- With me right now
is Sir Michael Marmot
with the University
College London.
Thank you so much
for being here.
- Pleasure.
- I know your work
focuses really
on the social
determinants of health
and I guess my question is, why
do we need to focus on that?
- We know that when
people get sick,
they need access to a
high-quality healthcare system.
The social determinants
of health is addressing
the question
of why people get sick
in the first place
and that ill health
and particularly
inequalities in health
are not simply due to lack
of access to healthcare.
They're due to the conditions
in which people are born,
grow, live and work, and age
and inequity and power,
money and resources
that give rise to inequities
in the conditions of daily life.
And that's what I mean by the
social determinants of health
and we should address
them because they are
the fundamental drivers
of inequalities in health
and setting it right is a
matter of social justice.
People make the argument,
no government will
take you seriously
unless you can make
the economic case.
It'll save money.
Maybe, but that's not my case.
My case is one of
social justice.
- Considering that
health inequity is
such a great problem,
how do we address
that specifically?
- I've spent a
lot of time trying
to bring together the
evidence on what we can do.
The evidence is key because
we can make lots of mistakes
just proceeding
with good intentions
so the evidence is
absolutely essential
and we need to take action
through the life course.
In my English review
of social determinants,
I had six domains:
early child
development, education,
employment and
working conditions,
minimum income, everyone
in a rich society
should at least have
the minimum necessary
for a healthy life.
The fifth one is healthy
and sustainable places
to live and work
and the sixth is
what I call taking
a social determinants
approach to prevention.
- You talk about
equity and equality.
You use both of those words.
A lot of people use
them interchangeably
but you say it's important
to differentiate.
- Well, so firstly you notice
I don't use the word disparity
which tends to be used in the
US for a variety of reasons.
I think, equality
frightened the horses a bit.
Equality doesn't fit
with the US model
of doing things very well.
The way I use the words,
the systematic inequalities
in health between social groups
that are judged to be
avoidable, by reasonable means,
and are not avoided are
unfair, hence inequitable.
So, inequity refers
to those inequalities
that are judged to be
avoidable by reasonable means
and are not avoided.
And that's why the overriding
purpose is social justice
to set right these
inequities in health.
- Okay.
Thank you very much.
- My pleasure.
(people talking)
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