If you are interested in the social determinants of health and have not yet heard of The Health Gap: The Challenge of an Unequal World you might be in for a treat. It is written by Sir Michael Marmot, a Professor of Epidemiology and Public Health. He provides the well-reasoned argument for fairer societies.
It is difficult not to be won over by this scientific yet emotive book; his ‘evidence-based optimism’ is quite catching. Whether it was subliminally intended or not, by the time I reached the end of the book, the image of a standing ovation had sprung to mind.
Fairly early in the book he states that, ‘Health is too important to be left solely to doctors.’ As a GP, I was about to feel disheartened but then part of me was relieved and wanted to read more. He next takes you on a journey, meeting disadvantaged individuals from around the world and then places them in a much larger context of facts, figures, and evidence. He observes that, the poorer the area, the worse the life expectancy. Glasgow, for example, has a 20-year difference in average life expectancy between two areas (one rich, one poor) just miles apart. And if you ignore the extremes of social class and look at people in the middle, their life expectancies are, well, somewhere in the middle. I think to myself, yes, this all makes unjust sense.
However, he then explains that nearly everyone in the UK has access to free medical care, schooling, and clean water supplies. Food is affordable and healthy lifestyle advice is readily available. He leaves the reader in suspense with the question, if it is not medical health care or even good public health, then what is creating ‘the health gap’?
In response, he presents a chapter on empowerment. He describes three types of empowerment: material, psychosocial, and having a voice (political). When people lack finances, opportunities, and structure to their lives they become disempowered and make choices that are perhaps less healthy, even if they know it is bad for them. He believes if people had fair conditions in which they are born, grow, work, live, and age, it would give them the freedom to make healthier decisions and engage in new positive challenges.
What is interesting about the author is his refusal to take a one-sided political stance. Despite coming to conclusions about how society should be organised, he is quite assertive in telling us that the book is based on evidence and facts. He wants to appeal to all parties, because the health of society should be on every political agenda. However, I feel some political parties might be more enthusiastic about his strategies than others.
I do like Marmot’s vision. He remains firmly optimistic for the future and I think that is what people like about him. His reports nationally and globally have already led to action and he is keen to keep moving things forward. In his final chapter he talks of everyone working together so that we can achieve great things and makes reference to moving mountains. Some might find it a bit cheesy, but I think it is an important point. Clichéd ideas are fine when they are backed with science and evidence. I finished the book feeling he really does reach out to many. He makes simple points from complex evidence, with positive results.
- © British Journal of General Practice 2017