RSM In Conversation Live with Professor Sir Michael Marmot

good evening everybody and welcome to the 43rd episode of in conversation live uh i'm roger kirby president of the rural society of medicine and it's a real honor this evening to present to you uh sir michael marmot sir michael was born in london in 1945 when he was a young child he his family moved to australia to sydney and he attended the boys school there graduating in 1968. he earned a phd in 1975 at the university of california for research into coronary heart disease in japanese americans he's been a world leader in the study of health inequalities for over 35 years he's just told me that he's the 49th most highly ranked author for citations of his work uh in the world so wow he was chair of the commission on social determinants of health which was set up by the world health organization in 2005 and i think that was the launch really of so much of his really good work and he produced closing the gap in a generation in 2008. in 2010 he produced a very influential report for gordon brown entitled fair society in healthy lives the marmot review and 10 years later he's published a review of that entitled health equity in england 10 years on this year's published two further reports built back fairer and sustainable health equity achieving a net zero uh in the uk and he's told me he's just been doing a zoom uh in uh with with colleagues in egypt today to talk about uh equity in the uh eastern mediterranean and we'll be talking about that he's also served as president of the british medical association and he's currently president of the british lung foundation michael you are so welcome to uh to our program we're proud of this these in conversation programs so let's start at the beginning uh a bit like they do on desert island dis and and uh your upbringing and education at the university of sydney i mean do you have happy memories of your childhood and down under oh very happy memories i i think what i might have done had i not spent time in the street with a fruit box and a cricket bat and a cricket ball playing cricket uh every afternoon after school um i might have done all sorts of other things but it was very happy very happy time but there was a bit of a cultural cringe in australia there was a feeling that everything happened somewhere else there was some place in heaven called the hammersmith hospital where they wrote textbooks that were passed down from god i thought um or the massachusetts general hospital i couldn't imagine that textbooks in medicine were written by real people because they came from so far away so i knew at some point that i was going to leave australia and discover what was going on outside and so you moved then to california foreign university of california berkeley so and you started work there on on some uh looking at japanese immigrants to california and their differential rates of stroke and heart disease and just briefly give us a a kind of flavor of that work well it was a remarkable story that if you look at men of japanese ancestry in japan hawaii and california as they migrate across the pacific the rate of heart disease goes up and the rate of stroke goes down so if you were looking for genetic explanations of why the japanese seem to be protected from heart disease they lose that protection as they migrate across the pacific [Music] and that's re was really interesting and i was interested in culture society uh the conventional explanation is that the rate of heart disease must go up because the diet becomes more westernized and indeed the diet does become more westernized but when we looked at the japanese in california at those whose society and upbringing was more traditionally japanese and those who are more acculturated more westernized we found that the more acculturated japanese had higher rates of heart disease regardless of cholesterol levels smoking levels blood pressure so it wasn't just due to westernization of diet or lifestyle it was related to society and culture yes and that that was a very widely quoted study but you then decided to leave california some people will be asking why you left such a nice part of the world and you came back to london but you came back via the philippines is that right yeah it was hard to leave california the thing that clinched it donald reed who was professor of epidemiology at the london school of hygiene and tropical medicine said we'll halve your salary you won't have any high living it'll be high intellectual activity but grim living and that was so attractive i couldn't turn it down but in between i did a consultancy for the world health organization western pacific region based in manila in the philippines and my mission was trying to get the philippine health center for asia to do epidemiology actually to be involved in cardiovascular epidemiology right well before we we we talk about london and what happened there there's a question from david mummery thank you david could you comment on health inequalities in australia between aboriginal australians and other people living in uh australia i spent a week or two in darwin where there's an awful lot of aboriginal people and they they they don't look as though they're terribly healthy any comments on them yeah the um the gap in life expectancy was alleged to be 17 years between indigenous and non-indigenous australians the official figures now are more like 10 years 10 or 11 years both for men and for women so shorter life expectancy and the striking thing is that no one's in any doubt that australian aboriginals live in poverty compared to the non-indigenous population but when you look at the causes of death that contribute to this excess mortality in indigenous australians it's not infinite and child mortality it's not the usual causes we associate with poverty it's heart disease cancer endocrine disorders including obesity chronic obstructive pulmonary disease which is really interesting it's in general non-communicable diseases which we know are related to the social determinants of health and in recent years whenever i've gone to australia i've made a point of visiting indigenous communities meeting people working on health and health care in indigenous communities and become something of an advocate and the insight i was given by uh one person working at an aboriginal health center was the answer to the question when people say we've spent billions trying to close the health gap between indigenous and non-indigenous australians how come it doesn't work and the answer i was given was if you've spent 200 years disempowering a group of people don't expect money by itself to solve the problem money is important but so too is empowerment control over your lives and that's absolutely vital yeah absolutely so from the philippines you came back to london and that must have been the 1990s was it i'm actually a bit older than that 1976. all right um and then you were a researcher in public health for for many years but um i think it was your connection with donald hassan then the cmo at the time that that got you in involved in issues of inequality in the 90s to begin with before that who connection so just just tell us a little bit about about how that interest in in what life interest in inequalities came about what when when did the sort of penny drop that this was the key to so many problems well when i came from berkeley back to london in 1976 and jeffrey rose working with donald reed at the london school of hygiene troubled medicine said to me i know you're interested in social and cultural things donald and i have been doing the whitehall study of british civil servants we don't have very much that social and cultural it's really about risk factors but we do know people's grade of employment where they are in the hierarchy you could look at that so i did and at the time the conventional wisdom was that high status people were more likely to have heart attacks than low status football managers exactly don't work so hard you'll have a heart attack was the conventional wisdom and looking at the whitehall study of british civil servants what i found was quite remarkable if you look at mortality from heart disease the lower the position in the hierarchy the higher the mortality from coronary heart disease and from a whole range of other diseases as well and if you think that british civil servants exclude the richest people in society no bankers no hedge fund managers and exclude the poorest everyone's employed it's not very wealthy if you're an office assistant living in london you're finding it difficult to live but you're not in absolute poverty and in this group excluding the richest excluding the poorest the lower you were in the hierarchy the higher the mortality the shorter the life expectancy and that which i saw which i found i published my first paper on it in 1978 and that's kept me exercised ever since first trying to explain it what what's this about if it's not wealth and it's not poverty it's something about inequality what we call the social gradient what's that about and then it kept me exercised in policy terms so firstly the research question why how do we explain it but secondly what are the policy implications of the research so that kept me going ever since and it was really when donald atchison [Music] stepped down as cmo that you have to remember that so 1978 i published my first paper on whitehall and 1979 margaret thatcher was elected prime minister i was told that um social inequalities were not of interest you'll remember the black report was published in 1980 well it was completed in 1980 margaret thatcher refused to publish it and famously she said there's no such thing as society so how can there be social inequalities if there's no society so what i did supported by the medical research council supported by the u.s national institutes of health i set up the whitehall 2 study to investigate the causes of inequalities but it was pure research because the government wasn't least bit interested in the findings and then the government changed in 1997. tony blair his pure research became today's applied research the labor government set up an inquiry under sir donald atchison and donald invited me to be part of it and i pushed hard that we had to consider the gradient health inequalities were not just about poor health for the poor we had to consider the whole gradient so john frank's asking he says lovely to hear you tell you a whole story when would you say you you became a social epidemiologist would it would it be in that thatcher era that that you could call yourself that that gave you your life work i i never bothered much with titles um of what it was called um it was initially curiosity driven research uh gosh how do we get this social gradient and the more i looked at it the more i concluded that the social gradient was related to the structure of society social causes and there was a wonderful canadian fraser mustard beautiful name who i knew by reputation because he had been a researcher on platelets and anti-platelet drugs in the heart disease field and i knew of that work and he turned up in my office one day in london at ucl and he said i want to talk about the whitehall study and this was in the mid 1980s about 1986 they're about 87 and he said i want to talk about the white horse study this is a fundamental importance to policy he said i said not in britain it isn't um no one's interested he said well they are in canada and we're going to put it on the map in canada and he did they were writing newspaper articles in the canadian press about the whitehall study and he said this is a fundamental importance and he set up he was president of the canadian institute of advanced research and he set up this group this population health group and very much about around the gradient and the causes of inequalities so i don't know that i called myself a social epidemiologist but it was the wonderful fraser mustard who said to me your research has fundamental importance for society i said oh gosh does it well let's think some more about it social gradients is it's a good expression of course you know those gradients are getting steeper and not not less steep as well we'll come on to talk so so i think the real breakthrough in in getting the message out to the world came from that w.h.o report that you did in the in 2006 seven eight i think before yeah so how did that happen because the who did they approach you to do this michael or they funded this i suppose yet they did and well the background was there was a commission on macroeconomics and health and the commission on macroeconomics and health said invest in reducing major killing diseases hiv aids tuberculosis malaria in order to get economic growth and i thought at the time i was doing a mini sabbatical at trinity college cambridge organized by amateur sen who was then the master of trinity nobel prize winning economist and philosopher and jeff sax had published this report and i said marty don't you think he got it upside down we don't want to improve health in order to get a better economy i didn't go into medicine to cure people's illness so that they could become richer or i didn't go into public health to try and improve population health so the society could become wealthier it's the other way around we want to improve society in order to get better health right and amateur sen said i agree with you and i said why don't we get a group together to say that and the manchester said yeah sure and then he said to me it might be a good idea to get who backing right so i went off to who and said how about setting up a commission on social determinants of health that was in december 2003 right in fact soon after we jw lee who was the director general took the decision i published my first book status syndrome in 2004 and i brought jw lee a copy and he said status syndrome who's at higher risk and i said everybody below the seventh floor uh his office being on the seventh floor in geneva this was geneva the eighth floor was a reception area everyone below the seventh floor and he smiled and he said just like the monkeys and the apes yeah i said yes so he invited me to come to a seminar that the who executive board was holding in reykjavik in iceland in december i thought wow it doesn't get light in reykjavik in december and he made copies of my book he bought copies of status syndrome for all the members of the executive board and the idea was that i should convince them that this commission was worth doing and that was fun so yeah it came you know it was a series of conversations i don't think i would have got there without amateur sen saying let's get who backing for this and amateur became a member of the commission so how does it co how did that commission work you you how many people did did you uh rope in to help you and was it centered in london and you're in your labs or did you where you back and forth to geneva for to do things today so i thought if you're going to have a commission like this it needs to be regionally representative and in my mind regional representation meant you had professors from yale as well as harvard or oxford as well as cambridge you know that's regional representation uh forget it mate um that's not how who works so we had commissioners some were politicians we had ricardo lagos former president of chile pascal mukumbi former prime minister of mozambique we had former government ministers we did have distinguished academics but we had people from all over the world from every region of who and that was very much i mean they called for nominations they were something like 295 nominations for a commission of 18 people so it was a bit selective and i was nervous i'm chairing this thing and i've got former presidents and prime ministers and ministers and so on around the table and i thought how's this going to work i know how to have arguments with academics i don't know how to have arguments with politicians it was brilliant it was terrific they they were i don't know if it was the insight of jw lee and his colleagues at geneva that produced such a wonderful group of commissioners but they were absolutely terrific and about halfway through i when we got to know each other very well and i professed my insecurity what am i doing sharing this thing you people you know you're very important people and i'm just a humble professor and they said no no it's okay michael you know something about the topic well it was just wonderful learning exercise and we had two secretariats one in geneva at who and one in my office at ucl in london so i did go back with some forwards between geneva and london we work closely with the geneva secretariat we wrote the report in london which was important and we set up nine knowledge networks so we had experts from around the world on nine topics that i chose thought to be important giving us the wisdom of the global literature on social determinants of health so it was the most amazing learning exercise for all of us indeed we did a consultation exercise we did several before we started and one distinguished us professor said you know i was involved in a previous commission where the report was really written before we met but that won't happen this time michael doesn't know enough um so that was nice but it was true i didn't know enough i couldn't write the report before we met we learned together and the report looked nothing like i imagined it would look like at the beginning how many pages did that report turn out to be can you remember as several hundred i guess it was yeah it was a few hundred pages and the commission had ten meetings i remember them all as if it were yesterday in different parts of the world um and we produced a draft at our last meeting which was in japan and i thought well we've done it and the commissioners spent two days going over every single word of the draft and the end result was we went back home and rewrote it completely and we went back with some forwards with commissioners who people and the like and we put on the cover social injustice is killing on a grand scale we put that on the cover which was a bit unusual for a who report and i think it did have influence and i think it's lasted you were telling me before we came online that somebody commented that that most reports don't last very long but this one what did he say to you well it was a swedish parliamentarian so we published it in 2008 and in 2013 i was a meeting in stockholm and he said the half-life of most commission reports is six weeks your report is still being discussed in the swedish parliament five years later and he said next time you come to stockholm come to the parliament we'd like to talk to you so i did i was back in stockholm a few months later and i went to the parliament and i met the social committee and i said to them yesterday i was at a meeting at salah the swedish association of local authorities and regents something like 280 local areas represented and i said the enthusiasm in that room for social determinants of health and health equity was quite remarkable so i'm really pleased i said to the parliamentarians that you're still discussing my report i'd be even more pleased if you did something about it because if you don't at a national level i can tell you if every local authority in sweden is taking action you're going to be left behind you'll have the whole of the swedish population marching in one direction and you'll have to run round to the front of the march and pretend you were leading it well it you've got to be patient when you're doing all this because um it was a few years later the then minister of health invited me for breakfast in stockholm and he said i want to tell you that i'm setting up a swedish commission on social determinants of health and uh he said you'll know who the chair was he didn't tell me at the time but it was a close colleague alejundberg and so they did set up a swedish commission it took a while but it means that these things if you try and ask the question did report a lead to outcome b that's a very difficult question to answer but the we the global commission report went through some twists and turns and finally there was a swedish commission which directly flowed from the global report but quite a lot happened in between there's there's a good question from deepesh gapal saying how do you stay motivated when it seems so little is is changing in terms of social uh inequalities i mean maybe maybe things are changing now well kobe's made them worse i suppose but but yeah how do you stay motivated you're still working terribly hard i can tell by by the way you've been in that office today and you've been zooming around the world we were we were discussing so well so i'm very much a glass half full person so let's think about the nothing that's happened since the 2008 report i was invited by the british government to do the marmot review in england fair society healthy lives which we published in 2010 i was invited by the european region of who to chair the european review of social determinants in the health divide i was then invited by the american region of who the pan-american health organization to chair the commission of paho on equity and health inequalities in the americas and then i was invited by the eastern mediterranean region of who mainly the muslim countries of north africa and the middle east when they invited me to do it i said look i can't they said why not well i'm busy and i don't really know anything about your region and they said it's an equity issue you've done it for euro you've done it for paho you have to do it for us so we did and let's come back to the english review the 2010 review now it's possible to say not much happened which is why we published the 10 years on review health equity in england the marmot review 10 years on but it's not true that nothing happened coventry became a marmot city greater manchester said we'd like to be a marmot region gateshead produced a new strategy based on marmot principles we're having local authorities all around england um i was invited to trieste in italy i was told that they were having a big meeting because they were a marmot city then i was invited to bologna with the c yeah the penny dropped i said they're not a marmot city no one's mentioned that name no no of course not we just said that to get you here but it doesn't matter the point is that what they were doing in trieste what they were doing in bologna was exactly similar to the kinds of actions that we were pushing so i don't spend my time thinking oh look at all the governments and national entities and regions and cities that are ignoring the insights on social determinants and health equity i spend my time saying look at the people who are taking this seriously and it's exciting so the reason i stay motivated if i thought that i was banging my head against a wall i'd stop immediately but the we'll see what happens in cairo in the eastern mediterranean but they encouraged me i thought that if i produced a report referring to the health equity impact of violent conflict the problems of health equity in refugees and migrants the problems of great gender inequity in a region most of his money comes from fossil fuels say pointing out the climate crisis which comes from production and consumption of fossil fuels i was allowed to say all of that in my report which we published today so no i don't feel like no one's listening i feel like people are listening all over i couldn't i could not have imagined when we did the who commission in 2005 to 2008 we asked ourselves what would success look like before we began the commission and this is so far beyond what i dared imagine that i'm positively enthusiastic yeah good for you i i set down the six broad policy objectives from your 2010 report strengthening early childhood development interventions education and and so on and so forth i mean of of those which do you think would if you could have chosen say two out of those six that that could have come to pass which would you say the most important would it be education would it be health would it be incomes very deliberately did not prioritize them we said all six are vital and they're linked so for example take early child development early child development is affected by child poverty so to say i'll only go for recommendation number one which is the early years give every child the best start in life and ignore recommendation number four which was about people having enough money to lead a healthy life if people don't have enough money to lead a healthy life their children are going to grow up in poverty so one and four are linked number five was healthy and sustainable places in which to live and work we know that over the 10 years from 2010 the proportion of people who had to pay more than a third of their income on housing on rent that proportion went up and of course it follows the social gradient the poorer the household the more money they have to spend on rent so rent becomes a health issue because if you're paying a lot of money on rent you can't afford healthy eating food insecurity goes up so i deliberately didn't prioritize all six are important and we need government to deal with all six don't close sure start children's centers don't increase child poverty don't education don't reduce the spending on education by eight percent per pupil which is what happened after 2010 number three the right employment and working conditions the rise of the gig economy which is appalling number four i which i've just been talking about have enough money to lead a healthy life number five healthy and sustainable places in which to live and work including housing so don't say we're going to focus on education and ignore rough sleepers and other homeless people and number six was taking a social determinants approach to behavior looking at prevention in a social context so they're all vital i wanted action on all six and one of the problems of the decade from 2010 to 2020 is they pretty well all moved in the wrong direction and life expectancy i think especially in women in the northeast decreased i mean why why do you think women were worse affected than men any thoughts about that michael yeah we didn't say it in my report my february 2020 report but talking about it after the report what i should have said and didn't say there was an analysis that something like two-thirds of the impact of austerity fell on women the cuts disproportionately affected women and and and so you can see why it's credible that i mean the inequalities continue to be bigger in men than women but that adverse trend seemed to be marginally bigger in women than men and it may be because the effects of austerity were much bigger and the the impact for me of our idea that took root with the who commission which is that the health of a society helps you understand how well that society is doing so in that decade from 2010 to 2019-20 when life expectancy more or less stopped improving when inequalities got bigger and life expectancy for the poorest people outside london went down that tells us that society was not doing well and it means whatever you were doing in 2010 was causing damage the question is what but in retrospect well even at the time a lot of people said you can't cut everything in sight and expect nothing to happen if you cut funding to local government in a regressive way as we pointed out in my 2020 report for the least deprived 20 of local areas the spending per person went down by 16 and in the most deprived 20 it went down by 32 now if you assume all that money is being wasted so you can cut with impunity nothing will happen but what a remarkable assumption it's highly likely that not all that money was being wasted it was being spent on green space and libraries and shore start children's centers and social care for older people it wasn't all being wasted it was being spent on good things and if you do it you reduce it in a regressive way don't be surprised that they're ill effects and that's what i think we saw that miserable health picture that we described in february 2020 the politics of austerity and the results of austerity i think weren't realized at the time i mean it's surprising that that people didn't pick on up on it but then then or you know you've just uh uh enunciated the the uh that your your second report the 10 years on report but then that was just before covid came along and disrupted everything even more so let's let's look talk a little bit about covert because that's another of your most recent reports is that the impact of cobit on inequality so could you just tell us summarize that report yeah there was a lovely piece in the london review of books that um suggested that sales of albert camus the plague rose in line with the rise of kovitz 19. the more coveted 19 cases and deaths there were the more people went and bought camus the plague and what this review suggested uh quoting camus that the plague brings to the surface the reality of a corrupt society i thought that was putting it a bit too strongly i put it and said the plague coped 19 will expose the inequalities in society and amplify them and indeed that's what it did i mean you remember in the early days of the pandemic they said it's the great leveler you know people coming back from skiing holidays were getting sick and the prime minister the prince of wales and so on the great leveler but it was clear that that wouldn't last and what we saw with mortality from covet 19 was a very clear social gradient that looked almost exactly parallel to the social gradient immortality from all courses in other words the more deprived the area the higher the mortality from all causes and the higher the mortality from covert 19 almost exactly parallel which means the causes of inequalities in covet 19 and the causes of inequalities in health more generally overlap now for coven 19 there was some excess in the bottom three deciles which we think is related to frontline occupations and living in overcrowded multi-generational households but in general the inequalities were stark and similar to all causes and then of course you have the effect of lockdown closing the schools increases the educational divide kids from more advantage background their parents were doing home schooling they had better computer access to classes and the like kids from more deprived backgrounds nowhere to work at home parents less able to supervise homework schools less organized and they fell further behind the likelihood of being in a shuttered occupation increased in a linear fashion the poorer you were the lower your income the greater the likelihood of being in an occupation that in industry that closed down so we know that food insecurity went up during the pandemic it took a footballer to point that out sure so the pandemic exposed and amplified the inequalities in society and then the societal response to the pandemic increase the inequalities and that's why i called my second or third report last year the december report build bank fairer i said the status quo in february 2020 before the pandemic crashed upon us the status quo auntie was not desirable we do not want to go back to that we need to build back fairer take the pandemic and what happened as an opportunity to do things differently and and will our prime minister whose motto is built back better isn't it uh but i i must admit i like build back fairer more but will he listen do you think will the conservative government who who were behind austerity will they will they listen to your plea well debbie abrams mp asked the prime minister in parliament what he was planning to do about my report and we know that the prime minister is scrupulously honest and sticks to the truth so that when he said uh i admire michael marmont that had to be true he wouldn't have said it otherwise we've worked together for a long time that must be true and be assured that we will implement his report as we emerge so that was very reassuring um he's got the incentive of his red wall voters uh who are all in the northeast and the northwest and uh that's the area i think the northeast is slightly worse than the northwest in terms of deprivation the south yorkshire area and perhaps up to the humber and and so on so maybe i have talked to civil servants uh in the treasury and the cabinet office about the implications of my report for leveling up what they'll do with it i don't know but i've talked to them so in recent weeks so it comes back to the earlier question no one's listening in recent weeks i've talked to some senior conservatives and to civil servants as i said in the treasury and the cabinet office i've talked to liberal democrat peers and i've talked to senior labor politicians so i'll talk to anybody who will take the idea of social justice and a fair distribution of health and well-being take that idea seriously i want everybody to be working in that direction is there anything you think the medical profession i think there are million and a half people working in the nhs and of course you you could argue that you know the difference between the uk and the us is our nationalized health services makes a huge difference in terms of inequality i mean we've got lots of problems but america may have worse but can the medical profession actually do anything to help do you think well i have another evidence-based response to the question of um don't i get disgruntled disillusioned how do i stay enthusiastic the royal college of physicians set up a working group an advisory group on health inequalities and then they approached the other medical royal colleges so now they had a group a health and equalities alliance of the medical royal colleges and the royal college of nursing then they approached some other groups most of them initially began with british or with royal you know the british lung foundation british diabetic association the royal college of this that and the other they last time i looked this health inequality alliance of medical groups medical and nursing groups had 140 members right wow and so then the question is well what can the health service the health care service do and i've talked about five things when i was president of the british medical association we produced a report on what conductors do and the nurses are now producing a report on what can nurses do and we said education and training the second see the patient in broad perspective which is the good practice of medicine you don't treat homeless people and send them back onto the street so see the patient in broader perspective third the health sector as employer and i would now generalize that and say anchor institutions the hospital health care facilities having a positive impact on the community in which they're based the fourth is working in partnership and we have now social prescribing that's taken off and the fifth is advocacy being advocates to change things on behalf of the patients and the society that we serve so yeah there's a great deal the doctors nurses the health care system can do to address social determinants of health and that's a positive message let's turn to climate change because your other report and the uh the fourth report that i i've read today i've been reading all your works today uh michael let's talk about climate change and and um uh net zero uh and so on because they are interlinked are they inequality and probably climate change is is going to make things worse like in the same way that kovid did probably yeah i was invited by the government's climate change committee to convene a group to look at how actions to improve health could contribute to net zero greenhouse gas emissions because they asked me to do it i made it not just health but health equity avoidable inequalities in health and we had two clear messages one is don't take actions to reduce climate change and ignore inequalities so in other words look at the equity impact of your recommendations so i mean to take an extreme example if you make road pricing high enough then people can drive round in their mercedes and rolls royces uh with the hoi polloi off the roads or if you have to drive you just have to pay more and you get poorer so road pricing might be a very good way to deal with climate change but look at the equity impact of it don't just do it without regard to equity so that's one message the second message is a lot of the actions that we were suggesting would have the double benefit of dealing with the climate crisis and improving equity so making transport more sustainable making it safer to walk and cycle subsidizing public transport is good for the planet it reduces air pollution and air pollution is a contributor to inequalities in health so it has positive equity impact and health equity impact as well as being good for the planet and given how important both of these issues are the climate crisis and inequalities and both require reorganizing society in fairly fundamental ways let's do it at the same time that's why we called our report sustainable health equity yeah it's a it's a fantastic read so i'd really recommend that to our our viewers our listeners um let's give the british lung foundation a bit of a plug because you've present been president for a while and there's been been a merger with asthma uk i think which has given it uh impetus i'm sure um i was we were we had a rsm program on climate change that professor luxem has been organizing for us at the rsm and we had some speakers from india yesterday who was saying that during the covid lockdown in delhi for the first time they're able to see not just the himalayas but the first time they were able to see the sky the blue sky had been masked by pollution for children for all their young lives so the the you know air pollution is a massive issue isn't it i mean of course there's so many other issues but as a as a global health issue would you would you agree that it's one of the major things we're dealing we have to deal with yeah air pollution is a classic example of how we have to look at inequities between countries and inequities within countries at the same time in a rich country like britain the more deprived the area the worse the environmental quality we know if you look at schools in london schools in deprived areas have higher levels of air pollution than schools in non-deprived areas and you think that's appalling not only are our children being affected by growing up in a more deprived area their lungs are being damaged because the schools are surrounded by high levels of air pollution so there in our gross inequities within society and then between societies if you really want to see air pollution go to delhi go to mexico city go to cities in low and middle income countries and you see it now the who has estimated that there are something like seven million deaths annually attributable to air pollution half indoor air pollution and half ambient air pollution outdoor the indoor relates to cook cook stoves primitive cooking [Music] in low middle income countries and making environmentally friendly cooking stoves available is a very potentially positive contribution but half of it is outdoor pollution as you said in delhi i was in delhi in january 2020 before lockdown and from my hotel window i couldn't see the sky and as we were discussing before we came online around the time of my visit not while i was there the pollution was so bad that they did two things they cancelled a cricket match now you can imagine how bad the pollution has to be to cancel a cricket match in india they couldn't see the ball and it was so bad that they told people to stay home now having just been to delhi and seen the number of people who were sleeping on the streets i thought if you're told to stay home and home is the street what do you do and it comes back to your earlier question of which one would i address first and i said i'd address them all at the same time i want to make sure people had housing and i'd want to be addressing the levels of air pollution in a city like delhi last question because we're running out of time um the the we we've said that there hasn't been enough progress in the last decade in the uk in terms of fixing um inequalities in in britain but on a global scale uh the last decade the the 2010 to 2020 have had global inequalities diminished or are they have they got worse again we need to look within and between countries um the global inequalities between countries uh have improved if you uh look at the improvement in general in the african region in under five mortality um the the gap between the african region and other regions has diminished so the inequalities between countries have got less and where we've just done our report in the eastern mediterranean region the improvement in under five mortality in many countries has been very welcome really encouraging just terrific so um there's there are exceptions um countries that have slipped back and doing badly and we see in the eastern mediterranean region the impact of conflict life expectancy got worse in syria not just because of deaths and conflict but because of the incredible disruption of people's lives so conflict can have an adverse impact on health within countries what we've seen in britain regrettably is not unique many countries have had an increase in inequalities within countries the social gradients got steeper not everywhere but in many countries so that means continued challenge but if everything was going to hell that would be ghastly it isn't all going to hell as i said the between country inequalities in health in general have got smaller over the last decade well that's a positive message to end on so thank you so much apologies to the 73 people that sent in questions no way that i was going to be able to answer those and you're such a fluent speaker michael i thought it was was good to let you just tell your story um your story will go on youtube as of tomorrow or maybe the day after so if people have missed it and and or want to watch it again then they should be able to do so don't go away michael i've got a few announcements to make we're very proud of the other work that we do at the rsm the in conversation series is very popular but um we do our kovids series tomorrow and actually we've got the chief medical officer chris whittie uh uh answering questions to simon wesley the immediate past president uh is back and then simon wesley is appearing on desert island dis so don't forget to to watch that on friday at nine o'clock um next week we've got another in conversation with lady susan hayward jeremy hayward's wife who wrote a book what would jeremy think which really interesting book uh and uh that should be fun helen uh menages so we'll we'll be doing the interviewing and then on thursday uh we'll be talking to three people from europe about covid one from germany one from italy and one from france where the situation unfortunately does seem to be deteriorating fast so the last thing to say is that um of course the rsm is struggling for cash like so many uh institutions organizations we've got a 4.5 million pound loss this year because we can't use our hotel our restaurant our bar or our conference facilities so if anybody out there is feeling generous or would like to help us at the rsm continue with our program of education and uh supporting innovation in medicine please do uh send in a contribution michael it's been a such an honor to speak to you i mean your life work has just been absolutely astounding and i feel really humbled but also honored to have had the chance to speak to you so good night michael good night everybody and thank you so much for uh your contributions bye been my pleasure thank you

Channel: Royal Society of Medicine

Views: 3,143

Keywords: Royal Society of Medicine, In Conversation Live, Professor Sir Michael Marmot

Id: c6XvI2GtE6k

Length: 61min 31sec (3691 seconds)

Published: Thu Apr 01 2021