{"id":23591,"date":"2024-10-23T14:34:39","date_gmt":"2024-10-23T13:34:39","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2024\/10\/Sir-Michael-Marmot-Keynote-speech.pdf"},"modified":"2024-10-23T14:34:40","modified_gmt":"2024-10-23T13:34:40","slug":"sir-michael-marmot-keynote-speech","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/fr\/sir-michael-marmot-keynote-speech\/","title":{"rendered":"Sir Michael Marmot Keynote speech"},"author":17,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"<p class=\"attachment\"><a href='https:\/\/www.wma.net\/wp-content\/uploads\/2024\/10\/Sir-Michael-Marmot-Keynote-speech.pdf'>Sir Michael Marmot Keynote speech<\/a><\/p>\n<p>Global Context for Health Equity<br \/>\nUCL October 2024<br \/>\n@MichaelMarmot<br \/>\nhttp:\/\/www.instituteofhealthequity.org<br \/>\nWhy treat people and send them back to the conditions that<br \/>\nmade them sick?<br \/>\n1948<br \/>\nWHO<br \/>\nConstitution<br \/>\nUniversal<br \/>\nDeclaration<br \/>\nhuman rights<br \/>\n1978<br \/>\nAlma<br \/>\nAta<br \/>\nHealth for all<br \/>\nalbum25<br \/>\n2008<br \/>\nCommission on<br \/>\nSocial Determinants<br \/>\nof<br \/>\nHealth<br \/>\nWHO<br \/>\nPHC report<br \/>\nMovement for<br \/>\nhealth equity<br \/>\nSocial Justice<br \/>\nEmpowerment<br \/>\n\u2022Material<br \/>\n\u2022Psychosocial<br \/>\n\u2022political<br \/>\nCreating conditions for<br \/>\npeople to lead flourishing<br \/>\nlives<br \/>\nThe Commission on<br \/>\nSocial Determinants of<br \/>\nHealth (CSDH) \u2013 Closing<br \/>\nthe gap in a generation<br \/>\nStrategic Review of Health<br \/>\nInequalities in England:<br \/>\nThe Marmot Review \u2013 Fair<br \/>\nSociety Healthy Lives<br \/>\nReview of Social<br \/>\nDeterminants of Health and<br \/>\nthe Health Divide in the<br \/>\nWHO European Region<br \/>\nCSDH Conceptual Framework<br \/>\nSOCIAL DETERMINANTS OF HEALTH AND HEALTH INEQUITIES<br \/>\nSOCIOECONOMIC<br \/>\n&amp; POLITICAL<br \/>\nCONTEXT<br \/>\nGovernance<br \/>\nPolicy<br \/>\nMacroeconomic<br \/>\nSocial<br \/>\nHealth<br \/>\nCultural and<br \/>\nSocietal norms<br \/>\nand values<br \/>\nEducation<br \/>\nOccupation<br \/>\nIncome<br \/>\nGender<br \/>\nEthnicity \/ Race<br \/>\nSocial Position<br \/>\nMaterial Circumstances<br \/>\nSocial Cohesion<br \/>\nPsychosocial Factors<br \/>\nBehaviours<br \/>\nBiological Factors<br \/>\nHealth Care System<br \/>\nDISTRIBUTION<br \/>\nOF HEALTH<br \/>\nAND<br \/>\nWELL-BEING<br \/>\nSource: CSDH Final Report, WHO 2008, adapted from Solar &amp; Irwin, 2007<br \/>\nThe UK Context<br \/>\nLife expectancy at birth, England, 1999-2001 to 2020-22<br \/>\nSource: ONS (2024) National life tables; England<br \/>\nA decade+ of<br \/>\nausterity<br \/>\nGeorge Osborne still defends the legacy of Austerity<br \/>\n\u2022 \u201cThere\u2019s a simple truth, if you have a very large crash or economic<br \/>\ncrisis, the country pays the price\u2026<br \/>\n\u2022 The basic truth\u2026 a country has to live within its means\u2026<br \/>\n\u2022 The economic policies we pursued after 2010 meant that we<br \/>\nactually had the strongest growth in the G7, more jobs were<br \/>\ncreated\u2026 there\u2019s a lot to be proud of. Britain in 2016 was<br \/>\nbuzzing\u2026 people were looking at the UK and saying that\u2019s the<br \/>\nexample we want to follow.\u201d<br \/>\nSource: The Rest is Politics &#8211;<br \/>\nLeading<br \/>\n11<br \/>\n12<br \/>\nPublic sector expenditure (% of GDP) declined in the UK<br \/>\n13<br \/>\n0<br \/>\n5<br \/>\n10<br \/>\n15<br \/>\n20<br \/>\n25<br \/>\n30<br \/>\n35<br \/>\n40<br \/>\n45<br \/>\n50<br \/>\n2008\/09 2009\/10 2010\/11 2011\/12 2012\/13 2013\/14 2014\/15 2015\/16 2016\/17 2017\/18 2018\/19 2019\/20 2020\/21<br \/>\nPercent<br \/>\nSocial protection<br \/>\nEducation<br \/>\nRecreation, culture and<br \/>\nreligion<br \/>\nHealth<br \/>\nHousing and community<br \/>\namenities<br \/>\nEnvironment protection<br \/>\nEconomic affairs<br \/>\nPublic order and safety<br \/>\nDefence<br \/>\nGeneral public services<br \/>\nProportionate<br \/>\nUniversalism<br \/>\nChange in government funding per head of population by 2019\/20 by male<br \/>\nlife expectancy in 2010-12, local authorities in England<br \/>\nSource: NAO (2023 and ONS (2024)<br \/>\nHealth<br \/>\nInequalities, Lives<br \/>\nCut Short<br \/>\nExcess deaths in each quintile of area deprivations, based on the Index of<br \/>\nMultiple Deprivation, by sex, England, 2011-2019<br \/>\nSource: ONS population estimates and death rates for deprivation deciles in England<br \/>\nNote: See statistical appendix Health Inequalities, Lives Cut Short (2024) for method of calculation of excess deaths<br \/>\nExcess deaths in each decile of area deprivations, based on the Index of<br \/>\nMultiple Deprivation, by sex, England, 2011-2019<br \/>\nSource: ONS population estimates and death rates for deprivation deciles in England<br \/>\nNote: See statistical appendix Health Inequalities, Lives Cut Short (2024) for method of calculation of excess deaths<br \/>\nExcess deaths in each year 2009 to 2020, based on area deprivation deciles<br \/>\nusing the Index of Multiple Deprivation<br \/>\nSource: ONS population estimates and death rates for deprivation deciles in England<br \/>\nNote: See statistical appendix Health Inequalities, Lives Cut Short (2024) for method of calculation of excess deaths<br \/>\nEngland\u2019s<br \/>\nwidening health<br \/>\ngap: local places<br \/>\nfalling behind<br \/>\nChange in spending power per head of population by source, England,<br \/>\n2010\/11-2019\/20<br \/>\nSource: NAO (2021) Financial sustainability<br \/>\nof local authorities visualisation: update<br \/>\nHealthy life expectancy by sex and region, 2017-19<br \/>\nSource: ONS (2024) All data related to Health state life expectancies in England,<br \/>\nNorthern Ireland and Wales: between 2011 to 2013 and 2020 to 2022<br \/>\nReport of Commission of the Pan American Health Organization on<br \/>\nEquity and Health Inequalities in the Americas<br \/>\nLife expectancy at birth by<br \/>\ngross domestic product, 2016 or latest<br \/>\n56th Directing Council\u2028Washington, D.C., 23 \u2013<br \/>\n27 September 2018<br \/>\nInequalities in mortality in US &amp; Costa Rica 1990s<br \/>\nSource: Roserio-Bixby and Dow, PNAS 2016<br \/>\n26<br \/>\n27<br \/>\n28<br \/>\nSocial inequalities in cardiovascular deaths at ages 45 &#8211; 64:<br \/>\nPorto Alegre, Brazil<br \/>\nCVD deaths per 100,000<br \/>\ninhabitants<br \/>\nSocioeconomic level of districts<br \/>\nSource: Bassanesi, Azambuja &amp; Achutti, Arq Bras Cardiol, 2008<br \/>\nBUILD BACK FAIRER ACHIEVING HEALTH EQUITY IN THE EASTERN<br \/>\nMEDITERRANEAN REGION<br \/>\n\u2022 Report of the Commission on Social Determinants of Health in the<br \/>\nEastern Mediterranean Region<br \/>\n\u2022 March 2021<br \/>\nFramework for the social determinants of health<br \/>\nDo something, do more do better: Taking action<br \/>\nGovernance and political cultures<br \/>\nPolicies<br \/>\nResearch and monitoring<br \/>\nStructural Drivers<br \/>\nConflict and<br \/>\nConsequences<br \/>\nEconomic and<br \/>\ncommercial<br \/>\nCulture and society<br \/>\nThe natural<br \/>\nenvironment<br \/>\nConditions of Daily Life<br \/>\nMaternal and child health, Early<br \/>\nyears, Education<br \/>\nEmployment and quality of work<br \/>\nHealthy Aging<br \/>\nBuilt environment<br \/>\nHealth systems<br \/>\nHealth<br \/>\nequity and<br \/>\ndignified<br \/>\nlives<br \/>\nStratifiers: Position of migrants, refugees and gender<br \/>\nLife expectancy by Gross National Income (2019)<br \/>\nAfghanistan<br \/>\nYemen<br \/>\nSudan<br \/>\nPakistan<br \/>\nDjibouti<br \/>\nMorocco<br \/>\nJordan<br \/>\nTunisia<br \/>\nIraq<br \/>\nEgypt<br \/>\nIran (Islamic Republic<br \/>\nof)<br \/>\nLebanon<br \/>\nLibya<br \/>\nOman<br \/>\nBahrain<br \/>\nSaudi Arabia<br \/>\nKuwait<br \/>\nUnited Arab Emirates<br \/>\nQatar<br \/>\nSyrian Arab Republic<br \/>\n60<br \/>\n65<br \/>\n70<br \/>\n75<br \/>\n80<br \/>\n85<br \/>\n0 10 000 20 000 30 000 40 000 50 000 60 000 70 000 80 000 90 000 100 000<br \/>\nLife expectancy<br \/>\nat birth (years)<br \/>\nGNI per capita (2017 PPP $)<br \/>\nNote: No GNI per capita data available for Somalia and occupied Palestinian territory<br \/>\nSource: UNDP Human Development Report (2020) and WHO Global Health Observatory Data Repository<br \/>\n(2020)<br \/>\n33<br \/>\nGive Every Child<br \/>\nthe Best Start<br \/>\nChild poverty rates 2019-2021<br \/>\nSource: UNICEF Innocenti<br \/>\n0 5 10 15 20 25 30 35 40<br \/>\nColombia<br \/>\nUnited States<br \/>\nItaly<br \/>\nUnited Kingdom<br \/>\nPortugal<br \/>\nSwitzerland<br \/>\nSweden<br \/>\nAustralia<br \/>\nGermany<br \/>\nIreland<br \/>\nNorway<br \/>\nDenmark<br \/>\nChildren in relative income poverty (%)<br \/>\nChange in child income poverty rates, 2012-2014 to 2019-2021<br \/>\nSource: UNICEF Innocenti<br \/>\n-50 -40 -30 -20 -10 0 10 20<br \/>\nUnited Kingdom<br \/>\nNorway<br \/>\nFrance<br \/>\nGermany<br \/>\nAustralia<br \/>\nItaly<br \/>\nUnited States<br \/>\nMexico<br \/>\nNew Zealand<br \/>\nIreland<br \/>\nCanada<br \/>\nPoland<br \/>\nProportional change in child income poverty rate (%)<br \/>\nPublic spending early child education and care<br \/>\n37<br \/>\nOECD Family Database<br \/>\nMean performance in reading, by international decile of<br \/>\nsocio-economic status<br \/>\n0<br \/>\n100<br \/>\n200<br \/>\n300<br \/>\n400<br \/>\n500<br \/>\n600<br \/>\n700<br \/>\nFrance OECD Average US Hong Kong Macao UK Israel<br \/>\nBottom decile Second decile Middle decile Ninth decile Top decile<br \/>\n38<br \/>\nPISA, 2018<br \/>\nGap in life expectancy at age 30 between people with the highest and lowest<br \/>\nlevel of education, 2017 (or nearest year)<br \/>\nEffects of cash transfer programmes on mortality<br \/>\nSource: Richterman, A., Millien, C., Bair, E.F. et al.<br \/>\n(2023)<br \/>\n41<br \/>\n44%<br \/>\n90%<br \/>\n69%<br \/>\n43%<br \/>\n31%<br \/>\n29%<br \/>\n24%<br \/>\n21%<br \/>\n14%<br \/>\n28%<br \/>\n6%<br \/>\n18%<br \/>\n31%<br \/>\n26%<br \/>\n39%<br \/>\n40%<br \/>\n33%<br \/>\n53%<br \/>\n20%<br \/>\n4%<br \/>\n7%<br \/>\n20%<br \/>\n28%<br \/>\n26%<br \/>\n23%<br \/>\n39%<br \/>\n28%<br \/>\n8%<br \/>\n0%<br \/>\n6%<br \/>\n6%<br \/>\n15%<br \/>\n6%<br \/>\n13%<br \/>\n7%<br \/>\n5%<br \/>\nGLOBAL AVERAGE<br \/>\nNIGERIA<br \/>\nPAKISTAN<br \/>\nUNITED STATED<br \/>\nUNITED KINGDOM<br \/>\nHUNGARY<br \/>\nFRANCE<br \/>\nSWEDEN<br \/>\nSLOVENIA<br \/>\nDO YOU THINK CHILDREN TODAY WILL HAVE A BETTER, WORSE OF<br \/>\nROUGHLY THE SAME LIFE TO YOU?<br \/>\nA better life A worse life Roughly the same DK\/NR<br \/>\nSource: Gallup<br \/>\nSocial mobility: How many generations does it take to go from low income to middle<br \/>\nincome in different countries<br \/>\n42<br \/>\nSource: OECD<br \/>\nCOVID-19<br \/>\nAge-standardised mortality rates from all causes, COVID-19 and other causes per<br \/>\n100,000, by sex and deprivation deciles (IMD 2019), England, Mar 2020 &#8211; Apr 2021<br \/>\n44<br \/>\n0<br \/>\n200<br \/>\n400<br \/>\n600<br \/>\n800<br \/>\n1,000<br \/>\n1,200<br \/>\n1,400<br \/>\n1,600<br \/>\n1,800<br \/>\n2,000<br \/>\nAge standardised mortality rate (per 100,000)<br \/>\nAll causes<br \/>\nDue to COVID-19<br \/>\nOther causes than COVID-19<br \/>\nFemale<br \/>\n0<br \/>\n200<br \/>\n400<br \/>\n600<br \/>\n800<br \/>\n1,000<br \/>\n1,200<br \/>\n1,400<br \/>\n1,600<br \/>\n1,800<br \/>\n2,000<br \/>\nAge standardised mortality rate (per 100,000)<br \/>\nAll causes<br \/>\nDue to COVID-19<br \/>\nOther causes than COVID-19<br \/>\nMale<br \/>\nChange in LE, 2019-21, US and 19 peer countries<br \/>\n45<br \/>\nMasters, Aron and Woolf medRxiv preprint April 29, 2022<br \/>\nImpacts of Covid on life expectancy by ethnicity in New York<br \/>\nSource: UNAIDS<br \/>\nSource: UNAIDS<br \/>\nTaking action<br \/>\n51<br \/>\nHealth Equity\/Marmot Places \u2013 40+ local authorities<br \/>\n\u2022 Coventry<br \/>\n\u2022 Greater Manchester<br \/>\n\u2022 Cheshire and Merseyside<br \/>\n\u2022 Lancashire and Cumbria<br \/>\n\u2022 Luton<br \/>\n\u2022 Waltham Forest<br \/>\n\u2022 Gwent<br \/>\n\u2022 Leeds<br \/>\n\u2022 Southwest region<br \/>\n\u2022 Wokingham<br \/>\n\u2022 Medway<br \/>\n\u2022 Northumberland<br \/>\nScotland x national plus 3<br \/>\nplaces<br \/>\nOctober 2024<br \/>\n\u2022 Kent<br \/>\n\u2022 Oxford<br \/>\n\u2022 West Norfolk<br \/>\n\u2022 5 places in the pipeline<br \/>\nWithin places and nationally &#8211; sectoral action:<br \/>\n\u2022 Local Government \u2013 engine of change in places<br \/>\n\u2022 Health Care \u2013 moving to the causes of the causes of ill health<br \/>\n\u2022 The VCS \u2013 representing, delivering services and supporting<br \/>\n\u2022 Public services \u2013 education, CJS, transport<br \/>\n\u2022 Business and the private sector \u2013 employees, goods and services,<br \/>\nsocial impact<br \/>\n\u2022 National government and national institutions<br \/>\nKey partners:<br \/>\nBusinesses<br \/>\nHow businesses shape health: the IHE Framework<br \/>\nKey partners:<br \/>\nHealth care<br \/>\n\u2022 The East London Foundation Trust<br \/>\n\u2022 Three Integrated Care Systems<br \/>\n\u2022 Workforce<br \/>\n\u2022 The NHS and accountability for health inequalities<br \/>\nOur service users The wider Luton<br \/>\ncommunity<br \/>\nELFT as a training<br \/>\n&amp; employment<br \/>\nprovider<br \/>\nUniversal<br \/>\nTargeted<br \/>\nPartner with VCS<br \/>\norganisations to conduct<br \/>\ncommunity outreach for<br \/>\nemployment support to<br \/>\nvulnerable groups<br \/>\nEngage with young people to<br \/>\nraise aspiration and promote<br \/>\naccess to healthcare careers<br \/>\nELFT\u2019s Marmot Mountain: Potential actions in line with our vision<br \/>\nEstablishing good working relationships with community partners &amp; employers<br \/>\nBring meaningful employment &amp;<br \/>\napprenticeship opportunities to<br \/>\nlocal people<br \/>\nPromote access to employment &amp;<br \/>\napprenticeships at ELFT for SUs<br \/>\nand other disadvantaged groups by<br \/>\naddressing potential barriers in our<br \/>\nrecruitment processes<br \/>\nProvide training\/a skills academy<br \/>\nfor local people for jobs in health<br \/>\nand social care<br \/>\nImprove SU satisfaction with<br \/>\nemployment support services<br \/>\nprovided by ELFT<br \/>\nMonitor and increase the<br \/>\nnumber of SUs supported<br \/>\ninto good employment<br \/>\nEngage with public &amp; private sector<br \/>\nemployers to advocate for good quality<br \/>\nwork, mentally healthy workplaces &amp;<br \/>\nequitable access to volunteering and<br \/>\nemployment opportunities<br \/>\nMarmot Places<br \/>\n\u201cOnce the ICB and the Health and<br \/>\nCare Partnership went live in July<br \/>\n2022 it started to bring together<br \/>\npeople and organisations focusing<br \/>\non health inequalities, then the<br \/>\nrecommendations that came out<br \/>\nof Cheshire and Merseyside\u2019s All<br \/>\nTogether Fairer Partnership, in<br \/>\neffect, gave us our action plan for<br \/>\nthe next 5-10 years.\u201d<br \/>\n\u201cBeing a Marmot Place brings stakeholders together around health equity<br \/>\nand is a part of our journey to the Luton town-wide 2040 vision. You could<br \/>\nalmost overlay the Marmot Eight Principles onto the vision.\u201d<br \/>\n\u201cMaking Manchester Fairer, which began out of the Greater Manchester<br \/>\nMarmot Review, is owned by all partners, focuses on the wider<br \/>\ndeterminants of health and is the beginning of a long-term ambition to<br \/>\nput health inequalities and health equity at the forefront of people\u2019s<br \/>\nminds.\u201d<br \/>\n\u201cIf central government said the whole country was to<br \/>\nbecome a Marmot Country it would be very helpful<br \/>\nbecause then council leaders would understand that<br \/>\nwe have to stop working in silos and bring all sectors<br \/>\ntogether around the health equity system.\u201d<br \/>\n\u201cPartners advocate for \u2018living\u2019the Marmot<br \/>\nPrinciples as a culture and value base, working<br \/>\ntogether to embed equity in all policies. At times<br \/>\nteams may not recognise their work has<br \/>\ncontributed to the Marmot approach, even when it<br \/>\ndoes.\u201d<br \/>\nThe future of Marmot places?<br \/>\n\u00ab\u00a0The next Labour government\u2026will amplify the approach of<br \/>\n\u2018Marmot Cities\u2019 like Greater Manchester and Coventry by making<br \/>\nEngland a Marmot country, tackling the social inequalities that<br \/>\ninfluence health. We will ensure that children have the best start<br \/>\npossible to give them the building blocks for a healthy life, build<br \/>\non Labour\u2019s legacy towards a smoke-free Britain, and empower<br \/>\npeople to take responsibility for their own health.\u00a0\u00bb<br \/>\n\u201cRise up with me<br \/>\n\u2026<br \/>\nagainst the organisation of misery.\u201d<br \/>\nFrom: The Banner by<br \/>\nPablo Neruda<\/p>\n"},"caption":{"rendered":"<p>Sir Michael Marmot Keynote speech Global Context for Health Equity UCL October 2024 @MichaelMarmot http:\/\/www.instituteofhealthequity.org Why treat people and send them back to the conditions that made them sick? 1948 WHO Constitution Universal Declaration human rights 1978 Alma Ata Health for all album25 2008 Commission on Social Determinants of Health WHO PHC report Movement for [&hellip;]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{"filesize":5336139,"sizes":{}},"post":null,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2024\/10\/Sir-Michael-Marmot-Keynote-speech.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media\/23591"}],"collection":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/users\/17"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/comments?post=23591"}]}}