There are dramatic differences in health between countries and within countries. But this is not a simple matter of rich and poor.
A poor man in Glasgow is rich compared to the average Indian, but the Glaswegian's life expectancy is 8 years shorter. The Indian is dying of infectious disease linked to his poverty; the Glaswegian of violent death, suicide, heart disease linked to a rich country's version of disadvantage. In all countries, people at relative social disadvantage suffer health disadvantage, dramatically so. Within countries, the higher the social status of individuals the better is their health.
These health inequalities defy usual explanations. Conventional approaches to improving health have emphasised access to technical solutions – improved medical care, sanitation, and control of disease vectors; or behaviours – smoking, drinking – obesity, linked to diabetes, heart disease and cancer. These approaches only go so far. Creating the conditions for people to lead flourishing lives, and thus empowering individuals and communities, is key to reduction of health inequalities.
In addition to the scale of material success, your position in the social hierarchy also directly affects your health, the higher you are on the social scale, the longer you will live and the better your health will be. As people change rank, so their health risk changes.
What makes these health inequalities unjust is that evidence from round the world shows we know what to do to make them smaller. This new evidence is compelling. It has the potential to change radically the way we think about health, and indeed society.
Fairness Foundation event, January 2022
The Health Gap
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 are all linked to social disadvantage.
American Economic Association review, September 2018
Mind the Gap: A Review of The Health Gap: The Challenge of an Unequal World by Sir Michael Marmot
Mind the Gap: A Review of The Health Gap: The Challenge of an Unequal World by Sir Michael Marmot by Adriana Lleras-Muney. Published in volume 56, issue 3, pages 1080-1101 of Journal of Economic Literature, September 2018, Abstract: The Health Gap documents the large and persistent health gaps that...
International Journal of Epidemiology article, September 2017
The Health Gap: The Challenge of an Unequal World: the argument
In early 2015, the US city of Baltimore erupted. The precipitant of the eruption was the killing of a Black man in police custody; actually, one more killing of a Black man by police. 1 But the underlying cause was inequality in social and economic conditions.
Lancet article, September 2015
The health gap: the challenge of an unequal world
In Aldous Huxley's dystopia, Brave New World, there were five castes. The Alphas and Betas were allowed to develop normally. The Gammas, Deltas, and Epsilons were treated with chemicals to arrest their development intellectually and physically, progressively more affected from Gamma to Epsilon.