Austerity harms a nation’s health

Professor Marmot is the author of The Health Gap and the man behind a number of major health studies, including one for the World Health Organisation, another for the British government on the social determinants of health (The Marmot Review, 2010), and ten years on, an update on that report commissioned by Britain’s largest health thinktank, the Health Foundation, Health Equity in England: The Marmot Review Ten Years On.

He says that spending cuts in all sorts of areas — such as early child development and education — have had a terrible impact on the nation’s health. There have been steep rises in the number of children living in poverty. There is an affordable housing crisis, with many struggling to pay rent or a mortgage. There have also been structural changes in the job market, with the rise of the gig economy (though the extent to which this is the responsibility of government is open to dispute). In any case, he says, the upshot is that people in the bottom ten per cent of income levels would now have to spend around three quarters of their disposable income on food if they were to have a balanced, nutritious diet.

Of course, it’s obvious that if a family lacks sufficient funds to feed itself properly, the health of family members will suffer. But Professor Marmot’s most radical claim is that poverty and illness are also linked through a psycho-social transmission process. Those on low incomes are disproportionately afflicted by stress and anxiety, which in turn damage health. Such a process starts at the start of life with effects on early child development that cast a long shadow over the rest of a person’s life.

This is not merely an issue about absolute levels of poverty, although of course this matters hugely. But relative poverty matters too because it damages social solidarity and is linked to issues like crime that then feed back into health. What’s more, people at the bottom of a steep social hierarchy are likely to have even lower self-esteem and an even more diminished sense of self-dignity, than those at the bottom of a more equal society and this too affects their health.

Professor Marmot first identified the psycho-social levers on health in a pioneering research project on Whitehall civil servants. The top civil servants were not terribly, terribly rich. The lowliest civil servants were not terribly, terribly poor. They all had enough money to feed and house themselves. And yet those who reached the senior rungs of the civil service ladder tended to be healthier than those stuck on the lower rungs; the lower the rung of the civil servant, the higher the mortality rate. Exercise is good for us. Fruit and vegetables are good for us. Professor Marmot concluded that autonomy, having a sense of control over our lives, is good for us too.

Indeed, if we want to be a healthier nation in the future, he argues, far better to focus on creating a more equal and just society, than a wealthier one. For most people who live in a rich country like Britain, becoming wealthier will not mean becoming healthier. Michael Marmot was born in East London in 1945 to a Ukrainian-born father and a mother who was born in what was then Russia and is now Belarus. The family made the well-trodden move from East to North London. His father then decided to take a less well-trodden relocation to Shanghai, aiming to set up in the wholesale food business. It was a bold idea, but he arrived in 1949, the year Mao Zedong came to power — not ideal timing for an ambitious member of the petit bourgeoisie. So Marmot Snr emigrated to Australia, where he worked in the schmutter trade, and called on the family to join him from Edgware. Michael was raised in Sydney as an English Jew; the family mixed mostly with other English Jews (and certainly not with Jews from Poland or Germany!).

He began work in the UK in 1976 after completing a medical degree in Sydney and a doctorate at Berkeley in epidemiology. He says the one advantage of Covid is that everyone now knows the difference between an epidemiologist and a dermatologist.

The impact of his Jewish upbringing on his career has been more than skin-deep. Although he keeps Friday night, attends synagogue on religious high holidays, and has had his children barmitzvahed, he describes himself as “non-observant”. But he credits his cultural heritage with motivating his life-long commitment to social justice.