Policies fail to reflect wealth's role in health

Poor people are substantially sicker than rich people yet health policies fail to reflect this common knowledge, according to a world expert on health inequalities.

Prof Michael Marmot, director of University College London's Institute for Society and Health, yesterday called for more political will to tackle socioeconomic deprivation as a means to improving the health of world populations.

"My view is that we can do a lot to reduce health inequalities in our own countries and in the developing world by putting in place early childhood education, better housing and better working conditions," said Prof Marmot who is chairman of the World Health Organisation's Commission on Social Determinants of Health.

"The problem is that health policies are carried out as if we don't know that these issues are the keys to better health for people in lower socioeconomic groups," he said. Prof Marmot has been to the forefront of research into health disparities for the past 20 years and has also advised the British government on finding ways to reduce health inequalities.

According to Prof Marmot, only by tackling psychosocial, educational and material deprivation within communities can people's health status be improved. His publications include Status Syndrome: How your social standing directly affects your health and life expectancy.

He is also well known as the principal investigator into the Whitehall studies of British civil servants which found a clear relationship between social class and rates of disease.

"For instance, we often hear how vaccination and access to health services are the keys to solving maternal and infant mortality in sub Sahara Africa. But we know that the key driver of improving the health of these people is the education of women yet this is not being discussed."

Prof Marmot says that in western countries many alcohol and smoking prevention programmes do not reach poor people. "It's not because they haven't heard or don't know that smoking is bad for you. It is because on their list of priorities, giving up smoking is way down and they have to turn their attention to more immediate matters."

Instead, Prof Marmot suggests an in-depth look at what is at the root of poverty and these continued inequalities. "The problem is that the gap in health [between the rich and the poor] is widening in most countries. Even where I live and work in Camden in north London, I can travel half-an-hour's journey by bicycle and see a gap of 11 years in the life expectancy of people in different socioeconomic circumstances."

Prof Marmot was speaking to The Irish Times in advance of his lecture, Health in an Unequal World: A Matter for Social Justice at the Economic and Social Research Institute (ESRI) in Dublin yesterday. The annual lecture is organised by the ESRI to honour Dr R.C. Geary (1896- 1983), the first director of the institute and an eminent Irish statistician.

Prof Marmot heads a research group of about 120 people investigating the origins and prevention of cardiovascular disease with a particular focus on alcohol, nutrition and social, economic and cultural determinants of disease.