Sir-Michael-Marmot-Inaugural-Speech

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1
Inaugural
 Address
 as
 WMA
 President
 
Michael
 Marmot
 
Moscow
 
16
 September
 2015
 

 
Honoured
 Guests,
 Colleagues,
 

 
In
 May
 2011
 Mary
 hanged
 herself.
 
She
 was
 found
 in
 the
 yard
 of
 her
 grandparents’
 house
 on
 
a
 First
 Nations
 Reserve
 in
 the
 province
 of
 British
 Columbia
 in
 Canada.
 She
 was
 fourteen.
 She
 
was
 a
 First
 Nations,
 aboriginal,
 Canadian.
 

 
Her
 story
 has
 particulars.
 All
 suicides
 do.
 She
 had
 been
 physically
 and
 emotionally
 abused
 at
 
home
 and
 in
 her
 community,
 and
 possibly
 sexually
 abused.
 Her
 mother
 was
 mentally
 
unstable
 and
 heard
 voices
 telling
 her
 to
 ‘snap’
 her
 child’s
 head.
 Officials
 attributed
 the
 
suicide
 to
 a
 dysfunctional
 child
 welfare
 system,
 and
 to
 the
 fact
 that
 no
 one
 took
 her
 
complaints
 of
 abuse
 seriously
 or
 acted
 on
 them.
 

 
There
 is
 another
 way
 to
 look
 at
 Mary’s
 sadly
 foreshortened
 life,
 and
 that
 is
 to
 realise
 that
 
though
 her
 personal
 tragedy
 was
 unique,
 there
 are
 many
 young
 aboriginal
 Canadians
 who
 
experience
 similar
 tragedies.
 In
 fact,
 the
 aboriginal
 youth
 suicide
 rate
 in
 British
 Columbia
 is
 
five
 times
 the
 average
 for
 all
 young
 Canadians.
 
 One
 cannot
 understand
 fully
 why
 Mary
 saw
 
no
 way
 out
 without
 also
 asking
 why
 so
 many
 other
 young
 aboriginal
 people
 in
 British
 
Columbia
 reached
 the
 same
 desperate
 point.
 

 
The
 starting
 point
 is
 poverty,
 bone-­‐grinding
 poverty,
 low
 educational
 levels
 and
 high
 
unemployment.
 But
 there
 were
 about
 200
 bands
 of
 aborigines
 in
 British
 Columbia,
 more
 or
 
less
 all
 in
 poverty.
 Yet
 90%
 of
 the
 adolescent
 suicides
 occurred
 in
 12%
 of
 the
 bands.
 Why
 
 
some
 and
 not
 others?
 The
 difference
 was
 empowerment
 of
 communities.
 Empowered
 
communities
 participated
 in
 land
 claims;
 self-­‐government;
 had
 control
 over
 educational,
 
police
 and
 fire,
 and
 health
 services;
 and
 establishment
 of
 ‘cultural’
 facilities.
 The
 results
 
were
 clear:
 the
 greater
 the
 cultural
 continuity
 and
 community
 control
 over
 their
 destiny,
 the
 
lower
 was
 the
 youth
 suicide
 rate.
 Poverty
 is
 bad
 but
 poverty
 is
 not
 destiny.
 Empowerment
 of
 
communities
 can
 save
 lives.
 I
 draw
 similar
 lessons
 from
 studying
 the
 health
 of
 New
 Zealand
 
2
Maoris,
 Indigenous
 Australians,
 Native
 Americans
 or
 indeed
 that
 of
 excluded
 groups
 
elsewhere
 in
 the
 world.
 
-­‐-­‐-­‐
 

 
In
 January
 2010,
 Haiti’s
 earthquake
 wreaked
 havoc
 and
 200,000
 people
 died.
 Less
 than
 two
 
months
 later
 a
 quake
 500
 times
 stronger
 hit
 Chile
 and
 the
 death
 toll
 was
 in
 the
 hundreds.
 
Haiti
 was
 underprepared
 in
 every
 way
 imaginable.
 Chile
 was
 well
 prepared,
 with
 strict
 
building
 codes,
 well-­‐organised
 emergency
 responses
 and
 a
 long
 history
 of
 dealing
 with
 
earthquakes.
 True,
 the
 epicentre
 of
 the
 Haitian
 earthquake
 was
 closer
 to
 population
 centres
 
than
 that
 of
 the
 Chilean
 quake,
 but
 that
 was
 only
 part
 of
 the
 explanation
 for
 the
 different
 
scale
 of
 devastation.
 What
 turns
 a
 natural
 phenomenon
 into
 a
 disaster
 is
 the
 nature
 of
 
society.
 The
 number
 of
 people
 who
 died
 had
 more
 to
 do
 with
 Haiti’s
 lack
 of
 societal
 
readiness
 and
 response
 than
 with
 the
 strength
 of
 the
 quake.
 
-­‐-­‐-­‐
 

 
In
 2011
 the
 London
 borough
 of
 Tottenham
 broke
 out
 in
 urban
 riots.
 The
 precipitant
 was
 the
 
killing
 of
 a
 black
 man
 by
 police.
 But,
 unacceptable
 as
 that
 is,
 it
 was
 not
 the
 underlying
 cause.
 
Inequality
 was
 the
 culprit.
 I
 had
 been
 citing
 an
 area
 of
 Tottenham
 as
 having
 the
 worst
 male
 
life
 expectancy
 in
 London
 –
 18
 years
 fewer
 than
 in
 the
 best-­‐off
 area.
 All
 in
 one
 of
 the
 world’s
 
premier
 global
 cities.
 London
 now
 has
 more
 high-­‐end
 properties,
 a
 price
 tag
 more
 than
 
$5million,
 than
 Manhattan,
 Hong
 Kong,
 Singapore
 or
 Sydney.
 It
 is
 not
 surprising
 that
 the
 
riots
 broke
 out
 in
 the
 area
 with
 the
 worst
 health.
 Ill-­‐health
 does
 not
 cause
 riots.
 Nor
 do
 riots
 
cause
 ill-­‐health
 –
 at
 least
 not
 directly.
 Relative
 deprivation
 causes
 both
 urban
 unrest
 and
 ill-­‐
health.
 Ninety
 per
 cent
 of
 young
 people
 arrested
 in
 the
 riots
 were
 not
 in
 employment,
 
education
 or
 training.
 
 

 
Similarly,
 in
 Baltimore
 in
 the
 US.
 When
 a
 black
 man
 was
 killed
 in
 police
 custody
 riots
 broke
 
out.
 Not
 uniformly
 across
 the
 city,
 but
 in
 the
 area
 with
 condemned
 houses,
 low
 levels
 of
 
education
 and
 income
 and
 a
 twenty
 year
 disadvantage
 in
 life
 expectancy
 compared
 to
 the
 
area
 with
 leafy
 opulence.
 

 
Inequality
 strains
 the
 binds
 of
 a
 cohesive
 society.
 In
 Baltimore,
 those
 binds
 snapped.
 The
 
immediate
 effect
 is
 civil
 unrest.
 The
 longer
 term
 effects
 is
 health
 inequity.
 
-­‐-­‐-­‐
 
3

 
These
 examples
 illustrate
 that
 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.
 

 
There
 are
 three
 aspects
 of
 Mary’s
 tragedy
 worth
 emphasising.
 The
 first
 is
 the
 vital
 issue
 of
 
violence
 to
 girls
 and
 to
 women.
 It
 can
 be
 fatal,
 both
 because
 it
 drives
 women
 to
 suicide
 and
 
because
 they
 may
 be
 killed
 by
 their
 partners.
 Second,
 I
 emphasised
 empowerment
 
 of
 
communities.
 But
 empowerment
 of
 individuals
 is
 also
 of
 vital
 importance.
 A
 key
 route
 to
 
female
 empowerment,
 globally,
 is
 education.
 Evidence
 shows
 clearly:
 the
 greater
 the
 
education
 of
 women
 the
 less
 the
 likelihood
 of
 being
 subject
 to
 domestic
 violence.
 
 Third
 is
 
the
 importance
 of
 mental
 illness.
 Mental
 illness
 and
 substance
 use
 disorders
 constitute
 the
 
number
 one
 cause
 of
 years
 spent
 with
 disability,
 globally.
 We
 cannot
 be
 concerned
 with
 
health,
 globally
 and
 in
 our
 countries,
 and
 not
 be
 concerned
 with
 mental
 illness
 and
 
substance
 use.
 

 
More
 generally
 we
 need
 to
 recognise
 the
 importance
 of
 the
 mind
 to
 health
 equity.
 The
 mind
 
is
 the
 major
 gateway
 through
 which
 social
 determinants
 exert
 their
 effect
 on
 health.
 
Recognizing
 the
 importance
 of
 the
 mind
 takes
 us
 back
 to
 early
 child
 development
 and
 what
 I
 
have
 called:
 equity
 from
 the
 start.
 
 

 
In
 Aldous
 Huxley’s
 dystopia,
 Brave
 New
 World,
 there
 were
 five
 castes.
 The
 Alphas
 and
 Betas
 
were
 allowed
 to
 develop
 normally.
 The
 Gammas,
 Deltas,
 and
 Epsilons
 were
 treated
 with
 
chemicals
 to
 arrest
 their
 development
 intellectually
 and
 physically,
 progressively
 more
 
affected
 from
 Gamma
 to
 Epsilon.
 The
 result:
 a
 neatly
 stratified
 society
 with
 intellectual
 
function,
 and
 physical
 development,
 correlated
 with
 caste.
 
 
That
 was
 satire,
 wasn’t
 it?
 We
 would
 never,
 surely,
 tolerate
 a
 state
 of
 affairs
 that
 stratified
 
people,
 then
 made
 it
 harder
 for
 the
 lower
 orders,
 but
 helped
 the
 higher
 orders,
 to
 reach
 
their
 full
 potential.
 Were
 we
 to
 find
 a
 chemical
 in
 the
 water,
 or
 in
 food,
 that
 was
 damaging
 
children’s
 growth
 and
 their
 brains
 worldwide,
 and
 thus
 their
 intellectual
 development
 and
 
control
 of
 emotions,
 we
 would
 clamour
 for
 immediate
 action.
 Remove
 the
 chemical
 and
 
allow
 all
 our
 children
 to
 flourish,
 not
 only
 the
 Alphas
 and
 Betas.
 Stop
 the
 injustice
 now.
 
 
4
Yet,
 unwittingly
 perhaps,
 we
 do
 tolerate
 such
 an
 unjust
 state
 of
 affairs
 with
 seemingly
 little
 
clamour
 for
 change.
 The
 pollutant
 is
 called
 social
 disadvantage
 and
 it
 has
 profound
 effects
 
on
 developing
 brains
 and
 limits
 children’s
 intellectual
 and
 social
 development.
 Note,
 the
 
pollutant
 is
 not
 only
 poverty,
 but
 also
 social
 disadvantage.
 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.
 This
 
stratification
 in
 early
 child
 development,
 from
 Alpha
 to
 Epsilon,
 arises
 from
 inequality
 in
 
social
 circumstances.
 
 
This
 social
 gradient
 in
 children’s
 possibility
 to
 fulfil
 their
 potential,
 in
 its
 turn,
 has
 a
 profound
 
effect
 on
 children’s
 subsequent
 life
 chances.
 We
 see
 a
 social
 gradient
 in
 school
 performance
 
and
 adolescent
 health;
 a
 gradient
 in
 the
 likelihood
 of
 being
 a
 20
 year
 old
 not
 in
 employment,
 
education,
 or
 training;
 a
 gradient
 in
 stressful
 working
 conditions
 that
 damage
 mental
 and
 
physical
 health;
 a
 gradient
 in
 the
 quality
 of
 communities
 where
 people
 live
 and
 work;
 in
 
social
 conditions
 that
 affect
 older
 people;
 and,
 central
 to
 my
 concern,
 a
 social
 gradient
 in
 
adult
 health.
 A
 causal
 thread
 runs
 through
 these
 stages
 of
 the
 life
 course
 from
 early
 
childhood,
 through
 adulthood
 to
 older
 age
 and
 to
 inequalities
 in
 health.
 The
 best
 time
 to
 
start
 addressing
 inequalities
 in
 health
 is
 with
 equity
 from
 the
 start.
 But
 intervention
 at
 any
 
stage
 of
 the
 life
 course
 can
 make
 a
 difference.
 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
 can
 save
 lives.
 
The
 health
 gradient
 to
 which
 these
 life
 course
 influences
 give
 rise
 is
 dramatic.
 There
 is
 a
 
cottage
 industry,
 taking
 subway
 rides
 in
 various
 cities
 and
 showing
 how
 life
 expectancy
 
drops
 a
 year
 for
 each
 stop.
 I
 have
 referred
 to
 twenty
 year
 gaps
 in
 Baltimore
 and
 London;
 but
 
the
 health
 differences
 between
 rich
 and
 poor,
 dramatic
 as
 they
 are,
 are
 only
 part
 of
 the
 
problem.
 Commonly,
 people
 say
 to
 me:
 I
 am
 neither
 rich
 nor
 poor;
 what
 does
 any
 of
 this
 
have
 to
 do
 with
 me?
 The
 evidence
 shows
 that
 there
 is
 a
 social
 gradient
 in
 health
 that
 runs
 
from
 top
 to
 bottom
 of
 society.
 People
 in
 the
 middle
 have
 worse
 health
 than
 those
 above
 
them
 in
 the
 social
 hierarchy,
 but
 better
 than
 those
 below.
 We
 calculated
 for
 England
 that
 if
 
everyone
 enjoyed
 the
 same
 life
 expectancy
 as
 the
 top
 10%,
 based
 on
 education,
 there
 would
 
be
 202,000
 fewer
 deaths
 each
 year;
 over
 500
 a
 day.
 
 
One
 problem,
 then,
 is
 poverty.
 Another
 is
 inequality.
 Both
 damage
 health
 and
 lead
 to
 an
 
unjust
 distribution
 of
 health.
 
5
I
 have
 spent
 my
 research
 life
 showing
 that
 the
 key
 determinants
 of
 health
 lie
 outside
 the
 
health
 care
 system
 in
 the
 conditions
 in
 which
 people
 are
 born,
 grow,
 live,
 work
 and
 age;
 and
 
inequities
 in
 power,
 money
 and
 resources
 that
 give
 rise
 to
 these
 inequities
 in
 conditions
 of
 
daily
 life.
 Since
 the
 establishment
 of
 the
 WHO
 Commission
 on
 Social
 Determinants
 of
 Health
 
in
 2005,
 I
 have
 been
 using
 research
 knowledge
 to
 argue
 for
 policies
 on
 social
 determinants
 
of
 health.
 
Yet
 here
 I
 am,
 humbled
 by
 assuming
 office
 as
 President
 of
 the
 World
 Medical
 Association.
 Is
 
there
 not
 a
 contradiction?
 The
 World
 Medical
 Association,
 WMA,
 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.
 
 
The
 opening
 sentence
 of
 my
 recent
 book,
 The
 Health
 Gap:
 The
 Challenge
 of
 an
 Unequal
 
World,
 was:
 why
 treat
 people
 and
 send
 them
 back
 to
 the
 conditions
 that
 made
 them
 sick?
 
No
 one
 is
 as
 concerned
 about
 health
 and
 disease
 as
 we
 in
 the
 medical
 and
 other
 health
 
professions.
 It
 has
 been
 and
 will
 be
 my
 mission
 to
 encourage
 our
 concerns
 with
 the
 
conditions
 that
 make
 people
 sick.
 

 
I
 am
 hugely
 encouraged
 already.
 My
 friends
 in
 the
 Canadian
 Medical
 Association
 conducted
 
Town
 Hall
 meetings
 across
 Canada
 to
 engage
 the
 public
 in
 discussion
 on
 how
 the
 conditions
 
of
 their
 lives
 related
 to
 their
 health.
 The
 Canadian
 Medical
 Association
 then
 took
 the
 
initiative
 to
 suggest
 a
 meeting
 at
 BMA
 House
 in
 London.
 Twenty
 countries
 and
 200
 people
 
asked
 to
 come,
 including
 our
 now-­‐Chair
 of
 Council,
 Ardis
 Hoven,
 and
 then-­‐president,
 Xavier
 
Deau,
 and
 participated
 with
 enthusiasm.
 I
 apologise
 in
 advance:
 I
 already
 have
 more
 
invitations
 from
 medical
 colleagues,
 enthusiastic
 for
 the
 health
 equity
 agenda,
 than
 I
 could
 
possibly
 meet.
 We
 need
 a
 global
 social
 movement.
 

 
I
 have
 been
 arguing
 that
 we
 have
 the
 knowledge
 of
 what
 to
 do
 to
 act
 on
 social
 determinants
 
and
 health
 equity;
 we
 have
 the
 means.
 We
 need
 to
 ensure
 that
 we
 have
 the
 will.
 

 
Do
 we
 really
 have
 the
 means?
 Consider.
 What
 do
 the
 following
 have
 in
 common?
 
 

 
48
 million
 people
 of
 Tanzania
 
6
7
 million
 people
 of
 Paraguay
 
2
 million
 people
 of
 Latvia
 
top
 25
 US
 hedge
 fund
 managers
 

 
In
 2013
 each
 of
 these
 four
 groups
 had
 a
 total
 income
 of
 between
 $21
 and
 28
 billion.
 Imagine
 
with
 me
 something
 totally
 fanciful:
 that
 the
 25
 hedge
 fund
 managers
 gave
 up
 their
 income
 
for
 one
 year.
 It
 would
 double
 the
 income
 of
 Tanzania.
 The
 hedge
 fund
 managers
 wouldn’t
 
feel
 it,
 because
 they
 will
 earn
 an
 average
 of
 $1billion
 each
 the
 next
 year.
 I
 am
 not
 suggesting
 
for
 a
 moment
 that
 we
 simply
 pass
 the
 cash
 to
 individual
 Tanzanians.
 But
 think
 of
 the
 clean
 
water
 that
 could
 be
 piped,
 the
 schools
 that
 could
 be
 built,
 the
 nurses
 trained
 and
 employed.
 

 
There
 is
 a
 great
 deal
 of
 money
 sloshing
 about.
 Great
 inequality
 between
 countries
 stops
 the
 
money
 being
 spent
 in
 ways
 that
 would
 benefit
 the
 poor
 and
 the
 needy.
 

 
Suppose,
 though,
 that
 there
 was
 reluctance
 to
 see
 ourselves
 as
 part
 of
 a
 global
 community.
 
We
 would
 still
 have
 to
 address
 staggering
 levels
 of
 inequality
 of
 income
 and
 wealth
 within
 
countries.
 Here
 is
 an
 even
 more
 fanciful
 thought.
 Suppose
 that
 the
 hedge
 fund
 managers
 of
 
New
 York
 paid
 a
 third
 of
 their
 $24
 billion
 income
 in
 tax
 –
 unlikely
 I
 know
 –
 that
 money
 could
 
fund
 80,000
 New
 York
 schoolteachers.
 80,000.
 

 
What
 has
 this
 to
 do
 with
 doctors?
 At
 the
 meeting
 of
 National
 Medical
 Associations
 that
 we
 
held
 in
 London
 we
 heard
 inspiring
 examples
 of
 how
 doctors
 are
 already
 working
 with
 
communities
 to
 deal
 with
 the
 social
 causes
 of
 ill-­‐health.
 In
 India
 I
 was
 taken
 by
 medical
 
colleagues
 to
 a
 tribal
 area
 in
 Gujarat
 where
 the
 doctors
 are
 not
 only
 treating
 people
 who,
 
hitherto,
 had
 no
 access
 to
 health
 care,
 but
 are
 working
 with
 others
 in
 community
 
development
 and
 education
 to
 improve
 the
 conditions
 of
 daily
 life
 for
 marginalised
 people.
 
In
 Brazil,
 the
 social
 gradient
 in
 stunting
 of
 young
 children
 is
 becoming
 progressively
 flatter.
 
In
 Bangladesh
 and
 Peru
 inequalities
 in
 child
 mortality
 are
 decreasing.
 I
 am
 excited
 by
 the
 
interest
 generated
 in
 social
 determinants
 of
 health
 globally
 in
 every
 region
 of
 the
 world:
 
South
 Africa,
 Zambia,
 Morocco,
 Colombia,
 Cuba,
 Costa
 Rica,
 Panama,
 Surinam,
 Taiwan,
 
Sweden,
 Norway,
 Finland,
 Iceland
 and
 …
 I
 could
 go
 on.
 
 

 
Colleagues,
 we
 can
 make
 a
 difference
 to
 the
 causes
 of
 the
 causes
 of
 health
 equity,
 as
 part
 of
 
the
 practice
 of
 medicine.
 There
 is
 another
 we
 way
 we
 can
 make
 a
 difference,
 too.
 I
 do
 not
 go
 
7
for
 long
 without
 quoting
 the
 great
 German
 pathologist,
 Rudolf
 Virchow,
 who
 said
 that
 
“physicians
 are
 the
 natural
 attorneys
 of
 the
 poor”.
 
 We
 can,
 we
 do,
 we
 should
 speak
 up
 
about
 inequity
 in
 social
 conditions
 that
 damage
 the
 health
 of
 the
 populations
 that
 we
 serve.
 

 
It
 means
 too,
 that
 we
 should
 recognise
 and
 be
 vocal
 about
 any
 societal
 trends
 that
 are
 likely
 
to
 affect
 health
 equity:
 climate
 change,
 trade,
 financial
 crises.
 

 
I
 hold
 a
 Bernard
 Lown
 visiting
 professorship
 at
 Harvard.
 Bernard
 Lown,
 great
 cardiologist
 
and
 co-­‐founder
 of
 International
 Physicians
 for
 the
 Prevention
 of
 Nuclear
 War,
 said:
 never
 
whisper
 in
 the
 presence
 of
 wrong.
 Already
 WMA
 speaks
 up
 in
 a
 loud
 voice
 about
 the
 highest
 
ethical
 standards
 of
 our
 profession.
 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.
 Senator
 Robert
 
Kennedy
 in
 a
 famous
 speech
 criticised
 Gross
 National
 Product
 as
 a
 measure
 of
 social
 
progress.
 He
 said:
 

 

 the
 gross
 national
 product
 does
 not
 allow
 for
 the
 health
 of
 our
 children,
 the
 quality
 
of
 their
 education
 or
 the
 joy
 of
 their
 play.
 It
 does
 not
 include
 the
 beauty
 of
 our
 poetry
 or
 the
 
strength
 of
 our
 marriages,
 the
 intelligence
 of
 our
 public
 debate
 or
 the
 integrity
 of
 our
 public
 
officials.
 It
 measures
 neither
 our
 wit
 nor
 our
 courage,
 neither
 our
 wisdom
 nor
 our
 learning,
 
neither
 our
 compassion
 nor
 our
 devotion
 to
 our
 country,
 it
 measures
 everything
 in
 short,
 
except
 that
 which
 makes
 life
 worthwhile.
 

 
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
 
injustice
 in
 the
 world.
 Can
 we
 really
 be
 optimistic?
 Let
 me
 quote
 from
 Nobel
 Prize
 winning
 
poet
 Seamus
 Heaney:
 

 
History
 says,
 don’t
 hope
 
On
 this
 side
 of
 the
 grave.
 
8
But
 then,
 once
 in
 a
 lifetime
 
The
 longed-­‐for
 tidal
 wave
 
Of
 justice
 can
 rise
 up,
 
And
 hope
 and
 history
 rhyme.
 

 
So
 hope
 for
 a
 great
 sea-­‐change
 
On
 the
 far
 side
 of
 revenge.
 
Believe
 that
 further
 shore
 
Is
 reachable
 from
 here.
 
Believe
 in
 miracle
 
And
 cures
 and
 healing
 wells.
 

 
I
 have
 had
 much
 reason
 to
 praise
 our
 medical
 students
 at
 the
 IFMSA,
 and
 our
 junior
 doctors.
 
In
 the
 spirit
 of
 Heaney
 I
 say
 to
 our
 younger
 colleagues:
 believe
 in
 miracle
 and
 cures
 and
 
healing
 wells
 not
 just
 for
 our
 patients
 but
 for
 society,
 too.
 
 

 
If
 this
 sounds
 idealistic
 I
 remember
 the
 words
 of
 Halfdan
 Mahler,
 former
 Director-­‐General
 of
 
WHO,
 who
 said
 when
 we
 published
 the
 report
 of
 the
 Commission
 on
 Social
 Determinants
 of
 
Health:
 remember,
 idealists
 are
 the
 realists
 in
 human
 progress.
 

 
I
 have
 another
 poet
 who
 has
 been
 my
 companion.
 When
 we
 launched
 the
 Commission
 on
 
Social
 Determinants
 of
 Health
 in
 Santiago
 Chile
 I
 quoted
 Pablo
 Neruda.
 I
 did
 again
 at
 each
 
report
 we
 have
 published
 and
 I
 do
 so
 again
 now.
 I
 invite
 you
 to:
 
Rise
 up
 with
 me…
 
Against
 the
 organisation
 of
 misery.