Address Social Causes to Cut Health Inequality, Says Sir Michael Marmot
The social determinants of ill health are soluble when a society is ready to marshal its resources, said Sir Michael Marmot.
Eliminating health inequalities calls for a multifactorial approach throughout the life course, Sir Michael Marmot, M.B.B.S., Ph.D., M.P.H., a professor of epidemiology and public health at the University College London, said in a lecture at the George Washington University Schools of Medicine and Public Health in Washington, D.C.
Sir Michael Marmot, M.B.B.S., Ph.D., M.P.H.: “It’s our job to tell the truth about health inequalities and bring the best evidence to bear on policy debates.”
Aaron Levin
For decades, Marmot has studied the social determinants of health. He is perhaps best known for the Whitehall Studies, which revealed that British civil service workers with lower job status experienced greater stress and were more likely to have greater risk factors for heart disease and other problems than their higher-ranking colleagues.
Many of the social factors affecting health can be ameliorated with programs that improve prenatal care, early childhood development, and income supports for the unemployed and counter poverty among families of people with mental disorders, he said.
Inequality matters in health, said Marmot.
“The greater the distance between the rungs on the ladder, the more difficult it is for the next generation to get from one rung to the next,” said Marmot. “That undermines the very legitimacy of a democratic society.”
Mental health and illness are a critical part of the health equity equation, he said in an interview after his talk.
“You can’t be concerned about mental illness and not be concerned with the social determinants of health, and you cannot be concerned about the social determinants of health and not be concerned about mental illness,” said Marmot, author of The Health Gap: The Challenge of an Unequal World (Bloomsbury, 2015).
“If anybody doubts that the mind is important to physical health, they need look only at the 10- to 20-year reduced life expectancy for people with mental illnesses,” he said. “Mental illness and substance abuse are the number-one global causes of years spent with disability.”
While poverty and lower socioeconomic status increase the risk for many illnesses and disabilities, interventions to improve mental and physical health should aim at reducing risk across the whole social gradient, he said. Since both rich and poor can develop mental illness, all of society has a stake in the system that cares for those patients.
Early childhood development is another significant factor mediating inequality, because it determines readiness for school, which in turn influences one’s prospects in life, said Marmot. Children in better preschool environments will demonstrate higher reading rates in sixth grade and have longer life expectancy, but such benefits extend beyond themselves.
“What happens in this generation affects what happens in the next generation, too,” he said.
What can physicians do to mitigate these factors? asked one medical student in the audience.
“Learning about the social determinants of health is as important as physiology and chemistry,” he said. The education and training of physicians should expand their capability to see their patients in a perspective broader than a mere diagnosis. ■
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Published online: 11 December 2015
Published in print: December 5, 2015 – December 18, 2015
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