The event was chaired by Michael Marmot, author of the report, and John Humphrys acted as facilitator. Speakers included Prime Minister Gordon Brown ; Secretary of State for Health for England Alan Johnson ; Director General for Health and Consumer Protection Robert Madelin ; and WHO Europe Director Marc Danzon.
In his opening remarks, John Humphrys, an emminent British journalist, reminded the audience why health and social inequalities have remained on the political agenda for the last thirty years.
A journalist’s job, he said, is to simplify and then exagerrate. If he were to simplify the issue of health inequalities he would draw a line between the rich and the poor. The poor are poor because they don’t have as much money. The margin between the rich and the poor is huge. The health outcomes for poorer people are much worse and reflects their position on the social ’pecking order.’
Even simpler then, he argued, is the political solution. We just need to give them more money, and, as evidenced by the recent bank bail-outs, we have plenty of money to give.
If only the reality were so simple. John Humphrys rightly pointed out that political will is one obstacle to such a simple solution. The effect of social determinants on health, resulting in health inequalites, were clearly identified in the 1970s, yet because of a lack of political will it took at least eighteen years to get it on to the agenda. The purpose of the conference was therefore to ensure that it remains on the agenda and to provide the policy makers present with an opportunity to examine how, in practical terms, we can build policy to close the gap.
The British Prime Minister Gordon Brown reiterated the need for a political will to combat what he sees as avoidable illness and suffering. According to the Prime Minister, the most unacceptable of injustices require the most strenuous of efforts to ensure that they are overcome. The current political and financial climate should not represent an excuse to put our global ambition to reduce inequalities on hold, there could be no worse time for such a reaction. Global leaders should not draw back from the task at hand, but recognise that they have now become more urgent than ever.
His understanding of health inequalities encompassed both those between different countries, and those between people living in any one given country. The issue of health inequalities is one that needs to be tackled at all levels : global, regional, national and local. In order to illustrate his point, he stressed that whilst the gap in average life expectancy between Africa and Europe is in excess of thirty years, it must also be known that for every tube stop between Westminster and West Canning life expectancy decreases by one year. Even in the most prosperous of cities, health inequalities are pronounced. The geography of inequality reaches all levels and must be seen as the geoography of injustice.
The issue is therefore clear and the challenges are numerous. A recent report by the OECD has shown that the income gap is closing. It is now our responsibility, said Brown, to ensure that the health gap also begins to close. In repsonse to the recommendations made in the report, Michael Marmot has been commissioned by the UK government to undertake a study into the health gap in the UK. The report represents and opportunity for global leaders to establish their own initiatives to tackle inequalities within countries and between peoples.
In his final words, Gordon Brown recalled one conversation he had with Nelson Mandela at his 90th Birthday celebrations. Nelson Mandela said that he had climbed one mountain in his life [apartheid], but at ninenty years old there was still another mountain to climb and that was to tackle inequalities and poverty.
Alan Johnson also highlighted the fact that extreme wealth and poverty exist side-by-side. London is living proof of such inequity, but stressed that, given the interest surrounding the issue, it is evidently not the only example. Governments have become accustomed to working together on such issues as the environment, and more recently on economic questions ; the Marmot report states that health inequalities demand a global response, and governments should now make a concerted effort to move in that direction.
Using the mantra ’think global, act local,’ Johsnon stressed that whilst the challenges that countries face may be different, health inequalities are universal. The symptoms of disparities are the same across the world : deprivation, poor education and lack of opportunity. Even the best healthcare services in the world cannot cure these symptoms. The symptoms are intergenerational and, according to Johnson, we cannot afford to lose another generation to health inequality.
When Michael Marmot took the floor, he said he was encouraged by the statements from the Prime Minister and the Secretary of State for Health. He could have written them himself, he admitted, and this is an achievment. To hear key political actors talking about the social determinants of health in this way gives him a sense of hope for the achieving the task at hand.
Mr Marmot took the opporunity of having the floor to justify his objection to entirely economic arguments for health inequalities. Economic arguments, he said, have the ears of the politicians. Politicians, like journalists, simplify. It is the business of academics to say ’it’s not so simple.’
Why do people in Glasgow live on average eight years less than the Indian average life expectancy when people in Glasgow are fantastically rich compared to the Indian population ? Why does Cuba have a similar life expectancy to that of US citizens when the financial situation in the two countries cannot be compared ? The issue is clearly not just about money, it is about social gradient. Inequalities are not confined to the poorest of the poor, they are found in all socio-economic strata.
In recent years the pendulum has swung away from the public sector, Marmot stressed, and it is our responsibility today to ’nudge’ it back in the other direction. There should be a moral case made for reducing health inequalities, it cannot be an economic case alone. As Margaret Chan, Director General of WHO, pointed out, a whole range of factors determine health outcomes ; healthcare is an important determinant of health, lifestyles are an important determinant of health. It must always be rememebered that it is factors in the social environment that determine access to healthcare and influence lifestyle choices in the first place.
The questions raised by the report address the issue of fairness and society, and an individual’s right to choose. Freedom should not be rigged, as it currently is, and society should be organised in a way that people have the chance to choose healthy lifestyles. The report provides the framework, but the next crucial step is to take the recommendations and make them practical.
Michael Marmot recognised that is unfashionable to commend a government, but said that the work that the UK Department of Health and the Prime Minister have been doing to reduce health inequalities has been brilliant. It is his hope that other countries see the value of tackling health inequalities in order to achieve an fair and equitable society for all.
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