Addressing health inequalities

27 September 2021

This year’s GGI Good Governance Award was presented to Sir Michael Marmot, Director at the UCL Institute of Health Equity, in recognition of his work on health inequalities and evidence-based decision making.

Before joining the UCL Institute of Health Equity, Sir Michael was a member of the Royal Commission Environmental Pollution before becoming chair of the Commission on Social Determinants of Health set up by the World Health Organisation in 2005.

He has also served as president of the World Medical Association and has authored several books including The Health Gap: The Challenge of an Unequal World (2005).

Sir Michael was presented his award at GGI’s annual lecture on 22 September by Nahida Abdulhamid, who joined GGI as a research and policy intern in July this year.

What follows is a transcript of Nahida’s speech, and Sir Michael’s reply.

Nahida Abdulhamid

"On behalf of GGI I would like to present this award to Sir Michael Marmot for his extensive and dedicated work on health inequalities and, most importantly, an evidence-based strategy to address the social determinants of health.

"We all know that health inequality is an intergenerational issue that needs solving. The solutions to health issues are not just about prescribing tablets and diet frameworks and whatever else the systems seem to be focusing on – or in fact blaming the individual. It goes beyond a clinical approach; it is about getting to the core causes of health issues, and this is exactly what Marmot does with his research: highlighting the many factors which affect or contribute to health inequalities. For example, the conditions in which people are born, grow, live, work and age.

"It is no surprise then, to come to the conclusion that the more deprived the area, the shorter your life expectancy. These social determinants are unfair and unjust – differences which are unacceptable to my generation and the coming generation. We are the future and if we want a thriving society then we definitely need thriving young healthy people!

"The UK prides itself as a wealthy, growing economy with high GDP, so why is it that poverty is increasing? This begs the question, what on earth is going on? Why are we not taking action?

"The government must do more to support our generation, push forward Sir Michael’s recommendations, create fair employment and good work for all, and ensure that the National Living Wage and welfare benefits are sufficient for everyone to afford a healthy lifestyle.

"If not now, when?

"So, I want to thank you, Sir Michael, not just for your profound research and solutions to health inequalities, but also for being a voice for humanity. I hope we can all switch on our Marmot brains and put pressure on the system to create conditions for people to take control of their own lives."

Sir Michael Marmot

"I want Nahida on my side. That was a brilliant summary of my work and a rousing call…it was just wonderful. The hairs stood up on my skin as she spoke. Thank you.

"I got to this issue of governance, in a way, indirectly because I start off as a researcher looking at the causes of inequalities of health. What I did was publish papers. Then I asked the question: what if they took this seriously. But then it occurred to me, maybe I should say what if we took it seriously? I chaired the World Health Organisation commission on social determinants of health, and we said, on the cover of our report, Closing the gap in a generation, ‘social injustice is killing on a grand scale’ – a bit unusual for a WHO report.

"While we were doing it, various people said to me: ‘Look, global health is about disease control: malaria, TB, HIV/AIDS’. And then they discovered primary healthcare, and that was it. And I was chairing a commission that was asking – exactly as you said, Nahida – ‘what about the conditions in which people are born, grow, live, work and age; inequities in power, money and resources that give rise to inequities in the conditions of daily life?’ So I was pushing global health to do things differently.

"After the WHO commission we’ve done commissions in the European region of WHO, in the Americas for the Pan American Health Organization, in the eastern Mediterranean, and then in Britain, of course. I was asked by Gordon Brown to translate the recommendations and findings of the global commission for England. And my Marmot Review: Fair Society Healthy Lives in 2010 and then the two reviews I did last year, Health Equity in England: The Marmot Review 10 Years On, documenting the rather miserable and disappointing health record over the last decade, and then Build Back Fairer, which gives, I’d like to think, a blueprint. If the government is serious about levelling up, we’ve told them what to do.

"But let me come back to the global commission. When I was chairing it, I told myself I would read Don Quixote – I hasten to add, in the English translation…930 pages of Spanish is beyond me – and it seems appropriate. Don Quixote wakes up and imagines himself to be a knight, running around doing chivalrous deeds, and everyone’s laughing at him. And that seemed pretty appropriate for what I was doing, chairing the commission: running around trying to make the world a better place, and I imagine that everyone was laughing at me. I said this to the Spanish minister for health and he said: ‘We need the idealism of Don Quixote the dreamer, but we also need the pragmatism of Sancho Panza.’

"So I would like you to dream with me about creating a fairer, more just world. Let’s take the practical steps necessary to achieve it.

"Thank you for this award."

Here to help