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The Health Gap: The Challenge of an Unequal World, by Michael Marmot
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In Baltimore's inner-city neighborhood of Upton/Druid Heights, a man's life expectancy is sixty-three; not far away, in the Greater Roland Park/Poplar neighborhood, life expectancy is eighty-three. The same twenty-year avoidable disparity exists in the Calton and Lenzie neighborhoods of Glasgow, and in other cities around the world.
In Sierra Leone, one in 21 fifteen-year-old women will die in her fertile years of a maternal-related cause; in Italy, the figure is one in 17,100; but in the United States, which spends more on healthcare than any other country in the world, it is one in 1,800. Why?
Dramatic differences in health are not a simple matter of rich and poor; poverty alone doesn't drive ill health, but inequality does. Indeed, suicide, heart disease, lung disease, obesity, and diabetes, for example, are all linked to social disadvantage. In every country, people at relative social disadvantage suffer health disadvantage and shorter lives. Within countries, the higher the social status of individuals, the better their health. These health inequalities defy the usual explanations. Conventional approaches to improving health have emphasized access to technical solutions and changes in the behavior of individuals, but these methods only go so far. What really makes a difference is creating the conditions for people to have control over their lives, to have the power to live as they want. Empowerment is the key to reducing health inequality and thereby improving the health of everyone. Marmot emphasizes that the rate of illness of a society as a whole determines how well it functions; the greater the health inequity, the greater the dysfunction.
Marmot underscores that we have the tools and resources materially to improve levels of health for individuals and societies around the world, and that to not do so would be a form of injustice. Citing powerful examples and startling statistics (“young men in the U.S. have less chance of surviving to sixty than young men in forty-nine other countries”), The Health Gap presents compelling evidence for a radical change in the way we think about health and indeed society, and inspires us to address the societal imbalances in power, money, and resources that work against health equity.
- Sales Rank: #58701 in Books
- Published on: 2015-11-03
- Released on: 2015-11-03
- Original language: English
- Number of items: 1
- Dimensions: 9.59" h x 1.26" w x 6.46" l, 1.00 pounds
- Binding: Hardcover
- 400 pages
Review
“Michael Marmot’s path-breaking work on the social determinants of health has made all of us rethink healthcare and social medicine. This is a lesson of tremendous practical importance to the world.” ―Amartya Sen
"Marmot convincingly details how socioeconomic inequities lead to health inequities . . . [He] passionately argues for people everywhere to promote a more 'just distribution of health' . . . Like a good courtroom attorney, Marmot builds a strong case and calls for action." ―Booklist
"[T]he author creates a strong case for policy changes that address human needs for autonomy, empowerment, and freedom in order to improve the well-being of people globally who are living in vulnerable and disadvantaged circumstances." ―Library Journal
"[Marmot's] research over the years has generated a catalogue of shocking headline findings, which are collected in this book to devastating effect. Page after page rams home the message that the poorer you are, the more likely you are to live a shorter, less healthy and in all likelihood less happy life . . . The Health Gap briskly and coherently explores why this might be the case . . . But Marmot is no doom-monger. Quite the opposite . . . this is a fundamentally optimistic book." ―The Independent
"Dr. Marmot weaves a masterful treatise on world financial and trade policy, availability of education to all people, and the robustness of infrastructure to support health status . . . To learn more about creative initiatives throughout the world that are improving conditions for human beings, buy this book, a bargain at any price." ―New York Journal of Books
"Now's the time to . . change the way we think about health. In his new book, UCL professor Michael Marmot reveals that the average person would have eight extra years of healthy life if they had the same opportunities as the richest in our society . . It's time to stop seeing health as a matter of lifestyle choice and start campaigning for justice--for all our sakes." ―The Observer
“Marmot's important study shows that--in every culture--our happiness and health are closely related to the place we occupy in the status hierarchy, and that that the key to status is our occupation.” ―The Guardian on STATUS SYNDROME
“Bubbling with findings, discreetly illuminated by the light of social justice, written considerately for ordinary readers . . . Packed with ideas that should have been coursing through public debate for years.” ―The Independent on STATUS SYNDROME
“If you want to understand why the health of people living in the United States, the richest and most powerful country in world history, lags far behind the health of people in other rich nations, then be prepared to wet your whistle here.” ―The New England Journal of Medicine on THE STATUS SYNDROME
About the Author
Sir Michael Marmot is Professor of Epidemiology and Public Health at University College London, and current president of the World Medical Association. He takes up the Lown visiting professorship at Harvard in 2015. He chaired the World Health Organization's Commission on Social Determinants of Health (2005–8), and the European Review of Social Determinants and the Health Divide, and will chair a review of health inequalities across the Americas for the WHO's Pan-American Health Organization (PAHQ). His recommendations have been adopted by the World Health Assembly and by many countries. The British Government appointed him to conduct a review of social determinants and health inequalities; the Marmot Review and its recommendations are now being implemented in three-quarters of local authorities in England. He is the author of The Status Syndrome, and lives in North London.
Most helpful customer reviews
7 of 8 people found the following review helpful.
Very Thought-Provoking!
By Loyd Eskildson
The conditions of people's lives can lead to physical and mental illnesses. Taking control of one's life and exercising, eating, and drinking sensibly, having time off on happy holidays is great if one is well off - financially and socially. Dr. Marmot asks, 'Why (just) treat people and send them back to the conditions that made them sick?' Being emotionally abused by your spouse, having family troubles, being unlucky in love, being marinal in society can all increase risk of disease.
Health is correlated with work status. In the Whitehall Study of 17,000 men (1978-84) at the bottom of British civil service found their mortality rate was 4X that of the men at the top; in between health improved steadily with rank. High stress, low control.
In 2012, the World Health Organization concluded that life expectancy in the world was 70, ranging from 46 in Sierra Leone to 84 in Japan. Regardless, in Nepal, life expectancy improved by about 20 years between 1980 and 2012, to 69; thus, progress can be rapid. More action is needed. Marmot contends that health inequalities are not a footnote to the health problems we face - they are the major health problem. We have major inequalities in health - both within and between countries.
About 13% of American boys aged 15 will not reach their 60th birthday, vs. only 7% in Sweden. If the U.S. has the best health care in the world, why do U.S. young adults have less of a chance for surviving to 60 than those in Costa Rica, Cuba, and Slovenia? Medical care has little to do with it - the differences are attributable mostly to homicide, suicide, car crashes, other accidents, drugs, alcohol, and other disorders. Russia is much worse - one-third of its 15-year-old boys do not make it to age 60 - only marginally better than Sierra Leonne. Twenty years ago, survival chances of 15-year-old Swedes was worse than now, and a lot like that of America's today. The U.S. is richer (national income/capita) than almost all the 49 countries ahead of it in survival. Russia's national income/capita (adjusted for purchasing power) is 20X that for Guinea-Bissau, yet boys in both have the same survival odds.
In Sierra Leone, one of every 21 fifteen-year-old girls in school will die during child-bearing years of a cause related to maternity. In Italy, it is one out of 17,100, and one of 1,800 in the U.S. Sixty-two countries have lower lifetime risks of maternal deaths than the U.S.
Among poor countries, higher national income is associated with better health (up to about $10,000/capita in purchasing power parity), among 'rich' countries getting richer does very little for health. Other things are more important.
Marmot's Three Main Points: 1)There is no good biological reason for most of the health inequalities we see within and between countries. 2)We know what to do to make a difference - rapid change is possible. 3)Health is related to how we organize our affairs. Good early child development, education, good working conditions, a cohesive society are all linked to better health.
Most people visiting Calton (near Glascow) would call it poor, yet it is fantastically wealthy vs. India - where one-third of the populace live on $1.25/day. Average income in India, adjusted for purchasing power, is $3,300. Almost everyone in Calton has shelter, a toilet, clean water, and food. Yet, life expectancy for men is 8 years less than the average for India.
The 2010 Global Burden of Disease study made estimates of the major causes of ill-health overall. In descending order, they were high-blood pressure, smoking, household air pollution, low fruit intake, high body mass index, high fasting plasma glucose level, childhood underweight, ambient particulate matter pollution, physical inactivity, high sodium intakes, . . .. Sanitation and unimproved water bring up the rear of the list, and childhood underweight comes after high body mass index.
Harry Burns compared mortality rates in Glasgow with those in Manchester and Liverpool. Causes of death with the largest relative excess in Glasgow were all psychosocial - drug-related poisonings, deaths associated with alcohol, suicide, accidents, and violence other than suicide.
The Top (Typical) Tips For Healthy Living: Don't smoke, Keep physically active. Eat a balanced diet, Drink alcohol, if at all, in moderation. Drive safely. No illegal drugs. Top Tips for Healthy Living Taking Living Conditions Into Account: Don't be poor. Don't live in a deprived area. Don't be disabled or have a disabled child. Don't work in a stressful, low-paid manual job. Don't be a lone parent. Claim all benefits to which you are entitled. Be able to afford a car. Use education to improve your position.
We now that tobacco, alcohol, and processed meats are bad for us - yet, the economic interests of those industries, along with cries of 'Nanny-State,' limit the action taken to limit their damage.
'The smaller the dress size, the larger the apartment.' Modern-day proverb.
1 of 1 people found the following review helpful.
Vital reading for an understanding of the true cause of health and disease
By John Martin
The Health Gap by Dr. Michael Marmot is essential reading for everyone concerned about health and their country. He is the president of the World Health Association and a long time advocate of the idea that social factors largely determine health. He is affiliated with University College London and the Institute of Health Equity there. Dr. Marmot demonstrates that the traditional view that health is a matter of personal responsibility (your behavior is a choice you make and it determines your health) is incorrect. Personal responsibility should be at the heart of health but people’s ability to take personal responsibility is shaped by their circumstances. A more accurate view is that inequities in health within and between countries are a result of social determinates such as income, education and the existence or lack of a social support structure. Thus in order to improve health it is necessary to focus on correcting and reducing these inequities. In sum, culture influences and affects health. Inequalities in health arise from inequalities in society not a lack of health care. Central to improving people’s health and well being is the empowerment of individuals and communities. Economists argue that poor health leads to poverty, Dr. Marmot replies that the reverse is more accurate—poverty leads to poor health. For example, the United States is one of the richest countries in the world and has one of the best health care systems yet the health of the American people is not particularly good because of the sharp inequities in American society. By contrast Cuba and Costa Rica are poor countries but have a high level of health. The Nordic countries have high health and relatively small inequities.
The book goes on to discuss a number of strategies for health reform. These include:
1. Reduce deprivation of children. The level of child poverty is a choice made by the political system of a country—in the U.S. the figure is 23%; by comparison it is 9 % in France. In addition, provision of high quality services for early childhood makes a big difference throughout the life of the child.
2. Provide more educational opportunities. A more educated society will be a healthier one.
3. Reduce the inequities in power, money and resources. The hazards from work are physical, psychological and financial.
4. Improve the health of older people. The world is aging rapidly and getting more female as women live longer than men. Empowering older people and recognizing their rights is essential to the overall health of a society.
5. Build resilient communities. He mentions a number of such communities, especially among indigenous people.
6. Provide a minimum income for healthy living to all.
Throughout the book Dr. Marmot provides the results of numerous studies and data sets to show the accuracy of his perspective. He also presents the views of others who share his views such as Thomas Piketty and Joseph Stiglitz. He closes the book with some examples of how countries around the world have taken steps to improve the health of their people by changing their social structure. Globally, as in the U.S. people are becoming fatter. They are eating more processed foods, drinking more sugary drinks and continuing to smoke cigarettes, especially now in low and middle-income countries. Finally in the last chapter, entitled “The Organization of Hope” Dr. Marmot indicates that progress must be made through the triangle of government, academia and people. He has written a number of other works to promote this idea including, “Fair Society, Healthy Lives” and “Closing the Gap in a Generation.” You can learn more about his program and ideas at www.instituteofhealthequity.org.
0 of 0 people found the following review helpful.
Outstanding, clever, entertaining, and O so expert, this book is a gift and an absolute pleasure to read.
By Bruce Albert MacKay
Outstanding, clever, entertaining, and O so expert, this book is a gift and an absolute pleasure to read...in other hands it could have been dreadfully boring. If, as Einstein once said, you consider yourself to be a citizen of the world, then this book is the universal salve you've been seeking. But it, read it, enjoy!
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