Professor Sir Michael Marmot

Director International Institute for Society and Health
Department of Epidemiology & Public Health
University College London

How healthy is your world?

"The most prominent public health issue for 2005 is inequity in health. This needs to be on the agenda for the next decade. Life expectancy (both sexes) in Japan is 82 and in Swaziland is 32.5. All other countries fall within this range. This 50 year range in life expectancy should be the number one public health issue. There are, too, large inequities in health within countries – even rich countries have a difference in life expectancy of twenty years or more between the most socio-economically disadvantaged and the most privileged.

There is no necessary biological reason why health inequities of such magnitude should exist. These inequities in health within and between countries are related not only to the functioning of health systems but, importantly, to the social determinants of health – the circumstances in which people live and work. It is for this reason that the Director-General, Dr Lee, has set up the Commission on Social Determinants of Health (CSDH). Equitable patterns of social and economic development are vital to health. The role of CSDH will be to put the social determinants of health on the policy agenda nationally and internationally."