The Health Gap: The Challenge of an Unequal World

Posted by Matt Quinn

Sat, 12 Sep 2015

Matt is currently National Secretary for Medsin-UK and and an intercalating student in Global Health at Imperial College. Contact him at

Read on for a Q&A with Michael Marmot, author of the new book "The Health Gap", and find out about a host of exclusive offers for Medsin members... 

'The poor not only die on average seven years sooner than the rich, but they can expect to face becoming disabled 17 years earlier'.

Here at Medsin-UK we are passionate about tackling the causes of health inequality and facilitating the members of our network to do the same.

This is why it is our pleasure to announce the release of “The Health Gap: The Challenge of an Unequal World” by Sir Michael Marmot, a leading expert in health inequalities and Director of the UCL Institute of Health Equity.

In this fascinating summation of 40 years of research Marmot strives to uncover the reason why social injustice is killing 200,000 people every year, and explains that it’s not simply about material wealth - wealth inequality and your position on the social hierarchy have just as big a role to play in determining life expectancy.

He delves into the reasons why countries like Chile, Costa Rica and Cuba, with their highly quality, inclusive systems of education and health, have managed to achieve a life expectancy equal to above that of the USA, with only a fraction of its national income, and argues that we need to change our ideas about health for the sake of a fairer society in which we can all live longer and healthier.

In recognition of the book's significance we are thrilled to announce that we will have ten free copies of the book to give as prizes at our Medsin Conference 2015, the Inequality Revolution (buy your tickets here!).

To top it off, National Conference and Medsin Autumn Weekend attendees will be able to claim a 20% discount on the book - exciting or what? Keep an eye on your inboxes!

We were also delighted to have a quick chat with Sir Michael about the book, which you can read below.. 

Sir Michael Marmot Q&A:


What does the Health Gap mean?

Marmot: If we look across the world there is a 40 year gap in life expectancy between the healthiest country – women in Japan – and the least healthy, in sub-Saharan Africa. Within countries, there is a twenty year gap in life expectancy between the best off and the worst off, even within one city such as Glasgow, London or Baltimore. The ‘health gap’ is also shorthand for the social gradient, which needs a bit more explanation. People in the middle of the social hierarchy, you and I, have health that is better than those at the bottom, but worse than those at the top. Health tracks the social hierarchy all the way from top to bottom.

What are health inequalities?

Marmot: If we describe people by their education, their income, their occupation or the general level of affluence of the area in which they live, we find a systematic pattern: the higher the social position the better the health. Not just life expectancy, as just described, but less illness and greater ability to function well at older ages. Where we judge these inequalities to be avoidable by reasonable means, they are unfair, inequitable.

What causes The Health Gap?

Marmot: When people, and policy makers, think of health they tend to think of health care and, perhaps, of life style. A major reason for writing The Health Gap was to show the evidence that inequalities in health are caused by social conditions in which we are born, grow, live, work and age; and inequities in power, money and resources that give rise to the conditions of daily life.

Of what part of the book are you most proud?

Marmot: Pride? Doesn’t quite describe it. My ambition was to make the evidence ‘real’. To turn the hundreds of scientific papers and reams of expert opinions into something that made sense in the lives of you and me.

Why are you so motivated to bridge The Health Gap?

Marmot: Cure and prevention: it’s the same motivation. I am so strongly motivated to improve social conditions, and make them fairer, because it will improve health for everyone and reduce inequalities.

What do you hope to achieve by publishing The Health Gap?

Marmot: I wanted to bring to a wider audience the understanding that how we organise our social affairs is a major determinant of how healthy we are. My basic assumption is that knowledge is better than prejudice, light better than darkness when it comes to deciding what sort of society we want. There is a great deal of knowledge out there as to what should go into these big decisions. The Health Gap, by showing how society affects health inequalities will, I hope, contribute to public understanding.and I am, I enjoy the benefits such a decent well-organised society.



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