Presentation by Sir Michael Marmot (Director, Institute of Health Equity, University College, London)

1. Social Determinants of Health and Sustainable
Human Development
Professor Sir Michael Marmot
http://www.instituteofhealthequity.org
@MichaelMarmot
January 2015

2. The WHO Commission on Social Determinants of Health
(CSDH) – Closing the gap in a generation
Improve the conditions in which people
are born, grow, live, work, and age
Tackle the Inequitable Distribution
of Power, Money, and Resources
Measure and Understand the Problem,
Evaluate Action, Expand the Knowledge
Base, Develop the Work Force

3. Health and sustainable human development
are inextricably linked
http://www.eurasia.undp.org/content/rbec/en/home/library/hiv_aids/Addressing-social-economic-environmental-determinants-of-Health

4. Prenatal Early Years Working Age Older Ages
Family building
Accumulation of positive and negative
effects on health and wellbeing
LIFE COURSE STAGES
MACROLEVEL CONTEXT
WIDER SOCIETY SYSTEMS
Perpetuation of inequities
Source: WHO Review of Social Determinants and the Health Divide in the European Region

5. Typology of multi sectoral action on NCDs
Source: Bell, Lutz, Webb & Small, UNDP 2013
• NCD-Sensitive Actions on Social Determinants
• e.g. education, employment, social protection,
healthy places
• NCD-Specific Actions on Social Determinants
• e.g. alcohol/tobacco taxes
• Expanding Delivery Platforms
• e.g. settings – schools, workplaces

6. Bringing
Development and
Health Together
UNDP/IHE 2014
http://www.eurasia.undp.org/content/rbec/en/home/library/hiv_aids/Addressing-social-economic-environmental-determinants-of-Health/

7. Key Findings: Health Aspects
Percentage of SEEDs for which the potential impact on
health had not and had been noted
Source: Bell, Grobicki and Hamelmann, IHE and UNDP 2014

8. Estimated odds of reporting poor or very poor general health
by socioeconomic characteristics, 25 EU Member States*,
2010
0 2 4 6 8
0 items - BASELINE
1 item
2 items
3 items
4+ items
Highest decile - BASELINE
9th
8th
7th
6th
5th
4th
3rd
2nd
Lowest decile
Tertiary (5&6) - BASELINE
Post-secondary, non-tertiary (4)
Upper secondary (3)
Lower secondary (2)
Primary (ISCED 1)
None or pre-primary (0)
Odds ratio
One variable in the model Three variables in the model
1st-4th
5th-9th
Level of education
Income distribution
Material deprivation
Source: Health inequalities in the EU
3 variables in the model 1 variable in the model

9. Prenatal Early Years Working Age Older Ages
Family building
Accumulation of positive and negative
effects on health and wellbeing
LIFE COURSE STAGES
MACROLEVEL CONTEXT
WIDER SOCIETY SYSTEMS
Perpetuation of inequities
Source: WHO Review of Social Determinants and the Health Divide in the European Region

10. Level of child development at end of reception
England
• 51.7% of all children achieved a good level of development at end of reception in 2012/13.
0
10
20
30
40
50
60
70
80
0 1 2 3 4 5
%
IMD Quntile
School Readiness: the percentage of children achieving a
good level of development at the end of reception
2012/13
England all
Linear (England all)
Least deprivedMost deprived
Source: IHE

11. Source: WHO Review of Social Determinants and the Health Divide in the European Region, using
data from EU SILC

12. Prenatal Early Years Working Age Older Ages
Family building
Accumulation of positive and negative
effects on health and wellbeing
LIFE COURSE STAGES
MACROLEVEL CONTEXT
WIDER SOCIETY SYSTEMS
Perpetuation of inequities
Source: WHO Review of Social Determinants and the Health Divide in the European Region

13. Employment and working conditions have
powerful effects on health and health equity
When these are good they can provide:-
• financial security
• paid holiday
• social protection benefits such as sick pay, maternity leave, pensions
• social status
• personal development
• social relations
• self-esteem
• protection from physical and psychosocial hazards
… all of which have protective and positive effects on health
Source: CSDH Final Report, WHO 2008

14. Case Study
Promoting Sustainable
Employment
(Macedonia)
Project aim: promote
sustainable employment and
support the government in
implementing Active Labour
Market Measures.
Source: Bell, Grobicki and Hamelmann, IHE and UNDP 2014

15. Business development services
Investments in community development
Lifelong learning
Job creation
SEEDs
of Health:
Promoting Sustainable Employment (Macedonia)
Source: Bell, Grobicki and Hamelmann, IHE and UNDP 2014

16. Dimensions of Inequity:
• Marginalised groups – vulnerable groups
• i.e. unemployed who face difficulties entering the
labour market
• Ethnicity – Roma
Promoting Sustainable Employment (Macedonia)
Source: Bell, Grobicki and Hamelmann, IHE and UNDP 2014

17. Promoting Sustainable Employment (Macedonia)
• Employment that provides fair
conditions of employment and
healthy working conditions is
beneficial for health
• Active Labour Market Measures
are a way of tackling the negative
impact of long-term unemployment
(e.g. on mental health)
• Can future similar projects build in mechanisms for
ensuring co-benefits for health?
Source: Bell, Grobicki and Hamelmann, IHE and UNDP 2014

18. Prenatal Early Years Working Age Older Ages
Family building
Accumulation of positive and negative
effects on health and wellbeing
LIFE COURSE STAGES
MACROLEVEL CONTEXT
WIDER SOCIETY SYSTEMS
Perpetuation of inequities
Source: WHO Review of Social Determinants and the Health Divide in the European Region

19. Wider Society
• Social exclusion
• Social protection across the life course
• Communities
Source: WHO Review of Social Determinants and the Health Divide in the European Region

20. Case Study
Vulnerable Communities
(Albania)
Project aim: improve the human
security and access to socio-
economic and civic rights of
vulnerable communities (Roma
and Egyptian origin) of Albania.
Source: Bell, Grobicki and Hamelmann, IHE and UNDP 2014

21. Early child development
Social cohesion
Discrimination/stigma
Community
participation
Investments in
community
development
Effective policing
SEEDs
of Health:
Vulnerable Communities (Albania)
Access to health care
Child protection
Access to social
services
Human rights
Lifelong learning
Access to education
Source: Bell, Grobicki and Hamelmann, IHE and UNDP 2014

22. Vulnerable Communities (Albania)
• The project impacts on health:
o Directly: increasing knowledge and enabling
improved access to health services
o Indirectly: increasing civil registration, improving
livelihoods and strengthening Roma civil society
Source: Bell, Grobicki and Hamelmann, IHE and UNDP 2014

23. Wider Society
• Social exclusion
• Social protection across the life course
• Communities
Source: WHO Review of Social Determinants and the Health Divide in the European Region

24. Per cent of the population aged 16 and over reporting bad or
very bad health in EU-SILC by social protection expenditure
per person in Euros purchasing power parity, 2010
Belgium
Bulgaria
Czech Republic
DenmarkGermany
Estonia
Ireland
Greece
Spain
FranceItaly
Cyprus
Latvia
Lithuania
Luxembourg
Hungary
Malta
Netherlands
Austria
Poland
Portugal
Romania
Slovenia
Slovakia
Finland
Sweden
United Kingdom
Iceland
Norway
0
5
10
15
20
0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000
Per cent of population aged 16+ in bad or very bad health
Social protection expenditure per person in Euros using purchasing power parity
Source: Report on Health Inequalities in the EU, 2013

25. Prenatal Early Years Working Age Older Ages
Family building
Accumulation of positive and negative
effects on health and wellbeing
LIFE COURSE STAGES
MACROLEVEL CONTEXT
WIDER SOCIETY SYSTEMS
Perpetuation of inequities
Source: WHO Review of Social Determinants and the Health Divide in the European Region

26. Case Study
Capacity-building for the
State Social Protection
Fund (Azerbaijan)
Project aim: contribute to better
governance in pension and social
insurance system through further
development and implementation
of the State Social Protection Fund
(SSPF)'s automated management
system.
Source: Bell, Grobicki and Hamelmann, IHE and UNDP 2014

27. Economic accountability in governance
Welfare policy for social protection
SEEDs
of Health:
Capacity-building for the State Social Protection
Fund (Azerbaijan)
Source: Bell, Grobicki and Hamelmann, IHE and UNDP 2014

28. Capacity-building for the State Social Protection
Fund (Azerbaijan)
• Strategic value of considering
health implications:
o Pensions provide income
o Systems and processes – basis
for building a healthcare
management system
Source: Bell, Grobicki and Hamelmann, IHE and UNDP 2014

29. Summary
• A systematic approach to addressing SEEDs of
health/health equity:
o Health and health equity as a central goal for
sustainable human development
o Whole of society approach and critical role of UNDP
• The right to the highest attainable standard of health
Source: Bell, Grobicki and Hamelmann, IHE and UNDP 2014

30. Michael Marmot
Health is a human right
Do something
Do more
Do better
Source: WHO Review of Social Determinants and the Health Divide in the European Region