“What good does it do to treat people and send them back to the conditions that made them sick?”
This is the question Sir Michael Marmot, Professor of Epidemiology and Public Health at University College London, said he asks himself repeatedly, during a speech he recently gave at Wits University regarding why health is not simply a matter of access to medical care.
Sir Michael is an expert in health and inequality, and says that as societies around the world become more unequal, the gap between levels of health widens.
“Social injustice is the biggest threat to global health and a radical change in society is needed if we really want people to live long healthy lives,” he added
The Professor, who has conducted research on health inequalities in communities across the world, compared a boy growing up in the affluent suburb of Greater Roland Park in Baltimore, United States to one growing up in the Upton Druid Heights neighbourhood in Baltimore’s inner city.
Even though they grew up a mere few kilometres apart, according to Marmot the boy from Roland Park can expect to live to the age of 83 whereas the one living in the inner city, will likely die 20 years earlier at the age of 63.
Reasons for Gap in Life Expectancies
“The conditions in which we live, early childhood development, income and education – these all predict how healthy we are and how long we will live,” says Marmot.
According to Marmot, only 10% of residents in Upton Druid Heights start tertiary education, while 75% of those living in Roland Park complete college. Virtually all children living in the suburb can read well by Grade 3, whereas less than 50% of children in the inner city can read proficiently by the same age.
There were 100 non-fatal shootings for every 10,000 residents, and nearly forty homicides in Upton Druid between 2005 and 2009, and zero non-fatal shootings in Roland Park during the same period.
The average annual household income in the city is $17,000 whereas Roland Park residents have a median income of $90,000 – more than 5 times higher.
Radical Change Needed in Society – South Africa Most Unequal
Professor Marmot argues that we need radical change in our societies; governments MUST invest aggressively in education and reduce the gap between the rich and the poor.
According to the International Monetary Fund (IMF) and the World Bank, South Africa is the most unequal country in the world. According to the IMF, 10% of the population earn around 60% of all income, compared to only 20 to 35 percent in more advanced economies.
Inequality is measured by the Gini Coefficient – a percentage estimate where zero represents perfect equality and 100 represents perfect inequality.
South Africa has the highest level of inequality in the world @ just over 63% – according to World Bank estimates, countries like Sweden and Norway have Gini Coefficients of 27% and 25% respectively.
What matters is not how wealthy a country is, but that the wealth is more evenly spread. The US is one of the wealthiest countries in the world, yet has some of the worst health outcomes because inequality is so rife, according to Marmot:
“Go into a typical American school and count one hundred boys aged fifteen. Thirteen of you will fail to reach your sixtieth birthday,” he says. “The US risk is double the Swedish risk, which is less than seven.”
Education over Military
Even though Costa Rica is not a wealthy nation, life expectancy is high, about 80 years in 2012; inequality is lower, quality education is accessible and the country’s decision to abolish its military in 1948 has freed up resources to invest in public amenities.
According to Marmot, the money and resources saved by not having to fund an army have instead been invested in education, for example, and decades later the health of Costa Ricans has improved dramatically.
Virtually every child aged three to five in Costa Rica attended pre-school in 2007, as compared to around 20% in many other South American countries. Ensuring children are educated and protected from abuse can radically change their prospects.
Inequality & Abuse
In England, argues Marmot, preventing early adverse events in childhood, such as verbal, physical or sexual abuse can reduce the likelihood of teen pregnancy by 38%, smoking later in life by 16% and having a poor diet by 14%.
Many instances of abuse occur in households with low incomes and high unemployment – as is the case with poor health and this can be seen in South Africa every day.
It is therefore vital that the social ills that drive bad health and early deaths in South Africa are addressed as a matter of urgency!
Marmot calls on governments around the world to make social security and free quality education top priorities – and not to further reduce assistance to people who need it most.
He says: “We need to do something. Do more. Do better.”