Sir Michael Marmot delves into the fundamental social determinants of health, showing that health outcomes are shaped far beyond the healthcare system-by factors such as income, education, housing, working conditions, and neighbourhood environments. Drawing on decades of research-including his landmark Whitehall Studies-Marmot highlights the health gradient, where each step down the socioeconomic ladder correlates with poorer health and shorter life expectancy. He stresses that inequality is not inevitable and that policy can meaningfully narrow this gap by addressing the “causes of the causes” that underpin disparities in health.
Marmot argues that closing this health gap requires evidence-driven, comprehensive policies, focusing on early childhood investment, fair employment, decent living conditions, and community empowerment. He advocates for “proportionate universalism”-providing universal services but with enhanced support targeted to those with greatest need. Marmot emphasizes that sustainable progress hinges on political will, societal commitment, and cross-sector collaboration. Instead of isolated medical interventions, we need systemic change to target the socioeconomic roots of health inequality.