The Health Gap ─ The Challenge of an Unequal World

The richest live, on average, longer than adults of upper middle class income levels, who in turn live longer than members of the middle class, and so on. How and why does this happen, when middle class families in any developed nation could hardly be considered poverty-stricken? The same phenomenon occurs with the level of education; adults with Ph.D.s live longer than those with a master's degree, master's longer than bachelor's, and so on again. This richer understanding of poverty and health is Michael Marmot's brilliant and arresting focus in The Health Gap as he approaches what he calls the "social gradient in health" and its complicated relationship to health and poverty.

As Marmot shows, improvement in the health of people who are relatively disadvantaged--i.e. most of us, compared to concentrations of wealth at the very top of the income ladder--is built on two intertwining pillars: material conditions for good health, and control of life circumstances or empowerment. Addressing these issues is the only path to improved health and healthcare for people of all income brackets around the world.

Sir Michael Marmot is Professor of Epidemiology and Public Health at UCL, a leading intellectual both in the UK and globally. He will take up the Lown visiting professorship at Harvard in 2015. He chaired the WHO Commission on Social Determinants of Health (2005-8), his recommendations have been adopted by the World Health Assembly and taken up by many countries, and 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 previously publishedStatus Syndrome in 2004.