global, national and local level
Early child development and education Healthy Places Conditions in which people are Fair Employment born, grow, live, work and age Social Protection Universal Health Care
Monitoring, Training, Research
CSDH Areas for Action

Health Equity in all Policies
Fair Financing Early child development and education Healthy Places Fair Employment Social Protection Universal Health Care Good Global Governance
Market Responsibilit y
Gender Equity
Political empowerment inclusion and voice
Every sector is a health sector
Health and well being as outcomes
Empowerment
Aboriginal Youth Suicide by Factors Present

1 4 0 1 2 0 1 0 08 0 6 0 4 0 2 0 0
Cultural Factors: Self-government Land claim participation Community Control: Health services Education Cultural facilities Police/fire services
0 1 2 3 4 5 6
Suicide Rate per 100,000.
Total Number of Cultural Factors Present

Chandler & Lalonde, 1998
Translating the CSDH recommendations into different country/regional contexts
United Nations, ECOSOC meeting July 2009
Yet, inequities in health outcomes persist within and among countries. Most of the difference is attributable to the conditions in which people are born, grow, live, work and age.
Translating the findings into country contexts
European Review of Health Inequalities and the Health Divide
The CSDH closing the gap in a generation
The Marmot Review Fair Society Healthy Lives
A Fair Society
Conditions in which individuals and communities have control over their lives
Marmot Review: 6 Policy Objectives

A. B.
C. D. E.
F.
Give every child the best start in life Enable all children, young people and adults to maximise their capabilities and have control over their lives Create fair employment and good work for all 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
Strengthening Communities Building partnerships with those affected, civil society and a range of civic partners.
Strengthening Communities:
Merseyside Fire & Rescue Service England: Promoting healthier, safer communities Community fire safety team follow up to home safety checks Youth programmes Community fire stations On site free gyms Gardens & gardening projects Community rooms
Health, sustainability and social justice
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A world where social justice is taken seriously

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Insecurity and Social Determinants of Health

Click to edit Master subtitle style Michael Marmot April 2012

Conflict and insecurity

Commission on Human Security 2003

Freedom from fear; Freedom from want

Inequalities in health within and between countries

CSDH Final Report 2008

Under 5 mortality per 1000 live births by wealth quintile

EMR countries in conflict

Source: Watts, Siddiqi, Shukrullah,Karim,Serag report to CSDH, 2007

Social determinants of maternal mortality in Afghanistan

Amowit 2002 reported in Watts et al, report to CSDH 2007

Death rates in Russia 1980-2007

Click icon to add chart

3M extra deaths (Men et al, BMJ,2003)

Causes of the causes

CSDH three principles of action

Monitoring, Training, Research

CSDH three Linked Areas for Action

Monitoring, Training, Research

CSDH Areas for Action

Political empowerment inclusion and voice

Every sector is a health sector

Health and well being as outcomes

Aboriginal Youth Suicide by Factors Present

Suicide Rate per 100,000.

Total Number of Cultural Factors Present

Translating the CSDH recommendations into different country/regional contexts

United Nations, ECOSOC meeting July 2009

Translating the findings into country contexts

European Review of Health Inequalities and the Health Divide

The CSDH closing the gap in a generation

The Marmot Review Fair Society Healthy Lives

Marmot Review: 6 Policy Objectives

Health, sustainability and social justice

Click icon to add chart

A world where social justice is taken seriously

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