The Health Gap: The Challenge of an Unequal World

Citation

Woody Caan (2016), "The Health Gap: The Challenge of an Unequal World", Journal of Public Mental Health, Vol. 15 No. 2, pp. 116-116. https://doi.org/10.1108/JPMH-01-2016-0002

This book looks in depth at one of the most challenging areas of health policy. Widening economic inequalities both within and between countries threaten the health and stability of humanity. At the moment in the UK (and many other places) policy-makers prefer to look the other way, rather than address this avoidable cause of illness and strife.

A public health book that is both inspiring and entertaining is a rare thing indeed. In The Health Gap, Professor Marmot looks back on a long career in medicine, spanning different countries and professional roles (he currently leads the World Medical Association). A unique feature of Marmot’s reflections is that he gives both international policy-makers and grass roots stakeholders a voice. This level of detail makes for quite a long book, but potential readers can gain an appetiser for his views in a short Lancet paper (Marmot, 2015). Readers who just want to dip into the book will find it well indexed, with over a dozen examples related to mental health. A more thorough read will be rewarded with insights not found in textbooks on public health, such as introducing the concept of “dignity” from the World Development Report, just before detailing the global burden of disease. In one sentence he captures the distinction between health inequalities and inequities: “Because if people are suffering from ill-health in ways that could be remedied but are not, that is quite simply unjust”.

Readers who are not used to the English style of humour may be puzzled by some of Marmot’s writing. A simple example is: “I was about to drink and drive and have unsafe sex and then, just in time, I remembered the Chief Medical Officer’s advice”. There is a rich vein of humour running through this book.

Among world-wide readers, Americans in particular who are not familiar with the social gradient in health may benefit from Marmot’s discussion of “Don’t people have poor health because they don’t have health care?”. Today many readers in high income countries may be unaware of the past history of inequalities characterised by a dominance of inherited wealth. Marmot discusses the health implications of Thomas Piketty’s Capital in the Twenty-First Century shortly before giving evidence that increasing “generosity” in a country’s social expenditure reduces poor health right across its social gradient. The book covers the whole life course, e.g. the effects of adversity in childhood, low pay in adulthood, and age-friendly cities. My favourite content related to “building resilient communities”. Indigenous voices from the Australia, Canada and New Zealand contribute to a truly “World” view, and some views (e.g. around women in Bangladesh’s garment industry) offer a fresh perspective. The final chapter is entitled The Organisation of Hope.