The health gap

In his new book, The Health Gap, Michael Marmot sets out how our health and wellbeing could be dramatically improved. How can physio staff play their part?

The headline figures are stark. An 18-year gap in male life expectancy within different parts of the London borough of Westminster is about as big a difference as I can find. Shameful as that headline fact is, behind it are two more that should claim our attention. First, health inequalities are not confined to the differences between rich and poor, but there is a social gradient in life expectancy that runs all the way from the top to the bottom of society. Most of us are neither rich nor poor, yet people in the middle of the social hierarchy – us – have a shorter life expectancy than those at the top. The closer we are to the top – whether the hierarchy is based on education, area of residence or occupational status – the longer we can expect to live.

A second fact is particularly relevant to physiotherapists. The social gradient in healthy life expectancy is even more dramatic than the gradient in length of life. On average, people in Britain can expect eight fewer years of healthy life than if they had the highest social level. That means earlier declines in grip strength, mobility, memory and other cognitive function, as well as fewer years of life.

Physiotherapists, like most health professionals treat the sick. What if we all, in the health professions, added a new dimension to our work: preventing the onset of illness and disability.

I wrote The Health Gap because I wanted to bring to a wider audience – health professionals and the wider reading public – the powerful and inspiring evidence on the social determinants of health Inequalities in health arise from the conditions in which people are born, grow, live, work and age and inequities in power, money and resources that give rise to inequalities in the conditions of daily life.

Suppose your thinking goes along the lines of: I help people who are sick and disabled, how can I get involved with early child development, education, poor housing, domestic violence and social isolation? In other words, you might accept the evidence that I lay out on social determinants, the causes of the causes, of health inequalities, but think that it is not your role to deal with them.

Enter the firefighters. In The Health Gap, I give the example of Merseyside Fire and Rescue Service. The firefighters’ primary job is putting out fires. Once theygot involved with preventing fires they realised they could become agents of community change to improve health: getting deprived children off the streets, reporting suspected domestic violence to trained professionals, helping with housing, reducing social isolation of older people.

If firefighters can, in the words of another of our partners, the West Midlands Fire and Rescue Service, improve lives to save lives, so can each of us in the health professions. We can become true agents for helping to achieve a just distribution of health.

Professor Sir Michael Marmotis the director of the Institute of Health Equity, University College London

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