Today’s keynote speaker at the Adler School of Professional Psychology’s conference on urban mental health was Professor Sir Michael Marmot, a researcher at University College London who specializes in studying health inequities around the world. He made a number of excellent points.
One of his points was that disparities in income and wealth have been associated with poor health outcomes in the US and Britain more than in other countries (for example, the Scandinavian countries). He pointed out that Britons have universal access to health care, but lower income Britons, like lower income Americans, still don’t have the health enjoyed by similar income people from some other countries.
The take-away from all this is that neither more money nor wider availability of “health care” (actually, the system of paying for medical treatment services. about which we argue so much in this country, and which other countries provide free) can ensure good health for large groups of people. Of course, if a person is diagnosed with cancer and has no insurance, he or she may die. But prevention is also important, as is managing the traumatic stress that goes with poverty. Nutrition, exercise, attitudes, and avoiding risky behaviors such as smoking and heavy drinking, need to be combined with better access to health care, to produce healthier communities.
Another point he made is that some decisions made by public policy makers, economists, and politicians – such as a decision to let unemployment rise in order to avoid inflation -may be expected to cause some people to die, because unemployment is correlated with higher rates of suicide, homicide, and illness. Although “correlation is not causation,” his point was that some evidence cannot be ignored without dehumanizing the people who experience problems of poor physical and mental health. We should be looking at the processes that lead to these outcomes, rather than characterizing the people who suffer from them as less worthy than ourselves and excluding them from access to the resources that could help them.
Our current conversation about whether people are “entitled” when they need help from the rest of us – with getting food, health care, and safe places to live – was obviously in the background of all he was saying. Race is an obvious issue when discussing this, and he described his research with the castes of India to illustrate that marginalization has real effects on people’s health, even with financial and service resources being equal.
Professor Marmot’s work is available at the “Marmot Review” of the Institute for Health Equity at UCL. The conference link is here and the Twitter hashtag is #ISE2012.