World Physicians Urged To Speak Up About Health Inequity

(16.10.2015) A rallying call to physicians of the world to speak up about inequality and the causes of ill health was delivered today (Friday) by Sir Michael Marmot in his inaugural speech as the new President of the World Medical Association.

Speaking at the WMA General Assembly in Moscow, Sir Michael, Director of the Institute of Health Equity at UCL, University of London, said he had spent his research life showing that the key determinants of health lay outside the health care system in the conditions in which people were born, grow, live, work and age and showing that inequities in power, money and resources gave rise to the inequities in conditions of daily life.

‘The way we organise our affairs, at the community level or, indeed at the whole societal level, are matters of life and death. As doctors we cannot stand idly by while our patients suffer from the way our societies are organised. Inequality of social and economic conditions is at the heart of it.'

Now, Sir Michael wanted the world's doctors to get involved. He said: ‘The World Medical Association upholds the highest ethical standards of the practice of medicine. It speaks out fearlessly when the right of doctors to pursue their noble calling is threatened. As President, I want the WMA to use the same moral clarity to be active against the causes of ill-health and what I call the causes of the causes - the social determinants of health.'

In his speech to delegates from more than 50 national medical associations, Sir Michael declared: ‘We can, we do and we should speak up about inequity in social conditions that damage the health of the populations that we serve.

‘We should not whisper at the gross inequities in the world that give rise to health inequities. In fact, so close is the link between social conditions and health that, I argue, health equity is a good measure of social progress; much better than income growth. Health and health equity are not only worthwhile in themselves but they reflect much else that makes life worthwhile: the freedom to lead lives we have reason to value. As doctors, at our best, we flourish in the cause of social justice.' 

There is a great deal of money sloshing about. But great inequality between and within countries stops the money being spent in ways that benefit the poor and the needy. Sir Michael illustrated his point by saying that if the top 25 US hedge fund managers gave up their combined income for one year, around $23 billion, it would double the income of Tanzania.

The best time to start addressing health inequities is with equity from the start - good early child development across society. But intervention at any stage of the life course could make a difference. Enabling young people to become employed, relieving adult poverty, paying a living wage, reduction in fuel poverty, improving working conditions, improving neighbourhoods, and taking steps to reduce social isolation in older people saves lives.

Referring to the stratification of early child development Sir Michael said: ‘If this were caused by a chemical in food or water, we would clamour for its removal. Stop the injustice now. Unwittingly perhaps, we tolerate such an unjust state of affairs with seemingly little clamour for change. The pollutant is not only poverty, but also social disadvantage. It has profound effects on developing brains and limits children's intellectual and social development. There is a clear social gradient in intellectual, social, and emotional development—the higher the social position of families the more do children flourish and the better they score on all development measures.' 

Sir Michael highlighted the issue of domestic violence. He said that empowerment of women through education was key to prevention. He added: ‘Evidence shows clearly: the greater the education of women the less the likelihood of being subject to domestic violence.' 

Sir Michael said that there is a great deal of injustice in the world, but he was optimistic that we can make a difference.

Full text of speech, please click here.