good does it do to treat people and send them back to the conditions
that made them sick?”
Sir Michael Marmot, Professor of Epidemiology and Public Health
at University College London, asks.
societies around the world become more unequal, the gap between
levels of health widens. Marmot says that social injustice is the
biggest threat to global health and a radical change in society is
needed if we really want people to live long and healthy lives.
Baltimore, for example:
has grown up in the Upton Druid Heights neighbourhood in Baltimore’s
inner city,” explains Marmot, who has conducted research on health
inequalities in communities across the world. “Bobby has grown up
in Greater Roland Park.”
merely kilometres apart, people living in the suburban and affluent
Roland Park can expect to live to the age of 83.
LeShawn, living in the inner city, will probably die 20 years
earlier. Life expectancy in Upton Druid Heights is just 63 years.
reasons for this massive gap?
10% of residents in Upton Druid Heights start tertiary education,
while 75% of those living in Roland park complete college.
all children living in the suburb can read proficiently by the third
grade. Less than half of children in the inner city can read
proficiently by the same age.
2005 to 2009 there were 100 non-fatal shootings for every 10,000
residents, and nearly 40 homicides in Upton Druid,” he says.
Roland Park there were no non-fatal shootings in the same
in the city earn an average annual income of $17,000 while
Roland Park residents have a median income more than five times
higher – $90,000.
conditions in which we live, early childhood development, income and
education – these all predict how healthy we are and how long we
will live,” says Marmot. He argues that our societies need to
change radically: we need to invest aggressively in education and
reduce the gap between the rich and the poor.
is this more relevant than in South Africa, the most unequal country
in the world according to the International Monetary Fund (IMF) and
the World Bank.
IMF estimates that 10% of the population earn around 60% of all
income, compared to only 20% to 35% in more advanced economies.
is measured by the Gini Coefficient – a percentage estimate where
zero represents perfect equality and 100 represents perfect
Africa has the highest level of inequality in the world at just over
comparison, Sweden and Norway have Gini Coefficients of 27% and 25%%
respectively, according to World Bank estimates.
does not matter how wealthy a country is. It matters that the wealth
is more evenly spread.
the wealthiest nations in the world, the US, has some of the worst
health outcomes, argues Marmot, because inequality is rife.
into a typical American school and count one hundred boys aged 13.
Thirteen of you will fail to reach your 60th birthday,” he says. Is
13 out of 100 a lot? The US risk is double the
Swedish risk, which is less than seven.
says that life expectancy in Costa Rica is high, about 80 years in
2012, even though it is not a wealthy nation. But inequality is
lower, quality education is accessible and, interestingly, the
country’s decision to abolish its military in 1948 has freed up
resources to invest in public amenities. Marmot argues that the money
and resources saved by not having to fund an army have been instead
invested in, for example, education – and decades later the health
of Costa Ricans has improved dramatically. In 2007 almost every
single child aged three to five in Costa Rica attended pre-school.
This is compared to just over 20% for many other South American
countries such as Paraguay.
children are educated and protected from abuse can radically change
England, says Marmot, preventing early adverse events in childhood,
such as verbal, physical or sexual abuse, can reduce the likelihood
of teen pregnancy by 38%. Many instances of abuse occur in households
with low incomes and high unemployment.