The Health Gap - The Challenge of an Unequal World

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 (and now, with the new administration chipping away at Obamacare, the statistics stand to grow even more devastating). 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. Overview: 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 In A Baltimore Inner-city Neighborhood, A Man's Life Expectancy Is 63; In Another Neighborhood Not Far Away, It's 83. The Same 20-year Avoidable Disparity Exists In Nearby Neighborhoods Of 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--inequality Does. Suicide, Heart Disease, Lung Disease, Obesity, And Diabetes 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. 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. Author 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. We Have The Tools And Resources To Improve Levels Of Health For Individuals And Societies Around The World, And Not To Do So Would Be A Form Of Injustice. 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.--adapted From Book Jacket. The Organisation Of Misery -- Whose Responsibility? -- Fair Society, Healthy Lives -- Equity From The Start -- Education And Empowerment -- Working To Live -- Do Not Go Gentle -- Building Resilient Communities -- Fair Societies -- Living Fairly In The World -- The Organisation Of Hope. Michael Marmot. Includes Bibliographical References (pages 347-369) And Index. 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