Making Social Determinants of Health Matter: An Interview With Sir Michael Marmot

Sir Michael Marmot and Ryan Meili, family physician at the West Side Community Clinic in Saskatoon discuss the Social Determinants of Health and the evidence that the SDOH are getting more widely known among the population. 

Introduction

The social determinants of health approach has been applied to many populations but, strangely, not often to men’s health. Two exceptions are Professor John J. Macdonald's Australian National Male Health Policy and his 2006 article in the Australian Medical Journal Shifting paradigms: a social-determinants approach to solving problems in men’s health policy and practice. The social determinants of health approach helps us towards a more evidence-based and compassionate approach to men’s health.

Overview

There's a debate and criticism around the term "Social Determinants of Health". To some the term feels incomplete, and it should be socioeconomic, socio-political etc. Sir Michael states that understanding the meaning of this term is what is crucial. What people worry about in their lives will affect and influence their health, factors like: housing, security, jobs, neighbourhoods etc.

Sir Michael feels that the role of physicians is not only to cure the sick, but to find out the underlying causes for illness and address the conditions that made them sick. Prevention of illness must be the focus to making people, communities and populations well, namely addressing the social determinants of illness. Doctors can incorporate this concept in their day-to-day practice if they are provided with tools to address them, such as getting appropriate training and support from partners in the community, or find out what's available to assist patients with their social circumstances. Simply handing out medication is not enough, but there's a need to deal with the real problem.

In order to get to the causes of the causes Sir Michael is looking at the conditions in which people are born, grow, live, work and age and sees the impact it has on people's health and the evidence for that. Not caring about people's living conditions and turning a blind eye is unacceptable.

The social determinants of health needs to be a political issue that parties should address, and engaging the public in issues that are important to them like affordable housing, good neighbourhoods and good schools for our children are all beneficial to health and part of the social determinants of health. The public, in turn, need to engage the politicians.

Sir Michael uses stories to communicate and engage with the public. He spends a lot of time looking at evidence and statistical data, and adding a story about triumph over adversity -things getting better - have a big impact because they are inspiring, and the evidence shows that you are making a difference.

He has written a new book called The Health Gap The Challenge of an Unequal World  available in Australia in October 2015.

About Sir Michael Marmot

Sir Michael Gideon Marmot, FBA, FMedSci, FRCP is Professor of Epidemiology and Public Health at University College London, and has for the past 30 years led a research group on health inequalities.

He is engaged in research on the social determinants of health and leads the English Longitudinal Study of Ageing (ELSA). He is also the Chair of the Department of Health Scientific Reference Group making efforts to deal with health inequalities, and Chair of the commission on Social Determinants of Health, as well as Vice President of the Academia Europaea.

Sir Michael was knighted in 2000 by Her Majesty the Queen for services to Epiemiology and understanding health inequalities. Sir Michael has also won awards in Epidemiology and Health Services Research, and is an honorary fellow of the British Academy. (WHO)