Michael Marmot – författare

'Punchily written … He leaves the reader with a sense of the gross injustice of a world where health outcomes are so unevenly distributed' Times Literary Supplement'Splendid and necessary' Henry Marsh, author of Do No Harm, New StatesmanThere are dramatic differences in health between countries and within countries. But this is not a simple matter of rich and poor.A poor man in Glasgow is rich compared to the average Indian, but the Glaswegian’s life expectancy is 8 years shorter. The Indian is dying of infectious disease linked to his poverty; the Glaswegian of violent death, suicide, heart disease linked to a rich country’s version of disadvantage. In all countries, people at relative social disadvantage suffer health disadvantage, dramatically so. Within countries, the higher the social status of individuals the better is their health. These health inequalities defy usual explanations. Conventional approaches to improving health have emphasised access to technical solutions – improved medical care, sanitation, and control of disease vectors; or behaviours – smoking, drinking – obesity, linked to diabetes, heart disease and cancer. These approaches only go so far. Creating the conditions for people to lead flourishing lives, and thus empowering individuals and communities, is key to reduction of health inequalities. In addition to the scale of material success, your position in the social hierarchy also directly affects your health, the higher you are on the social scale, the longer you will live and the better your health will be. As people change rank, so their health risk changes. What makes these health inequalities unjust is that evidence from round the world shows we know what to do to make them smaller. This new evidence is compelling. It has the potential to change radically the way we think about health, and indeed society.

Gener, livsstil och tillgång till sjukvård är viktiga för hälsan, men andra faktorer spelar många gånger en ännu större roll, nämligen hur vi lever vårt liv i samhället och hur vi har det på arbetet. Michael Marmot undersöker här sambandet mellan status och hälsa – statussyndromet – och belyser betydelsen av bland annat utbildning, inkomst, föräldrabakgrund och yrke. Utifrån nära tre årtionden av forskning lägger han fram häpnadsväckande bevis för hur subtila skillnader i social position kan leda till viktiga skillnader i hälsa och livslängd, beroende på olika möjligheter att ha kontroll över sitt liv och vara socialt engagerad.

Statussyndromet handlar inte om sjukdom för de fattiga och god hälsa för alla andra, utan den handlar om en kontinuerlig variation, en hälsogradient. Redan på 1970-talet började författaren studera de noggrant skiktade brittiska statstjänstemännen i de berömda Whitehallstudierna och fann att sjukdomsfrekvensen ökade ju längre ner man kom på den sociala stegen. Samma företeelse har visat sig finnas runtom i världen, inklusive Sverige. Marmot tar med läsaren på en resa i Europa, till USA och till många fjärran platser när han, varvat med levandegörande exempel och anekdoter, presenterar rikligt med internationell forskning. I boken granskas befolkningar vars hälsa är hårt drabbad, i synnerhet i de tidigare kommunistländerna i Central- och Östeuropa. Här undersöks också befolkningar vars hälsa är anmärkningsvärt god, framför allt den japanska, men också relativt fattiga befolkningar vars goda hälsa tycks strida mot deras brist på pengar, som t.ex. i den indiska delstaten Kerala.

Ett av budskapen är att över en viss nivå av resurser är det vad människor har i jämförelse med andra som är avgörande för hälsan. Betydelsen av pengar, relativ position och makt utforskas. Ett slående exempel är att Oscarsvinnande skådespelare lever i genomsnitt fyra år längre än kollegerna som ”bara” nominerats. Stödjande relationer i den privata sfären och graden av tillit och social sammanhållning i samhället är centrala dimensioner för hälsan, men samhällen varierar i hög grad i fråga om hur de uppmuntrar den typ av relationer som kan skydda mot sjukdom.

Eftersom människor är olika kommer det alltid att finnas ojämlikheter, men omfattningen av deras effekter på hälsan går att kontrollera, skriver Marmot. Med denna fängslande bok ger han kunskapsunderlag för handling som leder till bättre hälsa för alla och samtidigt minskade skillnader.

Boken innehåller ett efterord av Töres Theorell, professor i psykosocial medicin vid Karolinska Institutet och tidigare föreståndare för Institutet för Psykosocial Medicin.

Michael Marmot är en forskare i världsklass som skriver djupsinnigt om liv och död med elegansen hos en essäist i världsklass. Denna betydelsefulla nya bok .../ visar hur skadligt det kan vara med ojämlikhet, hierarki och social isolering. Alla som engagerar sig i vårt samhälles hälsa bör läsa den här boken. Robert D. Putnam, författare till Den ensamme bowlaren och Better together.

Översättning Göran Grip

Social Determinants of Health, 2nd Edition gives an authoritative overview of the social and economic factors which are known to be the most powerful determinants of population health in modern societies. Written by acknowledged experts in each field, it provides accessible summaries of the scientific justification for isolating different aspects of social and economic life as the primary determinants of a population''s health. The new edition takes account of the most recent research and also includes additional chapters on ethnicity and health, sexual behaviours, the elderly, housing and neighbourhoods. Recognition of the power of socioeconomic factors as determinants of health came initially from research on health inequalities. This has led to a view of health as not simply about individual behaviour or exposure to risk, but how the socially and economically structured way of life of a population shapes its health. Thus exercise and accidents are as much about a society''s transport system as about individual decisions; and the nation''s diet involves agriculture, food manufacture, retailing, and personal incomes as much as individual choice. But a major new element in the picture we have developed is the importance of the social, or psycho-social, environment to health. For example, health in the workplace for most employees - certainly for office workers - is less a matter of exposure to physical health hazards as of the social environment, of how supportive it is, whether people have control over their work, whether their jobs are secure. A similar picture emerges in other areas ranging from the health importance of the emotional environment in early childhood to the need for more socially cohesive communities. Social Determinants of Health should be read by those interested in the wellbeing of modern societies. It is a must for public health professionals, for health promotion specialists, and for people working in the many fields of public policy which we now know make such an important contribution to health.

Coronary heart disease is the leading cause of death worldwide affecting millions of people in both developed and developing countries. The dual aims of this book are to review the well-established and emerging risk factors in coronary heart disease and to apply this knowledge to public health approaches to disease prevention. The book includes authoritative accounts of studies within a single population and international studies, important areas of methodological development, trials to test preventive strategies, and the application of epidemiological and other knowledge to the development of public health policy for the prevention of widespread disease. It is an all-encompassing work containing contributions from the world authorities in the field.The book is divided into four sections. The introduction reviews advances in the understanding of, and the current status, of risk factors for CHD. Section 2 looks at recent global trends and emerging patterns of CHD morbidity and mortality in several countries, and includes chapters on work done under the auspices of WHO on the global burden of disease in relation to smoking and blood pressure. Section 3 focuses on advances in understanding the aetiology of CHD with each chapter focused on a particular risk factor. Section 4 explores measures of prevention and intervention in terms of public health policy with specific examples from around the world.

Social Determinants of Health, 2nd Edition gives an authoritative overview of the social and economic factors which are known to be the most powerful determinants of population health in modern societies. Written by acknowledged experts in each field, it provides accessible summaries of the scientific justification for isolating different aspects of social and economic life as the primary determinants of a population's health.The new edition takes account of the most recent research and also includes additional chapters on ethnicity and health, sexual behaviours, the elderly, housing and neighbourhoods.Recognition of the power of socioeconomic factors as determinants of health came initially from research on health inequalities. This has led to a view of health as not simply about individual behaviour or exposure to risk, but how the socially and economically structured way of life of a population shapes its health. Thus exercise and accidents are as much about a society's transport system as about individual decisions; and the nation's diet involves agriculture, food manufacture, retailing, and personal incomes as much as individual choice. But a major new element in the picture we have developed is the importance of the social, or psycho-social, environment to health. For example, health in the workplace for most employees - certainly for office workers - is less a matter of exposure to physical health hazards as of the social environment, of how supportive it is, whether people have control over their work, whether their jobs are secure. A similar picture emerges in other areas ranging from the health importance of the emotional environment in early childhood to the need for more socially cohesive communities.Social Determinants of Health should be read by those interested in the wellbeing of modern societies. It is a must for public health professionals, for health promotion specialists, and for people working in the many fields of public policy which we now know make such an important contribution to health.

Why do Oscar winners live for an average of four years longer than other Hollywood actors?Who experiences the most stress - the decision-makers or those who carry out their orders?Why do the Japanese have better health than other rich populations, and Keralans in India have better health than other poor populations - and what do they have in common?In this eye-opening book, internationally renowned epidemiologist Michael Marmot sets out to answer these and many other fascinating questions in order to understand the relationship between where we stand in the social hierarchy and our health and longevity. It is based on more than thirty years of front-line research between health and social circumstances. Marmot''s work has taken him round the world showing the similar patterns that could be affecting the length of your life - and how you can change it.

''Splendid and necessary'' - Henry Marsh, author of Do No Harm, New StatesmanThere are dramatic differences in health between countries and within countries. But this is not a simple matter of rich and poor. A poor man in Glasgow is rich compared to the average Indian, but the Glaswegian''s life expectancy is 8 years shorter. The Indian is dying of infectious disease linked to his poverty; the Glaswegian of violent death, suicide, heart disease linked to a rich country''s version of disadvantage. In all countries, people at relative social disadvantage suffer health disadvantage, dramatically so. Within countries, the higher the social status of individuals the better is their health. These health inequalities defy usual explanations. Conventional approaches to improving health have emphasised access to technical solutions – improved medical care, sanitation, and control of disease vectors; or behaviours – smoking, drinking – obesity, linked to diabetes, heart disease and cancer. These approaches only go so far. Creating the conditions for people to lead flourishing lives, and thus empowering individuals and communities, is key to reduction of health inequalities. In addition to the scale of material success, your position in the social hierarchy also directly affects your health, the higher you are on the social scale, the longer you will live and the better your health will be. As people change rank, so their health risk changes. What makes these health inequalities unjust is that evidence from round the world shows we know what to do to make them smaller. This new evidence is compelling. It has the potential to change radically the way we think about health, and indeed society.

Why do Oscar winners live for an average of four years longer than other Hollywood actors?Who experiences the most stress - the decision-makers or those who carry out their orders?Why do the Japanese have better health than other rich populations, and Keralans in India have better health than other poor populations - and what do they have in common?In this eye-opening book, internationally renowned epidemiologist Michael Marmot sets out to answer these and many other fascinating questions in order to understand the relationship between where we stand in the social hierarchy and our health and longevity. It is based on more than thirty years of front-line research between health and social circumstances. Marmot's work has taken him round the world showing the similar patterns that could be affecting the length of your life - and how you can change it.