Michael G Marmot

University College London | UCL · Department of Epidemiology and Public Health

Mental disorders account for at least 18% of global disease burden, and the associated annual global costs are projected to be US$6 trillion by 2030. Evidence-based, cost-effective public mental health (PMH) interventions exist to prevent mental disorders from arising, prevent associated impacts of mental disorders (including through treatment), an...

The COVID-19 pandemic exposes and amplifies pre-existing inequalities even in places with relatively well-controlled outbreaks such as Hong Kong. This study aimed to explore whether the socioeconomically disadvantaged fare worse via various types of worry in terms of their mental health and well-being. Between September and October 2020, 1067 adult...

Objective: In 2010, the principle of proportionate universalism (PU) has been proposed as a solution to reduce health inequalities. It had a great resonance but does not seem to have been widely applied and no guidelines exist on how to implement it. The two specific objectives of this scoping review were: (1) to describe the theoretical context i...

The COVID-19 pandemic has substantially induced worries and affected individual mental health and subjective well-being. Nonetheless, a high level of social capital could potentially protect individuals who suffer from mental health problems and thus promote their subjective well-being, especially under the social distancing policies during the pan...

Although coronavirus disease (COVID-19) outbreaks have been relatively well controlled in Hong Kong, containment remains challenging among socioeconomically disadvantaged persons. They are at higher risk for widespread COVID-19 transmission through sizable clustering, probably because of exposure to social settings in which existing mitigation poli...

Costa Rica es un país de especial interés en la Región de las Américas y en la salud mundial debido a su buena salud. El Programa de las Naciones Unidas para el Desarrollo clasifica a los países según su nivel de desarrollo humano con base en la esperanza de vida, la educación y el ingreso nacional. Aunque Costa Rica está clasificada en el puesto 6...

The severity of COVID-19 infections could be exacerbated by the epidemic of chronic diseases and underlying inequalities in social determinants of health. Nonetheless, there is scanty evidence in regions with a relatively well-controlled outbreak. This study examined the socioeconomic patterning of COVID-19 severity and its effect modification with...

The COVID-19 pandemic has amplified the central role nurses play across settings and systems in optimising health outcomes on a global scale. They are key players in providing high-quality clinical care of individuals, families and communities and make expert contributions across policy, education and research domains. Nurses are at the frontlines...

The ongoing COVID-19 pandemic has spotlighted the role of America's overcrowded prisons as vectors of ill health, but robust analyses of the degree to which high rates of incarceration impact population-level health outcomes remain scarce. In this paper, we use county-level panel data from 2927 counties across 43 states between 1983 and 2014 and a...

Objective: To explore national and socioeconomic differences in overall job satisfaction, we examined whether those differences can be explained by what job-related factors. Methods: Our datasets for this study are from the Whitehall II study and the Japan Civil Servant Study. Of the participants who were 5540 cases, with 3250 people from Great...

Background Childhood adversity (CA) has previously been linked to various health problems in adulthood. Investigations into the differential impact of distinct types of CA on a wide range of outcomes are scarce. This study aimed to assess the impact of self-reported childhood family conflict and/or financial strain on health and social functioning...

Evidence has shown that some of the major causes of health inequities arise from the conditions in which people are born, grow, live, work and age, in addition to a wider set of forces and systems shaping individuals' and societies' health and well-being. Such conditions are known as the 'social determinants of health'. However, efforts to address...

Background: As one of the world's most powerful international financial organisations, the International Monetary Fund (IMF) is uniquely positioned to shape global developmental trajectories by influencing domestic policy arrangements. However, its role in shaping population health is understudied. Methods: We use previously unavailable cross-natio...

International financial organisations like the International Monetary Fund (IMF) play a central role in shaping the developmental trajectories of low- and middle-income countries through their conditional lending schemes, known as “structural adjustment programmes”. These programmes entail wide-ranging domestic policy reforms that influence local h...

Objectives. To investigate the role of the Family Health Strategy (FHS) in reducing social inequalities in mortality over a 9-year follow-up period. Methods. We carried out a population-based cohort study of individuals aged 60 years and older from the city of Bagé, Brazil. Of 1593 participants at baseline (2008), 1314 (82.5%) were included in this...

Background: Physical and cognitive functioning in older age follows a socioeconomic gradient but it is unclear whether the strength of the association differs between populations. Using harmonised data from an international collaboration of cohort studies, we assessed socioeconomic inequalities in physical and cognitive functioning and explored if...

Theresa Marteau and colleagues argue that behavioural and social causes of poor health must be tackled in parallel to reduce inequalities

Summary As a setting where children and adolescents live and learn, linked to the family and embedded within the wider community, schools have an important influence on every student's health. Many health interventions have used schools as a platform, often for standalone programmatic initiatives to reduce health risks, and sometimes for more compr...

Background: Given the effect of chronic diseases on risk of severe COVID-19 infection, the present pandemic may have a particularly profound impact on socially disadvantaged counties. Methods: Counties in the USA were categorised into five groups by level of social vulnerability, using the Social Vulnerability Index (a widely-used measure of socia...

Background We examined whether COVID-19 could exert inequalities in socioeconomic conditions and health in Hong Kong, where there has been a relatively low COVID-19 incidence. Methods 752 adult respondents from a previous random sample participated in a telephone survey from 20 April to 11 May 2020. We examined demographic and socioeconomic factor...

Costa Rica has long been a country of special interest in the Americas and in global health because of its good health. The United Nations Development Programme ranks countries according to their level of human development based on life expectancy, education and national income. Although Costa Rica is ranked at 63 and classified as ‘High’, in terms...

Los importantes desafíos a la equidad en la salud en la Región de las Américas, como se detalla en el informe de la Comisión Independiente de la Organización Panamericana de la Salud sobre Equidad y Desigualdades en Salud en las Américas (1), fueron el impulso inicial para este número especial de la Revista Panamericana de Salud Pública sobre la eq...

Background: given the effect of chronic diseases on risk of severe COVID-19 infection, the present pandemic may have a particularly profound impact on socially disadvantaged counties. Methods: counties in the USA were categorised into five groups by level of social vulnerability, using the Social Vulnerability Index (a widely used measure of socia...

Background People of South Asian and of African Caribbean descent have elevated risks of some cardiovascular diseases compared to Europeans. How ethnicity relates to recurrent risk, and explanations for between ethnic group differences in recurrence are unclear. We characterized long-term risk of major adverse cardiovascular event (MACE) and mortal...

People living in low social conditions have higher morbimortality risk and lower access of health services. Primary Health Care (PHC) has been recommended as the main strategy to achieve the goal of health for all. Since 1994 the Brazil MoH proposed a new strategy PHC called Family Health Strategy (FHS), to reorganize and restructure the universal...

BACKGROUND: Mental illness is a major disease burden in the world and disproportionately affects the socially disadvantaged, but studies on the longitudinal association of poverty with anxiety and stress are rare, especially in Asia. Using data from Hong Kong, we aimed to (1) assess the cross-sectional association of poverty with anxiety and stress...

Objective Ethnic differences in cardiovascular disease incidence, but not cardiovascular disease recurrence, are reported. We characterised long-term risk of major adverse cardiovascular event (MACE) and mortality following a non-fatal cardiovascular event in a British cohort of South Asians, African Caribbeans and Europeans. Methods We identified...

Objective. In 2010, the principle of proportionate universalism (PU) has been proposed as a solution to reduce health inequalities. It had a great resonance but does not seem to have been widely applied and no guidelines exist on how to implement it. The two specific objectives of this scoping review were: (1) to describe the theoretical context in...

Several studies have reported a higher rate of COVID-19 mortality in men.[1–3] A higher rate of COVID-19 mortality has also been reported in Black, Asian and minority ethnic (BAME) groups,[3–5] especially among healthcare providers.[6]

The Social Determinants of Health (SDHs) are well known for their interaction on health outcomes and they can have a stronger impact on migrant health whom have higher probability to live in precarious living and working conditions compared to the hosting population. Migrant health is a public health issue which has to be considered taking into acc...

Several studies have reported a higher rate of COVID-19 mortality in men compared with women. A higher rate of COVID-19 mortality has also been reported in Black, Asian and minority ethnic (BAME) groups, compared with White ethnicity, especially among healthcare providers. While some studies attempted to examine if existing disparities could be exp...

A global health equity movement relies on research showing how socia factors affect health.

The Case Studies in Social Medicine demonstrate that when physicians use only biologic or individual behavioral interventions to treat diseases that stem from or are exacerbated by social factors, we risk harming the patients we seek to serve.

To quantify and compare 9-year all-cause mortality risk attributable to modifiable risk factors among older English and Brazilian adults. We used data for participants aged 60 years and older from the English Longitudinal Study of Ageing (ELSA) and the Bagé Cohort Study of Ageing (SIGa-Bagé). The five modifiable risk factors assessed at baseline we...

Background: Socioeconomic disadvantage is a risk factor for many diseases. We characterised cascades of these conditions by using a data-driven approach to examine the association between socioeconomic status and temporal sequences in the development of 56 common diseases and health conditions. Methods: In this multi-cohort study, we used data f...

Background: Low socioeconomic position is consistently associated with increased risk of premature death. The aim of this study is to measure the aggregate scale of inequality in premature mortality for the whole population of England. Methods: We used mortality records from the UK Office for National Statistics to study all 2 465 285 premature...

To access this data, please use the following link: https://doi.org/10.14324/000.ds.10086658 This data shows the number of premature deaths (which are deaths before age 75) in England between 2003 and 2018, and the number of premature deaths that can be attributed to socioeconomic inequality. We calculated the number of attributable deaths by: (1)...

Better data on health disparities and commitment to interventions focused on the determinants of inequality are essential, argue Eric Friedman and colleagues.

This chapter addresses health inequalities and focuses on social determinants of health. Inequalities in health relate fundamentally to inequalities in society. Overall health and inequalities in health in a population are indicators of how successful a society is meeting the needs of its members. The chapter describes the substantial differences a...

Background Drug use disorders are an increasing cause of disability and early death in the USA, with substantial geographical variation. We aimed to investigate the associations between economic decline, incarceration rates, and age-standardised mortality from drug use disorders at the county level in the USA. Methods In this observational analysi...

Health inequities across the Americas are avoidable and unjust yet continue to persist. Systemic social determinants of health, which could be addressed at the policy level, are root causes of many inequities and prevent marginalized individuals and at-risk populations from reaching optimal health and well-being. In this article, we describe our ap...

Chronic inflammation has been proposed as having a prominent role in the construction of social inequalities in health. Disentangling the effects of early life and adulthood social disadvantage on inflammation is key in elucidating biological mechanisms underlying socioeconomic disparities. Here we explore the relationship between socioeconomic pos...

A whole systems approach that integrates action on the social determinants of health is essential to reduce the burden of non-communicable disease, argue Michael Marmot and Ruth Bell

Background This paper reports on a five-year study using a theory-based program logic evaluation, and supporting survey and interview data to examine the extent to which the activites of the South Australian Health in All Policies initiative can be linked to population health outcomes. Methods Mixed-methods data were collected between 2012 and 201...

OBJECTIVES To evaluate the geographical and socioeconomic differences in mortality and in life expectancy in Italy; to evaluate the proportion of mortality in the population attributable to a medium-low education level through the use of maps and indicators. DESIGN Longitudinal design of the population enrolled in the 2011 Italian Census, followin...

Background: The aim of the study is 2-fold. Firstly, it attempts to investigate the potential impact of major political and economic changes on inequalities in all-cause mortality among men and women with different levels of education in three Eastern European countries. Secondly, to identify changes in contribution of smoking and drinking to educ...

Our new Case Studies in Social Medicine series highlights the importance of social concepts and context to clinical medicine. Articles in the series will discuss clinical cases and translate social medicine tools for use in education, clinical practice, and health system planning.

Background Social cohesion has a potential protective effect against depression, but evidence for Central and Eastern Europe is lacking. We investigated the prospective association between social cohesion and elevated depressive symptoms in the Czech Republic, Russia and Poland, and assessed whether alcohol drinking and smoking mediated this associ...

Doctors know about health—it is what you lose when you have disease. And they know about disease—it is what happens when you have disordered pathology. People interested in prevention know about health—ill-health can be prevented by behaving better and avoiding the evils of drink, drugs, overweight and unsafe sex. Health policy people know about he...

This chapter discusses evidence linking social inequalities, across social, economic, and environmental dimensions to inequalities in mental health. A framework for thinking about the lifetime causes of inequalities in mental health is presented and used to discuss how experiences and conditions affect mental health across the life course. The chap...

Self-perceptions of own social position are potentially a key aspect of socioeconomic inequalities in health, but their association with mortality remains poorly understood. We examined whether subjective social status (SSS), a measure of the self-perceived element of social position, was associated with mortality and its role in the associations b...

Social inequalities in cancer are a global problem, as has been well documented inthe World Health Organization (WHO)/International Agency for Research onCancer (IARC) publication Social Inequalities and Cancer.1Inequalities in income,wealth, education, and power disproportionally impact the most disadvantagedindividuals, communities, and countries...

Objectives To study whether subjective social status (SSS) was associated with mortality and its role in the associations between objective socioeconomic position (SEP) measures and mortality. Methods Cox regression was used to model the associations between SSS (measured using a 10-point continuous scale), objective SEP measures and mortality in...

2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Several studies have shown that diabetes confers a higher relative risk of vascular mortality among women than among men, but whether this increased relative risk in women exists across age groups and within defined levels of other...

Background: Several studies have shown that diabetes confers a higher relative risk of vascular mortality among women than among men, but whether this increased relative risk in women exists across age groups and within defined levels of other risk factors is uncertain. We aimed to determine whether differences in established risk factors, such as...

Four decades ago, U.S. life expectancy was within the same range as other high-income peer countries. However, during the past decades, the United States has fared worse in many key health domains resulting in shorter life expectancy and poorer health—a health disadvantage. The National Heart, Lung, and Blood Institute convened a panel of national...