Health Equity: The Marmot Report

Professor Sir Michael Marmot FRCP a is one of the foremost experts on health equity and the social determinants of health. He has lead a research group on health inequalities for over 35 years. This work has been instrumental in providing the evidence base for the links between health and social and economic factors. Professor Marmot and his team, working on behalf of the Consortium for the European Review of Social Determinants of Health and the Health Divide, have produced a report which has real significance for those working on these issues in the Canadian context. The European region has seen remarkable health gains in those populations that have experienced progressive improvements in the conditions in which people are born, grow, live, and work. However, inequities, both between and within countries, persist.

The Marmot report, of inequities in health between and within countries across the 53 Member States of the WHO European region, was commissioned to support the development of the new health policy framework for Europe: Health 2020. Much more is understood now about the extent, and social causes, of these inequities, particularly since the publication in 2008 of the report of the Commission on Social Determinants of Health.

The European review builds on the global evidence and recommends policies to ensure that progress can be made in reducing health inequities and the health divide across all countries, including those with low incomes. The report strongly recommends that action is needed—on the social determinants of health, across the life course, and in wider social and economic spheres—to achieve greater health equity and protect future generations.

In his blog review of the report, Ted Schrecker extracts several key points of relevance to the Canadian context:

• “The consortium writes that ‘[h]uman rights are central in our approach to action on the social determinants of health’. The fact that this was not true of the 2008 report has been identified as a significant omission by the distinguished human rights scholar Audrey Chapman, among others.
• Social protection – including ‘a minimum standard of healthy living for all’ that includes a nutritious and sustainable diet – is clearly and correctly identified as essential for reducing health inequity. Further, the consortium refers approvingly to the United Nations Social Protection Floor Initiative, a relatively low profile effort that is explicitly linked to a human rights approach. Could this be the start of an overdue convergence of concerns about health equity and social policy that often have been addressed by separate organizations and groups of professionals working in isolation from one another?
• The effects of unemployment and exposure to hazardous work environments are foregrounded, at a time when youth unemployment is higher than 50 percent in two WHO Euro countries and a source of concern throughout the region.
• Also foregrounded is the issue of health inequities among older Euro region residents – a concern with much broader applicability as populations age and social exclusion threatens to increase, especially in countries with high levels of economic inequality, a troubling trend that was evident even before the economic crisis.
• Most importantly, both the economic crisis and many policy responses are identified as threats to health equity. In the consortium's words: ‘Recognition of the health and social consequences of economic austerity packages must be a priority in further shaping of economic and fiscal policy in European countries,’ with health and social affairs ministries and – at the transnational level – the World Health Organization, UNICEF, and the International Labour Organization given a voice.”

Of specific relevance to our programs is:

“Panel 2: Recommendation 1(a) – provide adequate social and health protection for women, mothers-to-be, and young families. Specific actions recommended are:

1. Ensure that all women and girls have accessible, affordable and high-quality sexual and reproductive health services. This includes access to modern contraception and care in pregnancy and childbirth.  Aside from safe delivery as a basic right, such services help to decrease smoking rates in pregnancy and increase breastfeeding and provide support for effective parenting. These services should identify families at risk early and refer to appropriate services.
2. Ensure that strategies to reduce social and economic inequities benefit women of childbearing age and families with young children.
3. Heath ministers should act as advocates for social systems that provide income protection, adequate benefits, and progressive taxation to reduce poverty among children and pensioners.
4. Ensure that parenting policies and services empower women with children to take control over their lives, support the health and development of their children, and support a greater parenting role for men. In particular, family-friendly employment policies should be strengthened by introducing more flexible working hours – without turning to insecure short-term contracts – and making affordable child care available, to help parents combine work with their parental responsibilities.”

For a video link to Sir Michael Marmot’s keynote speech at the Canadian Medical Association annual meeting, focusing on health equity, click here.