THE HEALTH GAP

A close look at the health gap between the richest and better educated and those below them on the socioeconomic scale.

For more than three decades, Marmot (Epidemiology and Public Health/University Coll., London; The Status Syndrome: How Social Standing Affects Our Health and Longevity, 2004, etc.), who will become president of the World Medical Association later this year, has led research groups studying public health. His 2010 study, “Fair Society Healthy Lives,” known as the Marmot Report, proposed ways to reduce health inequalities in England. Here, the author’s canvas is broader as he looks at the social gradient in health in places across the globe, including Brazil, Finland, Eastern Europe, Cuba, Canada, the United States, and many others. Marmot argues that health is directly related to societal issues, that inequities in power, money, and resources give rise to inequities in the conditions of daily living and, thus, to inequities in health. Individual chapters deal with specific areas—child development, education, employment and working conditions, conditions for older people, and development of resilient communities—where changes would reduce health inequalities. While poverty plays a significant role in health, the author makes clear that empowerment is vitally important. Marmot’s text is largely accessible to general readers, sometimes even rather informal and occasionally chatty and personally revealing. However, the abundance of charts throughout the text is off-putting, often breaking the flow of the narrative. This supplementary material, which encapsulates textual information, might better have been placed in an appendix. Marmot’s intent is twofold: to make clear how society’s workings impact health and to point the way to a fairer society. His take-home message—“Do something. Do more. Do it better”—is succinct.

Marmot is more successful at delineating a social problem than at solving it, but he provides plenty of ammunition for those in position to tackle it.