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The Health Gap: The Challenge of an Unequal World

by Michael Marmot

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In a Baltimore inner-city neighborhood, a man's life expectancy is 63; in another neighborhood not far away, it's 83. The same 20-year avoidable disparity exists in nearby neighborhoods of cities around the world. In Sierra Leone, one in 21 fifteen-year-old women will die in her fertile years of a maternal-related cause; in Italy, the figure is one in 17,100; but in the United States, which spends more on healthcare than any other country in the world, it is one in 1,800. Why? Dramatic differences in health are not a simple matter of rich and poor; poverty alone doesn't drive ill health--inequality does. Suicide, heart disease, lung disease, obesity, and diabetes are all linked to social disadvantage. In every country, people at relative social disadvantage suffer health disadvantage and shorter lives. Within countries, the higher the social status of individuals, the better their health. Conventional approaches to improving health have emphasized access to technical solutions and changes in the behavior of individuals, but these methods only go so far. What really makes a difference is creating the conditions for people to have control over their lives. Author Marmot emphasizes that the rate of illness of a society as a whole determines how well it functions: the greater the health inequity, the greater the dysfunction. We have the tools and resources to improve levels of health for individuals and societies around the world, and not to do so would be a form of injustice. The Health Gap presents compelling evidence for a radical change in the way we think about health and indeed society, and inspires us to address the societal imbalances in power, money, and resources that work against health equity.--Adapted from book jacket.… (more)
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In a Baltimore inner-city neighborhood, a man's life expectancy is 63; in another neighborhood not far away, it's 83. The same 20-year avoidable disparity exists in nearby neighborhoods of cities around the world. In Sierra Leone, one in 21 fifteen-year-old women will die in her fertile years of a maternal-related cause; in Italy, the figure is one in 17,100; but in the United States, which spends more on healthcare than any other country in the world, it is one in 1,800. Why? Dramatic differences in health are not a simple matter of rich and poor; poverty alone doesn't drive ill health--inequality does. Suicide, heart disease, lung disease, obesity, and diabetes are all linked to social disadvantage. In every country, people at relative social disadvantage suffer health disadvantage and shorter lives. Within countries, the higher the social status of individuals, the better their health. Conventional approaches to improving health have emphasized access to technical solutions and changes in the behavior of individuals, but these methods only go so far. What really makes a difference is creating the conditions for people to have control over their lives. Author Marmot emphasizes that the rate of illness of a society as a whole determines how well it functions: the greater the health inequity, the greater the dysfunction. We have the tools and resources to improve levels of health for individuals and societies around the world, and not to do so would be a form of injustice. The Health Gap presents compelling evidence for a radical change in the way we think about health and indeed society, and inspires us to address the societal imbalances in power, money, and resources that work against health equity.--Adapted from book jacket.

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