national symposium on ageing research canberra 24 september, 2003 “linking research, policy and...
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NATIONAL SYMPOSIUM ON AGEING RESEARCH
Canberra24 September, 2003
“Linking research, policy and practice”
Michael MarmotInternational Centre for Health and Society
UCL
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TRANSLATING RESEARCH EVIDENCE INTO POLICY
SUCCESSES AND FAILURES
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TRANSLATING RESEARCH EVIDENCE INTO POLICY
SUCCESSES
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00.10.20.30.40.50.60.70.80.9
11.11.21.31.41.51.61.71.81.9
2
Admin
Prof/Exec
Clerical
Other
All Cause Mortality by Grade of EmploymentWhitehall Men 25 year Follow-up
Marmot and Shipley, 1996
40-64yrs 64-69yrs 70-89yrs
Rel
ativ
e ra
te
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Independent Inquiry into
Inequalities in Health
REPORT
CHAIRMAN: SIR DONALD ACHESON
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GENERAL RECOMMENDATIONS
1. Health Inequalities Impact Assessment All policies to favour the less well-off.
2. High priority to women of childbearing age, expectant mothers and young children.
3. Further steps to reduce income inequalities and improve living standards of poor households.
Independent Inquiry into Inequalities in Health
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AREAS FOR FUTURE POLICY DEVELOPMENT (1)
POVERTY & INCOME HOUSING AND ENVIRONMENT EDUCATION MOBILITY, TRANSPORT, POLLUTION EMPLOYMENT NUTRITION NATIONAL HEALTH SERVICE
Independent Inquiry into Inequalities in Health
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AREAS FOR FUTURE POLICY DEVELOPMENT (2)
MOTHERS AND FAMILIES OLDER PEOPLE ADULTS OF WORKING AGE GENDER ETHNICITY
Independent Inquiry into Inequalities in Health
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Tackling Health Inequalities
Summary of the 2002
Cross-Cutting Review
HM TREASURY
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National Targets for Tackling Health Inequalities
Infant Mortality (Deaths in the first year of life) “Starting with children under one year, by 2010 to reduce by at least 10% the gap in mortality between routine and manual groups and the population as a whole”
Expectation of Life “Starting with local authorities, by 2010 reduce by at least 10% the gap between the fifth of areas with the lowest life expectancy at birth and the population as a whole.”
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TRANSLATING RESEARCH EVIDENCE INTO POLICY
FAILURES?
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STRATEGIES FOR BUILDING RESEARCH CAPACITY
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WHY DO WE NEED INTERDISCIPLINARY RESEARCH?
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Social structure
Social Environment
Work
Health Behaviours
Patho-physiologicalchangesOrgan impairment
Well-beingMortalityMorbidity
Genes
Early Life
Culture
BrainNeuro-endocrine and immune
Psychological
Material factors
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EPIDEMIOLOGY STATISTICS SOCIOLOGY SOCIAL PSYCHOLOGY PSYCHOBIOLOGY NEURENDOCRINOLOGY ECONOMICS MOLECULAR GENETICS
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FUNDING INTERDISCIPLINARY RESEARCH
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FUNDING INTERDISCIPLINARY RESEARCH?
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RESEARCH INTO AGEING
Ageing as a lifelong process
Needs of older people
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THE NATIONAL RESOURCE OF LARGE LONG-TERM COHORT STUDIES
Study Year of birth Sample size
Location of data
ELSA* 1900-1951 (N=16,000)
UCL
Whitehall 2* 1930-50
(N=10,308) UCL
NSHD* 1946
(N= 5,362) UCL
NCDS* 1958
(N=17,414) IOE
BCS70 1970
(N=17,198) IOE
ALSPAC* 1991-2
(N=14,000) Bristol
Millennium 2000-1
(N=20,000) IOE
Birth 1-5 years 6-16 years Early Adulthood 17-30 yrs Early & Middle Adulthood 31-45 years
Later Middle Adulthood 46-65 years
Later Life 66+
• has or is about to collect DNA
data collection period
1946 cohort: www.nshd.mrc.ac.uk1958, 1970 & Millennium cohorts: www.cls.ioe.ac.ukALSPAC: www.alspac.bristol.ac.ukELSA & Whitehall: www.ucl.ac.uk
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RESEARCH INTO AGEING
The English Longitudinal Study of Ageing
(ELSA)
General Background
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Research team International Centre for Health and Society, UCL Institute for Fiscal Studies and UCL National Centre for Social Research plus researchers from Cambridge, Oxford,
Nottingham
Funding from NIA and UK government
The English Longitudinal Study of Ageing (ELSA)
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Key Research Areas Health trajectories, disability and healthy life expectancy The relationship between economic position and health The determinants of economic position in older age The timing of retirement, and post retirement labour
market activity The nature of social networks, support and participation Household and family structure, and the transfer of
resources
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Broad questionnaire coverage
Demographics Health Social participation Housing Employment and earnings Pensions and retirement
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Broad questionnaire coverage (cont)
Income and assets Cognitive function Psychosocial Expectations Measurements Self completion (social support, GHQ12, Beck
depression inventory)
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Collaboration with UK panel studies
1946 birth cohort
Whitehall II– Testing of explanations for inequalities in
health– Cohort growing older and retiring
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Collaboration with UK panel studies
1946 birth cohort
Whitehall II
BHPS– Full age cross-section– Focus on older people in 2002 wave– Sharing of topics and measures
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Comparative issues Ex-ante policy evaluation difficult Understanding causal relationships difficult Comparative data can:
– Help understand differences between countries– Expand sources of variation available to researchers (conditional
on enough observables to make the comparison valid)– Help examine role of institutions directly
Principal international comparators: Health and Retirement Study (HRS), SHARE
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ELSA will look quite like HRS Two-yearly frequency Exit interview (post mortality, with proxy) Modular structure + core content Unfolding brackets Financial respondent Expectations But with some differences:
– biomedical health data– cognitive function– psychosocial factors– Face to face waves 1 and 2 (plus nurse visit wave 2)
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FUTURE DIRECTIONS FOR AUSTRALIA?