Michael Marmot

Terveyskuilu muuttaa radikaalisti käsityksiämme siitä, mikä kaikki vaikuttaa uuden tutkimustiedon perusteella ihmisten terveyteen. Kun uusi sotekierros alkaa ja asiaa puidaan taas päivittäin tiedotusvälineissä, on kirja välttämätöntä luettavaa kaikille, jotka ovat kiinnostuneita, mihin suuntaan Suomen terveydenhuoltoa ja sosiaaliturvaa viedään. Kirja on myös tärkeä varoitus, mitä voi tapahtua jos Suomen terveys- ja sosiaalihuoltoa muutetaan Britannian ja Yhdysvaltojen suuntaan. Glasgow'ssa köyhimpien asuinalueiden miehet kuolevat keskimäärin 28 vuotta nuorempina kuin varakkaimpien kaupunginosien miespuoliset asukkaat. Yhdysvaltalaiset käyttävät terveydenhuoltoonsa yli kaksi kertaa enemmän varoja kuin suomalaiset, mutta saavat tällä rahalla WHO:n mukaan vasta maailman 63. parhaan terveydenhuoltojärjestelmän.

'Punchily written … He leaves the reader with a sense of the gross injustice of a world where health outcomes are so unevenly distributed' Times Literary Supplement'Splendid and necessary' Henry Marsh, author of Do No Harm, New StatesmanThere are dramatic differences in health between countries and within countries. But this is not a simple matter of rich and poor. A poor man in Glasgow is rich compared to the average Indian, but the Glaswegian’s life expectancy is 8 years shorter. The Indian is dying of infectious disease linked to his poverty; the Glaswegian of violent death, suicide, heart disease linked to a rich country’s version of disadvantage. In all countries, people at relative social disadvantage suffer health disadvantage, dramatically so. Within countries, the higher the social status of individuals the better is their health. These health inequalities defy usual explanations. Conventional approaches to improving health have emphasised access to technical solutions – improved medical care, sanitation, and control of disease vectors; or behaviours – smoking, drinking – obesity, linked to diabetes, heart disease and cancer. These approaches only go so far. Creating the conditions for people to lead flourishing lives, and thus empowering individuals and communities, is key to reduction of health inequalities. In addition to the scale of material success, your position in the social hierarchy also directly affects your health, the higher you are on the social scale, the longer you will live and the better your health will be. As people change rank, so their health risk changes. What makes these health inequalities unjust is that evidence from round the world shows we know what to do to make them smaller. This new evidence is compelling. It has the potential to change radically the way we think about health, and indeed society.

In this groundbreaking book, Michael Marmot, president of the World Medical Association, reveals social injustice to be the greatest threat to global health In Baltimore's inner-city neighborhood of Upton/Druid Heights, a man's life expectancy is sixty-three; not far away, in the Greater Roland Park/Poplar neighborhood, life expectancy is eighty-three. The same twenty-year avoidable disparity exists in the Calton and Lenzie neighborhoods of Glasgow, and in other cities around the world. In Sierra Leone, one in 21 fifteen-year-old women will die in her fertile years of a maternal-related cause; in Italy, the figure is one in 17,100; but in the United States, which spends more on healthcare than any other country in the world, it is one in 1,800 (and now, with the new administration chipping away at Obamacare, the statistics stand to grow even more devastating). Why? Dramatic differences in health are not a simple matter of rich and poor; poverty alone doesn't drive ill health, but inequality does. Indeed, suicide, heart disease, lung disease, obesity, and diabetes, for example, are all linked to social disadvantage. In every country, people at relative social disadvantage suffer health disadvantage and shorter lives. Within countries, the higher the social status of individuals, the better their health. These health inequalities defy the usual explanations. Conventional approaches to improving health have emphasized access to technical solutions and changes in the behavior of individuals, but these methods only go so far. What really makes a difference is creating the conditions for people to have control over their lives, to have the power to live as they want. Empowerment is the key to reducing health inequality and thereby improving the health of everyone. Marmot emphasizes that the rate of illness of a society as a whole determines how well it functions; the greater the health inequity, the greater the dysfunction. Marmot underscores that we have the tools and resources materially to improve levels of health for individuals and societies around the world, and that to not do so would be a form of injustice. Citing powerful examples and startling statistics ("young men in the U. S. have less chance of surviving to sixty than young men in forty-nine other countries"), The Health Gap presents compelling evidence for a radical change in the way we think about health and indeed society, and inspires us to address the societal imbalances in power, money, and resources that work against health equity.

Why do Oscar winners live for an average of four years longer than other Hollywood actors? Who experiences the most stress - the decision-makers or those who carry out their orders? Why do the Japanese have better health than other rich populations, and Keralans in India have better health than other poor populations - and what do they have in common? In this eye-opening book, internationally renowned epidemiologist Michael Marmot sets out to answer these and many other fascinating questions in order to understand the relationship between where we stand in the social hierarchy and our health and longevity. It is based on more than thirty years of front-line research between health and social circumstances. Marmot's work has taken him round the world showing the similar patterns that could be affecting the length of your life - and how you can change it.

Social factors have a powerful influence on human health and longevity. Yet the social dimensions of health are often obscured in public discussions due to the overwhelming focus in health policy on medical care, individual-level risk factor research, and changing individual behaviours. Likewise, in philosophical approaches to health and social justice, the debates have largely focused on rationing problems in health care and on personal responsibility. However, a range of events over the past two decades such as the study of modern famines, the global experience of HIV/AIDS, the international women’s health movement, and the flourishing of social epidemiological research have drawn attention to the robust relationship between health and broad social arrangements. In Health Justice, Sridhar Venkatapuram takes up the problem of identifying what claims individuals have in regard to their health in modern societies and the globalized world. Recognizing the social bases of health and longevity, Venkatapuram extends the ‘Capabilities Approach’ of Amartya Sen and Martha Nussbaum into the domain of health and health sciences. In so doing, he formulates an inter-disciplinary argument that draws on the natural and social sciences as well as debates around social justice to argue for every human being’s moral entitlement to a capability to be healthy. An ambitious integration of the health sciences and the Capabilities Approach, Health Justice aims to provide a concrete ethical grounding for the human right to health, while advancing the field of health policy and placing health at the centre of social justice theory. With a foreword by Sir Michael Marmot, chair of the WHO Commission on the Social Determinants of Health.

Social factors have a powerful influence on human health and longevity. Yet the social dimensions of health are often obscured in public discussions due to the overwhelming focus in health policy on medical care, individual-level risk factor research, and changing individual behaviours. Likewise, in philosophical approaches to health and social justice, the debates have largely focused on rationing problems in health care and on personal responsibility. However, a range of events over the past two decades such as the study of modern famines, the global experience of HIV/AIDS, the international women’s health movement, and the flourishing of social epidemiological research have drawn attention to the robust relationship between health and broad social arrangements. In Health Justice, Sridhar Venkatapuram takes up the problem of identifying what claims individuals have in regard to their health in modern societies and the globalized world. Recognizing the social bases of health and longevity, Venkatapuram extends the ‘Capabilities Approach’ of Amartya Sen and Martha Nussbaum into the domain of health and health sciences. In so doing, he formulates an inter-disciplinary argument that draws on the natural and social sciences as well as debates around social justice to argue for every human being’s moral entitlement to a capability to be healthy. An ambitious integration of the health sciences and the Capabilities Approach, Health Justice aims to provide a concrete ethical grounding for the human right to health, while advancing the field of health policy and placing health at the centre of social justice theory. With a foreword by Sir Michael Marmot, chair of the WHO Commission on the Social Determinants of Health.

The Science of Occupational Health is an evidence-based resource for all members of the health care team working with those affected by work-based stress - whether individuals suffering physical or psychological symptoms, or organizations trying to provide optimum conditions for healthy and productive employees. The authors offer a unique psychobiological perspective, discussing the modern workplace as a cause of stimulation and well-being, as well as of distress and illness. They provide a rigorous but highly accessible scientific account of the effects that stress has on mind and body, with key chapters on 'Responses to Stress', 'Stress-Related Health Problems', and 'Stress Hormones at Work'. This book offers the reader practical guidance on health promotion and preventive strategies at both individual and organizational levels. It concludes with a discussion of present occupational conditions around the world, and predictions of likely trends in the future.

Gener, livsstil och tillgång till sjukvård är viktiga för hälsan, men andra faktorer spelar många gånger en ännu större roll, nämligen hur vi lever vårt liv i samhället och hur vi har det på arbetet. Michael Marmot undersöker här sambandet mellan status och hälsa – statussyndromet – och belyser betydelsen av bland annat utbildning, inkomst, föräldrabakgrund och yrke. Utifrån nära tre årtionden av forskning lägger han fram häpnadsväckande bevis för hur subtila skillnader i social position kan leda till viktiga skillnader i hälsa och livslängd, beroende på olika möjligheter att ha kontroll över sitt liv och vara socialt engagerad. Statussyndromet handlar inte om sjukdom för de fattiga och god hälsa för alla andra, utan den handlar om en kontinuerlig variation, en hälsogradient. Redan på 1970-talet började författaren studera de noggrant skiktade brittiska statstjänstemännen i de berömda Whitehallstudierna och fann att sjukdomsfrekvensen ökade ju längre ner man kom på den sociala stegen. Samma företeelse har visat sig finnas runtom i världen, inklusive Sverige. Marmot tar med läsaren på en resa i Europa, till USA och till många fjärran platser när han, varvat med levandegörande exempel och anekdoter, presenterar rikligt med internationell forskning. I boken granskas befolkningar vars hälsa är hårt drabbad, i synnerhet i de tidigare kommunistländerna i Central- och Östeuropa. Här undersöks också befolkningar vars hälsa är anmärkningsvärt god, framför allt den japanska, men också relativt fattiga befolkningar vars goda hälsa tycks strida mot deras brist på pengar, som t.ex. i den indiska delstaten Kerala. Ett av budskapen är att över en viss nivå av resurser är det vad människor har i jämförelse med andra som är avgörande för hälsan. Betydelsen av pengar, relativ position och makt utforskas. Ett slående exempel är att Oscarsvinnande skådespelare lever i genomsnitt fyra år längre än kollegerna som ”bara” nominerats. Stödjande relationer i den privata sfären och graden av tillit och social sammanhållning i samhället är centrala dimensioner för hälsan, men samhällen varierar i hög grad i fråga om hur de uppmuntrar den typ av relationer som kan skydda mot sjukdom. Eftersom människor är olika kommer det alltid att finnas ojämlikheter, men omfattningen av deras effekter på hälsan går att kontrollera, skriver Marmot. Med denna fängslande bok ger han kunskapsunderlag för handling som leder till bättre hälsa för alla och samtidigt minskade skillnader. Boken innehåller ett efterord av Töres Theorell, professor i psykosocial medicin vid Karolinska Institutet och tidigare föreståndare för Institutet för Psykosocial Medicin. Michael Marmot är en forskare i världsklass som skriver djupsinnigt om liv och död med elegansen hos en essäist i världsklass. Denna betydelsefulla nya bok .../ visar hur skadligt det kan vara med ojämlikhet, hierarki och social isolering. Alla som engagerar sig i vårt samhälles hälsa bör läsa den här boken. Robert D. Putnam, författare till Den ensamme bowlaren och Better together. Översättning Göran Grip

"Bold, important and masterful . . . Marmot's message is not just timely, it's urgent." -The Washington Post Book WorldYou probably didn't realize that when you graduate from college you increase your lifespan, or that your co-worker who has a slightly better job is more likely to live a healthier life. In this groundbreaking book, epidemiologist Michael Marmot marshals evidence from nearly thirty years of research to demonstrate that status is not a footnote to the causes of ill health-it is the cause. He calls this effect the status syndrome. The status syndrome is pervasive. It determines the chances that you will succumb to heart disease, stroke, cancers, infectious diseases, even suicide and homicide. And the issue, as Marmot shows, is not simply one of income or lifestyle. It is the psychological experience of inequality-how much control you have over your life and the opportunities you have for full social participation-that has a profound effect on your health. The Status Syndrome will utterly change the way we think about health, society, and how we live our lives.