Health Disparities Expert to Lecture on Wednesday
A researcher who pioneered the first studies linking disease to social status will talk about his groundbreaking work next week. Michael Marmot, director of the International Centre for Health and Society at University College in London, will discuss "Inequalities in Health: Evidence Needed for Action" on Wednesday, February 28 in FXB G-13 at 4 p.m.
Several years ago, the World Health Organization (WHO) asked Marmot to summarize through 10 messages existing evidence that a person's place in society can affect health. Marmot and his colleagues at the center produced the resulting "Social Determinants of Health: The Solid Facts." His lecture on Wednesday will address those messages and give examples of the evidence that underlies them.
Marmot said that identifying scientifically rigorous evidence in a social science is extraordinarily difficult but necessary.
"Just as you wouldn't want a doctor in clinical medicine to try an untried therapy on you, you wouldn't want social policies to be implemented without evidence they work," said Marmot. "But I hasten to add that the means of getting the evidence in the two situations is not the same."
He
pointed out testing a new drug would involve a randomized controlled study
in which some participants would not receive the drug.Withholding, say,
parental contact from an infant to prove such contact is important in
early cognitive development would be unthinkable today. Instead, physicians
and others concerned with the social determinants of health, like Marmot,
must create other means to produce evidence, an area in which Marmot is
an undeniable expert.
He is an architect of two major epidemiological studies: Whitehall and Whitehall II, both involving members of the British Civil Service. In the first study, conducted in the 1960s, Marmot and his colleagues demonstrated a clear decline in health with each decrease in job grade, meaning those lower on the company totem pole were more likely to die at an earlier age than their bosses.
Marmot and his colleagues followed with the Whitehall II study in 1985 involving more than 10,000 men and, for the first time, women. The study confirmed its predecessor's findings and further identified conditions--such as how workers perceived their control of their work--as potential risk factors for disease (workers who felt their jobs were demanding and lacking in ways for them to control job tasks were more likely to develop cardiovascular disease).
In addition to the Whitehall studies, Marmot worked on the influential Acheson report published in 1998. The report made 39 recommendations to the British government about reducing social inequities that impact health. The government responded with its own report one year later, promising to implement some of the recommendations. Marmot and others are now monitoring the government's actions to see if they are true to their word.
Marmot thinks his research in England is applicable to the United States
"provided you don't make too simplistic a read of it," he said.
"Machinery of government questions may be different, but the broader
principles apply to both countries."
