Tackling health inequalities is a lifelong struggle
Sir Michael Marmot has spent his career trying to break down the barriers to health equality, and he believes it should be a main priority for governments
Sir Michael Marmot: “There’s an intimate relationship between where you are on the social hierarchy and your health. The people at the top have the longest life, those in the middle are shorter, and as you get lower and lower, the life expectancy gets shorter and shorter.”
Money doesn’t buy happiness, they say, but the clear evidence is that it does buy you extra years of life. The flip side of this, of course, is that the poor experience the worst health outcomes and the shortest life expectancies.
Tackling this massive health inequality should be a main priority of governments because of the ethical issues involved, says world-renowned epidemiologist Sir Michael Marmot, who has devoted his working life to the issue.
“There’s an intimate relationship between where you are on the social hierarchy and your health.
“The people at the top have the longest life, those in the middle are shorter, and as you get lower and lower, the life expectancy gets shorter and shorter,” he told The Irish Times on a visit to Dublin earlier this month.
Marmot’s research has detailed the “social gradient” affecting the length of all our lives according to where we are on the economic pecking order.
In a 2010 report for the last Labour government in the UK, he found that people living in the poorest neighbourhoods died seven years earlier on average than those in the wealthiest neighbourhoods.
A number of Irish reports, including the 2008 all-island study by the Institute of Public Health and the more recent work by the Tasc think-tank, have pointed to similar trends here, yet it isn’t clear that the Government has got the message.
Marmot believes all government policies should be proofed for their impact on health inequality. “We should have a health equity lens trained on all social and economic policy, asking what’s the likely impact on health equity of trends in health equality.
“Let’s not look just at debt and deficits but at the impact on people’s lives of government decisions and on health equity. And if the Minister for Finance says, ‘You’re being unrealistic,’ I say, ‘Sorry, mate, we don’t have the luxury of not doing that,’” says Marmot (68), lapsing just briefly into the Australian-accented patois of his youth.
Born in England, he moved to Australia in childhood and qualified as a medical doctor in Sydney. In the 1980s, he led ground- breaking research which identified a correlation between life expectancy and social status among British civil servants.
A former president of the British Medical Association, he chaired a World Health Organisation commission on social determinants of health from 2005-2008 and has won numerous awards for his work in public health.
In the UK review, he set out the six areas he believes governments need to develop policies to improve health equity – early child development; education; employment; minimum incomes for healthy living; health neighbourhoods; and a social determinants approach to prevention on issues such as smoking and obesity.