Why should health professionals know about the conditions in which you live?

Tuesday, 12 May 2015

By Professor Sir Michael Marmot, Director of the UCL Institute of Health Equity and President-Elect of the World Medical Association

Social injustice is killing people on a grand scale. In every country and community, we can see clear inequities in health outcomes. This is because inequities in society affect the conditions in which people are born, grow, live, work and age – what we call the ‘Social Determinants of Health’.

As a result, those who have limited economic and other resources, who have fewer opportunities, or live in damaging conditions, are more likely to have a shorter life expectancy, and to spend more years of their shorter life in ill health.

But the Social Determinants of Health don’t only impact on the very poor, or those living in the poorest countries. In fact, what we see is a gradient – everyone below those at the very top of society – the one per cent, have worse health than they could have. And in many countries, these inequalities are widening, making the gradient steeper.

The graph below gives an example of these health inequalities in England. It shows small areas, ranked according to their level of deprivation and their life expectancy. What we see is a clear correlation – the greater the deprivation of an area, the shorter the life of people living there. This amounts to a difference of seven years. The bottom line shows disability free life expectancy – the number of years someone can expect to live in good health. The inequality here is more shocking – there is a 17 year gap between those in the least and most deprived areas. This means that those people living in deprivation can expect to die seven years younger than their rich counterparts – and, live 10 more years of their shorter life with a limiting disability.

Recommendations for change

In 2010, we reported on these health inequalities, what causes them, and how to tackle them. The report, ‘Fair Society, Healthy Lives’ (The Marmot Review), set out six high level policy recommendations:

  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

Health professionals have a key role to play

In order to meet these policy objectives, improve the health of all, and reduce inequalities in health, health professionals have a key role to play. In 2013, we produced a report that specifically addressed this role, which we called ‘Working for Health Equity’. And now, as President-Elect of the World Medical Association, I will focus on how health professionals around the world can take action on the Social Determinants of Health in order to reduce inequalities in health.


Photo credit: Sir Michael and the West Midlands Fire Service, Aaron Manning

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