Professor Sir Michael Marmot conferred prestigious Companion of Honour for major achievement in public health
Professor Sir Michael Marmot, Director, University College London’s (UCL) Institute of Health Equity is conferred the highly prestigious Companion of Honour (CH) from His Majesty The King in this year’s 2023 New Year Honours List. The special distinction is awarded for having made a major contribution to the arts, science, medicine, or government lasting over a long period of time, and is limited to 65 people at any one time.
Sir Michael’s major contribution is his professional life-time work in public health. He trained as a doctor in 1968 in Sydney, Australia, where his obsession with ‘not sending people back to the circumstances which made them sick in the first place’ took him to the University of California, Berkeley, to study public health. His PhD in 1975 discovered the correlation between coronary heart disease and the changes to Japanese people’s lifestyle (stress and diet) since moving to the USA. Dr Marmot then returned to his birthplace, London, and, at University College London (UCL) his 50-year journey linking health inequalities to the circumstances in which we are born, live, grow, work and age (the Social Determinants of Health) continued.
Professor Marmot was knighted by Her Majesty The Queen in 2000 for services to epidemiology and the understanding of health inequalities. His analysis of health inequalities among Whitehall British Civil Servants led to the land-mark discovery of the ‘social gradient’ – those at the top of society are less likely to become ill and die early due to their favourable social determinants of health, with the middle classes fairing less well, and those living in the most deprived conditions living shorter lives than they should, in poorer health.
Commenting, Sir Michael said: “The award is, of course, personally wonderful. More than that, the award says something very good about Britain. I believe in telling the truth about the problems in society. That has involved compiling and publishing the evidence on health inequalities, their link to the Social Determinants of Health, and the importance of the social gradient. Over decades, when the evidence has shown it to be necessary, I have been critical of government policy, particularly since 2010. Despite that criticism this award has been made. It is a recognition of the importance of truth and evidence in having a reasoned debate about the kind of society we want. Without the support of UCL, with its eminent global reputation, my job would have been much harder.”
Sir Michael chaired the World Health Organization’s Commission on the Social Determinants of Health in 2008, which firmly put health inequalities on the global public health map, heralding ‘social injustice is killing on a grand scale’ and demanded ‘Closing the Gap in a Generation’. The findings of the subsequent review of health inequalities across England, Fair Society, Healthy Lives, commissioned by the then government, chaired by Sir Michael, and published in 2010, became enshrined into British public health policy.
However, as Sir Michael explains: “Sadly, the government’s rhetoric never had a chance in reality because of the sheer brutality of a decade of austerity, which was ‘justified’ by government to get the public finances in order – as if that somehow justified poor people dying before their time. Public expenditure went from 42% of GDP in 2010 to 35% in 2018 – and being sharply regressive – it made poor people poorer and deprived those in need of services, markedly increasing health inequalities.”
Sir Michael’s damning 10 years on review of health inequalities, published in 2020, revealed the scale of the damage: for the first time in more than 100 years life expectancy stalled, and actually declined for the poorest 10% of women; the amount of time people spent in poor health had increased, health inequalities had indeed widened, and the north/south health gap expanded. The Covid pandemic was a second challenge to health equity. Nine months after the COVID-19 pandemic hit, Sir Michael’s updated review ‘Build Back Fairer’ reaffirmed the evidence. A decade of austerity, and an approach to government that put low priority on equity of health and well-being, left the UK ill-prepared for the pandemic. Health inequalities increased and people died unnecessarily.
Sir Michael concluded: “The cost-of-living crisis is a third challenge to health equity. We see it in the drama of public sector workers, after 12 years of pay cuts, striking so they have enough money to feed their children without resort to foodbanks. The poor in Britain are poorer than in most European countries. A policy of low pay for essential workers is not only bad for their health it defeats government wishes to grow the economy. As the IMF asserted in 2015, the way to economic growth (and reduce health inequalities) is not to expand incomes of the richest 20%, it is to expand the incomes of the poorest 60% of the population.”
In the UK, central government may have overlooked what needs to be done to advance health equity. But the UCL Institute of Health Equity continues to work closely with cities and regions, nationally and globally, to implement the policy findings laid out in Fair Society, Healthy Lives, and in the report of the Commission on Social Determinants of Health.
Sir Michael has formed a partnership with Legal and General to show how business can improve health and reduce inequalities with a three-fold strategy: good pay and conditions for employees, healthy products and services, and wider impact on the community and environment. One aim is to convince FTSE 100 companies to build on the UN-supported Principles for Responsible Investment (PRI) and include tackling health inequalities i.e., ESG should become ESHG (Environmental, Social, Health and corporate Governance). COVID-19 showed that a healthy workforce is a productive workforce, which requires investing in people, both while they’re at work, and in the locality in which they live. To that end UCL Institute of Health Equity is launching a UK-wide Heath Equity Network next month (24th January, 2023) to build momentum for action across the country.
Sir Michael has 20 honorary doctorates from universities and colleges across the world. He has numerous awards for his work in public health from leading organisations, including the Prince Mahidol Award, the Balzan Prize, the British Medical Journal’s ‘Outstanding Contribution to Health’ and he was designated a Global Health Leader by the WHO Director-General. He served as President of the British Medical Association 2010-11 and of the World Medical Association 2015-16. He has chaired several reviews for the World Health Organization, including across the Americas, Europe and the Eastern Mediterranean, as well as the global review in 2008.
Professor Sir Michael Marmot, CH, MBBS, MPH, PhD, FRCP, FFPHM, FMedSci, FBA, Director, UCL Institute of Health Equity, can be followed on Twitter. He is the author of The Health Gap: the challenge of an unequal world (Bloomsbury: 2015) and Status Syndrome: how your place on the social gradient directly affects your health (Bloomsbury: 2004).
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