The Health Gap: The Challenge of an Unequal World by Michael Marmot (Bloomsbury) gives a vivid account of how social determinants of health impact the overall growth of a country. Marmot would like his readers, especially the policy makers, to realise the urgent need to move away from transactional technical solutions and look for a radical change in healthcare. He very ably brings forth some incredibly alarming facts across the world that should make the readers rethink conventional approaches for ‘social medicine’.
Social disadvantages are relative irrespective of economic status. Both poor and rich are prone to suicides, diseases, diabetes, drug addiction, etc., that have a direct bearing on health. The book talks about rich countries that now have clean water and safe toilets experiencing ill-health as a result of their own over indulgent behaviour vis-a-vis smoking, alcohol, and food that leads to obesity inferring that the same is passed as genetic hierarchy. For poor or rather struggling countries ill-health is result of unsanitary living conditions that affect healthcare.
The author, while explaining why health and disease are distributed unequally, carefully picks social causes across various communities. He is seen connecting limited conventional wisdom, reasons for cohesive living as protective against heart diseases and illustrates his experiment by drawing comparisons within the Japanese race as per geographical spread and immigration. Marmot, a professor of Epidemiology and Public Health at University College London, skilfully weaves lifestyle diseases and emotional distress at the helm of disease causing conditions, laying emphasis on physical as well as underlying or metaphysical social needs of a populace.
Vagaries of social gradients is explained through samples and experiments from Egypt, US, Mexico, Russia, Europe, Africa and other countries with not an authoritative tone but that of concern demonstrating the author’s deep involvement with his subject. His narration changes from fact-sharing to advocating and finally that of demanding comprehensive thoughts from readers as per impending healthcare pressures.
He says that relative inequality in income translates into absolute inequalities in capabilities, one’s freedom to be and to do. It is not only how much money one has that matters for health but what can one do with what one has which will result in where one can be. The book shows evidence that too much inequality of wealth damages social cohesion, likely to increase crimes.
Marmot’s views are certainly unique and presented in a very persuasive manner to underline the graveness of the truth the health status across the world holds. The author is fearless when owing to improved life expectancy he states we live in best of the times and he is stoic when he mentions the times as worst because of stark inequalities. He talks at length about building resilient communities and hope. Gandhi’s talisman is a philosophical break he takes and at the end he urges nations poor, developing or developed to do something, more and better. His focus remains on creating conditions for people to thrive and flourish through empowerment.
