Marmot places. An initiative that must be implemented in Catalonia

"Social Injustice is killing people on a grand scale’. (M.Marmot)

Health inequalities are the systematic differences in health between social groups. Where they are judged to be avoidable differences they are inequitable, unfair. 

Putting them right is a matter of social justice. Reducing these inequities requires actions to improve the social determinants of health – the social, economic, political, physical and cultural conditions that shape our lives and our behaviours.

 
The UCL Institute of Health Equity  established in 2011 and being led by Professor Sir Michael Marmot leads and collaborates on work that addresses the social determinants of health and improves health equity. The IHE created the concept of Marmot Places. 

A Marmot Place recognises that health and health inequalities are shaped by the social determinants of health (SDH) and takes action on these social determinants at a local level. 

Sometimes called the building blocks of health, these social determinants are the conditions in which people are born, grow, live, work and age, such as education, employment and housing, and lead to wide differences in people’s health and in their life expectancy. Many places across England and Wales have become Marmot Places putting health equity at the heart of their local strategies.

Becoming a Marmot Place: 

Marmot Places develop and deliver interventions and policies to improve health equity based on eight principles:

1. Give every child the best start in life. 
2. Enable all children, young people and adults to maximise their capabilities and have control over their lives. 
3. Create fair employment and good work for all. 
4. Ensure a healthy standard of living for all. 
5. Create and develop healthy and sustainable places and communities. 
6. Strengthen the role and impact of ill health prevention. 
7. Tackle racism, discrimination and their outcomes. 
8. Pursue environmental sustainability and health equity together.

Article: Public health and health inequalities: a half century of personal involvement Michael Marmot Journal of Public Health, 2022

LSE Health's Annual Lecture:: Social justice and health equity March 2025, M.Marmot

 

Photo Jordi Soldevila. Geometries de la injustícia II

______________________________________________________________________

The generational differences: Health systems leaders need to modernize the workplace and workforce practices to reflect the values of younger health care workers.

Why new generations workers are leaving from healthcare sector?

Many younger workers cite toxic cultural dynamics, such as micromanagement, hierarchical structures, and lack of support from leadership, as significant contributors to dissatisfaction and burnout.

Younger health care workers (physicians, nurses, social care, data managers, economists, lawyers....,),  have different values than older health care workers like:

1. Work-Life Balance: Many new workers prioritize flexibility and mental health, yet the rigid schedules and high stress of healthcare roles often clash with these values.
2. Communication Challenges: New employees increasingly seek purpose-driven careers, and closing the loop on communication is crucial. Are new employees instructed on how to communicate?. The practice of medicine is based on human interaction and communication, as well as science. Balancing patient needs inside an environment of mutual respect is the goal. The deskless workforce in healthcare is high-touch, with patient and co-worker interaction at the center of service delivery. Knowing how to build trust and collaborate is key, across all generations.
3. Conflict with Traditional Structures: Many younger employees feel out of sync with the hierarchical and rigid structures common in healthcare organizations, preferring collaborative and innovative environments.

Health system leaders and administrators should consider new strategies to modernize the workplace and workforce practices to reflect the values of younger health care workers.

• Create an environment to report instances of discrimination, inequalities, and racism quickly and anonymously.
• Develop equity-centered hiring and retention practices. Including (DEI) practice: diversity, equity, and inclusion. Employees want to work at organizations that prioritize DEI practices.
• Design a healthy environment that prioritizes employee wellness. Early-career health care workers who began working during the COVID-19 pandemic endured unprecedented stress and pressure that likely influenced their outlook. Both early-career and longtime health care workers increasingly report feeling burnt out; health care leaders need to create work environments that support overall wellbeing and make workers feel heard and valued. 
• Promote empathy among the managers and leaders to understand the concerns, feelings, and thoughts of their teams.
• Provide employment opportunities for people with disabilities.
• Create a specific mentoring programms to increase awareness regarding gender, young and old, diversity, equity, and inclusion in an organization.
• Support its employees at every step in their career and promote also the accountability at every step: “Accountability breeds response-ability.”― Stephen R. Covey.

Source: 

1. Morenike Ayo-Vaughan and Laurie Zephyrin, “Young Health Care Workers See More Discrimination in the Workplace, Leading to Added Stress and Burnout,” To the Point (blog), Commonwealth Fund, May 29, 2024. Blog

2. Forbes 2024

Photo Jordi Soldevila. Seqüència Xostakòvitx. Quartet número núm  8,

 ______________________________________________________________________

Managers in health care sector

Key ideas:

• The necessary skills of healthcare managers involve planning, organizing, implementing, monitoring, and evaluation skills.
• Management skills are focused on the use of organizational resources but they also have to center on the mobilization of the members of the organization.
• The good healthcare manager provides trust and confidence to staff and appreciates staff efforts.
• Communication and critical thinking skills, relational and organizations skills for healthcare management, were seen as essential competencies for development.
• Additional skills to manage subordinates and coordinate with top-level managers is necessary: like self-awareness, change management, and conflict resolution.
• Clarity on the roles and responsibilities of existing and new professionals working in healthcare is necessary.
• Interprofessional healthcare management can resolve the issue of superiority and inferiority among healthcare professions – medicine, nursing, allied health including laboratory and pharmacy, among others. It reinforces humility and teamwork while acknowledging the importance of each profession for the improvement of health.
• If a healthcare manager knows how to lead himself, it then becomes easier for him/her to familiarize and knowing more both the members and the organization well.
• Well-managed staff can lead to well-managed patients.
• Management skills can impact positively on patients’ health outcomes.
• Healthcare management is a profession

Bayot ML, Varacallo MA. Management Skills. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. 

Article

Photo Jordi Soldevila. Màcula de la “L” de l’espai Serrahima

_______________________________________________________________________

Research on Integrated Care Systems: workforce

Integrated care systems (ICSs) were given statutory powers and new legal responsibilities for the first time in July 2022 in UK. 

These changes were intended to increase collaboration in the health and social care sector and to enable the NHS, local authorities and other partners to take collective responsibility for improving health outcomes, reducing inequalities, delivering better value for money, and driving local social and economic development. 

This research examines the development of ICSs by assessing their efforts to develop system-wide approaches to the recruitment, training and retention of staff. Workforce issues such as these are currently some of the biggest challenges facing the health and care sector, and require a co-ordinated response from multiple organisations of the kind that ICSs were designed to enable. 

Leading system-wide transformation is slow and the work is hard, but there are clear signs that progress is being made. 

The research identified six distinctive ways in which ICSs are adding value: ◦ organising around a shared purpose ◦ building system leadership ◦ encouraging system-focused behaviours ◦ scaling and spreading success ◦ using resources more effectively ◦ managing complexity. The degree which this is happening varies across systems. 

Despite signs of progress, there is a clear risk of ICSs going ‘off track’ as a result of pressures on services, intense political scrutiny, and extremely difficult economic circumstances – and the effect these conditions are having on the behaviours of leaders locally, regionally and nationally. There is widespread concern that ICSs may not achieve their full potential unless more is done to create an environment conducive to their success. 

The research suggests that success relies primarily on supporting people to think, plan and act in ‘system-focused’ ways. If this is to happen, different behaviours are needed at all levels of the system. National bodies need to create a more enabling environment and ensure that accountability and funding mechanisms support system working. Local leaders need to model system working in their relationships with partners across the system. 

There is considerable interest in how ICSs are performing and there is a danger that attention focuses on the things that are easier to measure. The research suggests that the less visible work of supporting people to work together differently is critical for success and must not be undervalued. The ability to do this well is one of the key factors that will determine whether ICSs succeed in delivering better population health and more joined-up care for people using services.

Kingsfund report ICS, 2024

Photo Jordi Soldevila. Iteració de les portes tancades

_______________________________________________________________________

Is competitive pressure essential for sustaining quality in primary care services?

The authors Eduard Brüll, Davud Rostam-Afschar, and Oliver Schlenker study how the threat of entry affects service quantity and quality of general practitioners (GPs).

They leverage Germany’s needs-based primary care planning system, in which the likelihood of new GPs reduces by 20 percentage points when primary care coverage exceeds a cut-off. They compile novel data covering all German primary care regions and up to 30,000 GP-level observations from 2014 to 2019. Reduced threat of entry lowers patient satisfaction for incumbent GPs without nearby competitors but not in areas with competitors. They find no effects on working hours or quality measures at the regional level including hospitalizations and mortality.

While entry restrictions aim to ensure equitable access to care, they can unintentionally reduce service quality by weakening competition. Policymakers must navigate this trade-off carefully, ensuring that access does not come at the expense of quality. By preserving competitive incentives even in regulated markets, healthcare systems can achieve both equitable and high-quality care.

IZA Discussion Paper No. 17534

Access to working paper 2024 (pdf)

Photo Jordi Soldevila. Merry Christmas

_______________________________________________________________________

València. Building Disaster Resilience: A Systems Approach to Leadership Communication

 

This commentary published by Rand  by Millard McElwee and Monika Cooper last November the 4th (2024), can serve the Spanish authorities (local, autonomous communities and national) to reflect on how to improve the communication of possible disasters such as the one that occurred in València.

Some thoughts: 

"The future of disaster resilience requires us to learn from past political failures, such as the response to Hurricane Katrina, where the lack of clear communication and cohesive narratives deepened mistrust and fragmented communities. 

The inability to align messages across federal, state, and local levels not only delayed critical aid but also exposed the consequences of failing to address social and political divides. 

To move forward, policies must integrate AI and green infrastructure with a focus on rebuilding trust through transparent, unified narratives that guide communities in understanding risks and empowering them to act. Only by bridging these divides can the resilience needed to confront future climate threats be built".

Acces to the commentary: Building disaster resilience

Photo Jordi Soldevila. Geometries de la injustícia

_______________________________________________________________________

Centering Equity in the Implementation of Emerging Digital Health Technologies: AI, genomic medicine, digital media

Despite unprecedented spending on health in the United States and the rapid expansion in types and innovations of digital health technologies, many populations still get sick and die at higher rates than others. 

To address these persistent health inequities in the US, it will be crucial to center health equity in the implementation of digital health technologies, such as artificial intelligence or personalized genomic medicine. As the two nascent fields of health equity and digital equity find their footing after rapid implementation and scale-up in the post–coronavirus disease 2019 pandemic world, a focus on equitable implementation is particularly important to ensure that digital health technologies do not perpetuate or create new health inequities. However, to date, these fields have had a limited or siloed focus on equitable implementation.

This paper is the inaugural report in the RAND Center to Advance Racial Equity Policy Methods Volume series. This paper will be the first to center health equity in the implementation of digital health technologies by adapting a methodological framework for its implementation to support the planning and evaluation of digital health technologies. Without an explicit focus on equitable implementation, digital health technologies run the risk of further exacerbating existing health inequities or creating new ones. This paper offers approaches to policymakers, implementation scientists, clinical scientists, government regulatory bodies, and those working in the health and digital technology fields to take the lead in centering equity.

The paper, first describe the persistent health inequities in the United States and how the rapid adoption of digital health technologies can perpetuate those inequities. Then they discuss challenges and limitations of Implementation Science (IS) in centering equity in the rapid adoption of digital health technologies and translating these technologies into equitable improvements in public health. Next, they provide examples of how IS process and evaluation frameworks can be adapted to focus on digital and health equity to leverage emerging health technologies to course correct and address inequitable health outcomes.

Finally, they discuss how these adapted IS process and evaluation frameworks can be applied to address the pitfalls—and realize the promise—of three emerging fields at the intersection of racial and digital health equity: (1) genomic medicine, (2) artificial intelligence (AI) (specifically large language models [LLMs]), and (3) participatory digital media (e.g., blogs, digital stories).

Photo Jordi Soldevila. Gaza. Geometries de la injustícia

_______________________________________________________________________