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From our archives: July 2019
Michael Marmot Passionately
Delivers Yet Another
Wake Up Call At Harvard About Inequalities In
Health
“Crisis”,
“Calamity”, “Disaster” Are All Used To Describe
Negative Changes In
Life Expectancy
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Authors:
Roger Bernier, MPH, PhD
Michael Marmot
is
Director of the Institute of Health Equality at the University College
London Research Department of Epidemiology & Public Health and a
well-known champion for social determinants of health. He delivered
the annual Cutter Lecture in early May at the Harvard School of Public
Health entitled “Social Justice, Health Equity, and the Social
Determinants of Health.”
Life Expectancy As Index
The cornerstone of Marmot’s cause for alarm described in the Lecture
is the stall or fall in life expectancy in England in 2011 which until
then had been increasing by one year every four years since the
1920’s. If you believe that health tells us something fundamental
about how well a society is meeting the needs of its population, said
Marmot, then this is a “crisis” and the cause urgently needs to be
uncovered. Using additional data, Marmot showed that life expectancy
at birth is decreasing in some sections of the UK and is worse for the
poorest women. Not only is this a “calamity”, he said, but the
inequalities are getting worse and that this is a “disaster”. He went
on to present similar data about life expectancy and inequalities in
the US population.
One cannot expect to continue gaining in life expectancy, according to
Marmot, if inequalities are on the rise. He went on to suggest that
the election of Donald Trump and the Brexit vote.
Amenable To Change
Marmot then presented indirect evidence that heath inequalities can be
reduced and life expectancy can be improved through government
actions. He correlated changes in government administrations in the
UK and US with changes in life expectancy and infant mortality,
respectively, with populations faring worse with conservative or
Republican administrations. These changes are correlated with the
percentage of Gross Domestic Product being spent on social programs
with the US ranking only 23rd among OECD countries.
Role of Money
Marmot also went on to describe how having more money or purchasing
power does make a difference in life expectancy at birth in different
countries, but only up to a certain threshold. Above the threshold,
other factors play into the health determinants. For example, life
expectancy in Costa Rica, Cuba, and Chile is similar to that in the
US, however, the GDP per capita is much higher in the US. Something
else is driving health in these situations besides purchasing power.
Another way of illustrating this disparity is to note that poor
persons in Baltimore with the same purchasing power as persons in
Costa Rica have a life expectancy of only 63 years versus 77 in Costa
Rica.
Causal Model
Marmot described both 1) structural drivers such as racism, economic
systems, and cultural factors and 2) conditions of daily life such as
early life experiences as having impact on health equity and leading a
dignified life. An approach to health and well-being Marmot endorsed
is one he uncovered in New Zealand’s Department of Treasury which
states that “a well-being approach can be described as enabling people
to have the capabilities they need to live lives of purpose, balance,
and meaning for them.”
Closing Observations
“I believe that unarmed truth and unconditional love will have the
final word in reality. This is why right, temporarily defeated, is
stronger than evil triumphant.” These words from Martin Luther King
were invoked by Michael Marmot to parallel and encapsulate his
own two-pronged strategy of using evidence-based policy (truth) in a
spirit of social justice (love) to combat social inequalities.
To listen to the Cutter Lecture, readers may visit:
https://bit.ly/2x1ykBH
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