The 2016 Boyer Lecture Series titled Fair Australia: Social Justice and the Health Gap, were delivered by Professor Sir Michael Marmot, President of the World Medical Association, Director of the Institute of Health Equity and a leading researcher on health inequality issues for more than three decades.
Sir Michael’s lectures explored the challenges faced by communities in solving issues around health inequality.
You can now watch recordings of the lectures:
There are large inequalities in health within and between countries. Areas of deprivation are characterised not only by poor health, but high rates of crime and civil unrest. In Australia, understandably there is great concern at the huge health gap between indigenous and non-indigenous Australians. But in the non-indigenous population there is a social gradient in health: the higher the education or income the better the health. To explain this we have to look at the social determinants of health: the conditions in which people are born, grow, live, work and age; and inequities in power, money and resources.
The high rate of youth suicide in young Aboriginals in Australia and Canada alert us to the importance of early child development in all Australians. The good side of early childhood is the nurturing of psychological, linguistic, social, emotional and behavioural development. The bad side comes from adverse child experiences. Both of these follow the social gradient—the more well-off the family the better is early child development. Absence of the nurturing and presence of the harmful are important for the whole of life and are strong contributors to inequalities in health in adult life. There is much we can do to make things better at both the level of national policy and at the local level supporting families and children.
Unemployment is bad for health, but work can damage health, too. Jobs characterised by high demands and low control, imbalance between efforts and reward, organisational injustice, shift work and job insecurity increase risk of physical and mental illness. The lower the position in the social hierarchy the greater the concentration of these stressful characteristics. When work is no longer the way out of poverty, health suffers.
My evidence-based optimism is fuelled by examples, from round the world, of actions that make a difference to health inequalities. We need government action but action by communities, too. We should be seeking to create the conditions for individuals to take control over their lives. The aim is a more just society that enables social flourishing of all its members.