Sir Michael Marmot on Fairness and Health Equities

Sir Michael Marmot, University College London

Sir Michael Marmot, University College London

Yesterday, I attended the Edmonton-based Institute of Health Economics‘ VIIth Innovation Forum on the social determinants of health.

The keynote presentation was given by Sir Michael Marmot, Director of the Institute of Health Equity and MRC Research Professor in Epidemiology at University College, London, UK.

As some readers may be aware, Marmot is also the lead author of the 2010 Marmot Review, commissioned by the then UK Secretary of State for Health to propose the most effective evidence-based strategies for reducing health inequalities in England.

In his presentation, Sir Marmot highlighted the main pieces of evidence and assumptions underlying the key recommendations in this report with the notable title, ‘Fair Society, Healthy Lives”.

As he points out in his introduction to the report,

“Inequalities in health arise because of inequalities in society – in the conditions in which people are born, grow, live, work, and age. So close is the link between particular social and economic features of society and the distribution of health among the population, that the magnitude of health inequalities is a good marker of progress towards creating a fairer society. Taking action to reduce inequalities in health does not require a separate health agenda, but action across the whole of society.”

(Faithful readers, may recall the overtones of my previous post on ‘lifestyle choice vs. lifestyle chance’.)

The report further reminds readers that

“These serious health inequalities do not arise by chance, and they cannot be attributed simply to genetic makeup, ‘bad’, unhealthy behaviour, or difficulties in access to medical care, important as those factors may be. Social and economic differences in health status reflect, and are caused by, social and economic inequalities in society.”

Notably, investments in better education may well pay off in better health of the population.

“Inequalities in educational outcomes affect physical and mental health, as well as income, employment and quality of life. The graded relationship between socioeconomic position and educational outcome has significant implications for subsequent employment, income, living standards, behaviours, and mental and physical health.”

Thus the report recommends a life course perspective.

“Disadvantage starts before birth and accumulates throughout life…. Action to reduce health inequalities must start before birth and be followed through the life of the child.”

Sir Marmot reemphasized the key policy objectives from this report as relevant for all nations:

  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 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.

In addition, the report urges policy makers to ensure that all policies (and he really means ALL policies) should consider their impact on equality and health equity.

As to whether or not this vision can actually be implemented, Sir Marmot remains optimistic, noting specific examples of countries like India, which are paying attention and attempting to implement some of these ideas, while other countries (I will not name the less positive examples here) seem to appear less inclined.

Interestingly enough, yesterday, the Edmonton Journal happened to report that nearly 32 per cent of kindergarten kids in Edmonton are experiencing “great difficulty in one or more areas of development,”

According to this report,

The problems are most pronounced when it comes to communication skills and general knowledge, where 33 per cent are struggling, according to initial results from the early child development mapping project (ECMap) . As well, 29 per cent face problems with emotional maturity and 28 per cent with physical health and well-being, according to the Edmonton numbers posted this week. Twenty-five per cent have trouble with social competence and 21 per cent have trouble with thinking and language skills.”

Thus, in light of Sir Marmot’s presentation, there certainly appear to be room for concern regarding whether even countries like Canada are doing the best they can to meet the recommendations of the Marmot Review.

Certainly, substantial food for thought.

Canmore, Alberta