MEDICAL CENTER REPORT
04/16/08
Health-care disparities aren't divided into 'haves' and 'have nots,' expert says
Instead, look at how much social inequalities count in shaping health status, Marmot counsels
BY RITA KENNEN
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Looking slightly wrinkled and a bit jet lagged, Sir Michael Marmot, PhD, MPH, sat on a small stage recently alongside Ralph Horwitz, MD, chair of the Department of Medicine, in the dining room at Schwab Residential Center on campus.
Marmot had traveled more than 5,000 miles to be a guest speaker April 8 for the department's symposium, "Medicine, Social Policy and the Public Trust." Acclaimed around the world for his research into health inequalities, he discussed the basis of his work for the last 30 years: how socio-economic issues affect the quality of health care throughout the world.
Marmot spoke to an audience gathered to hear about his concept of the "social gradient" of health. Within the social gradient, people of color and with lower incomes tend to be sicker and die younger than individuals or groups higher up on the ladder. He contrasted that spectrum of differences with the more conventional idea of two distinct groups of "haves" and "have nots."
"The idea that things are on a gradient actually shakes people out of their regular way of thinking, whether it's policy makers, economists, biologists or psychologists," said Marmot. "It's not whether you have it or you don't have it, it's how much you have it."
Research into the social determinants of health has drawn attention to the consequences of class- and race-based disparities in the quality of, and accessibility to, health care. Marmot's work indicates that the circumstances we are born into, and the situations we live and work in, deeply determine our susceptibility to illness as well as our life expectancy. It also explains why achieving good health is a complex issue. Evidence is accumulating that good health often depends on socio-economic factors such as years of education, type of job and community, in addition to the influence of good genes, healthy diet and exercise.
At Marmot's presentation, when one audience member asked if gender played a role, he said that the theory of a social gradient applied to both men and women. "Women with a higher education experience better health outcomes, he said. The gradient concept is also apparent in studies of older Americans. Marmot cited research that showed older people with higher economic status tend to struggle against the onset of health problems 15 years later than people with lower socio-economic status.
Recognized as a leading researcher in health inequalities, Marmot is chairman of the World Health Organization's committee on social determinants of health. He was knighted by the Queen of England in 2000 for his contributions to the fields of epidemiology and understanding health equalities.
Marmot was featured in the recent television documentary, "Unnatural Causes: Is inequality making us sick?" a Public Broadcasting Service program highlighting case studies of inequality in health care throughout the United States.
His visit to Stanford was sponsored by the Department of Medicine, the Haas Center for Public Service, Stanford Center on Ethics and the Stanford Center for the Study of Poverty and Inequality.
Rita Kennen is a public relations officer in the Department of Medicine.
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