Dinner at WMA GA Moscow – Speech

My heart is full. On inauguration as WMA President, my speech (see elsewhere) invited National Medical Associations and individual doctors to rise to the challenge of health equity. I talked inequality of social and economic conditions damaging health and said that, at our best, doctors flourished in the cause of social justice. That evening, as I wandered around at the informal dinner chatting to people, the representative from Trinidad and Tobago said to me: you look like you are ready to dance.

“Not dance,” I said, “I’m floating; floating on a sea of well-being”. The question had been whether doctors would think that a message of social determinants was relevant to them. Yet, so many of the representatives here in Moscow have expressed their enthusiasm. The Danish Medical Association says that it is about to release a policy report that will deal with social determinants of health. They said that they had a Danish Marmot Review – Finn Diderichsen’s report – but now the doctors want concrete policy development. The Bolivians wanted to know how I could help. Colombia, Mexico, Costa Rica, Uruguay, Brazil, Argentina, Chile, Nigeria, South Africa, Trinidad and Tobago – all expressing enthusiasm. CMAAO, the Asian Network, wants us to work together. Alabania, India…it goes on.

The doctor from IPPNW had tears in his eyes because both in my inaugural address and at the informal dinner I had mentioned Bernard Lown. The first time was to quote his “never whisper in the presence of wrong”. The second was to say that working in the cause of health unites us, whatever the politics of our countries, or whether our leaders are locked in conflict. I cited the example of IPPNW and working for peace. At the height of the Cold War, two great cardiologists, Bernard Lown from the USA and Dr Chazov from USSR co-founded International Physicians for Prevention of Nuclear War. Building on their shining example, we should have a global movement of Doctors for Health Equity.

After the informal dinner a dozen doctors from Confemel, the Latin American network of Medical Associations, kidnapped me ‘just for five minutes’. At the end of a lively 55 minutes we celebrated our commitment with a little Tequila. I said that we were going to conduct a review of social determinants and health equity in the Americas and wanted to involve the Medical Associations. I in no way counted myself as knowledgeable about Latin America but in the last few years I had visited Brazil, Argentina, Uruguay, Chile, Peru, Colombia, Ecuador, Cuba, Costa Rica and Mexico, as well as the US and Canada. And next week I was going to Suriname. We agreed to explore how to work together and to meet in Buenos Aires in April, if not before.

My heart is full, and my diary overflowing.

I noted for our hosts from the Russian Medical Society, the importance of the great Russian authors for all of us. I said that in a recent profile in the BMJ, I had divided my life into three: before, during, and after reading Tolstoy’s War and Peace. I had a second reason for drawing attention to Tolstoy and that was Isaiah Berlin’s famous essay: The Hedgehog and the Fox. Berlin begins the essay by quoting the Greek poet Archilocus: the fox knows many things but the hedgehog knows one big thing. Berlin thought Dostoevsky was a hedgehog and Tolstoy a fox. Given my obsession with social determinants of health, was I a hedgehog? But in my book, The Health Gap, drawing on our various reports, I emphasise that improvement in health equity requires action through the life course from early child development through to older age. Action can also take place at the level of individuals, communities, governments local and national, and the planet. To keep up with the evidence on that array of possibilities, and changing when the evidence base changes, means being rather fox-like. A hedgehog with fox-like qualities is to follow in the tradition of Berlin’s estimation of Tolstoy’s view of history. Forgive this oversimplification, but Tolstoy, in his musings about theorise of history explores the question of how much influence the individual has, even Napoleon, as against the grand historical sweep. The question of free-will against determinism has resonance in public health. Are individuals the architects of their own poverty and ill-health? Or is it determined by stronger social conditions? It is a terrain worth re-visiting.

The hospitality of the Russian Medical Society and the experience of being in city whose dramatic history is embodied in its astonishingly varied architecture was a fitting backdrop for some big debates appropriate to the WMA.

*His inaugural speech in full text can be found here and his blog.

Sir Michael Marmot

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