Sir Michael Marmot synthesizes decades of research to show that health outcomes are shaped far beyond medical care, driven by what he calls the social determinants of health-the conditions in which people are born, grow, live, work, and age. He highlights the pervasive social gradient in health: across societies, those lower on the socioeconomic ladder experience greater illness and shorter life expectancy-even among people above the poverty line-underscoring that inequality itself, not just poverty, harms health. Drawing on examples like the Whitehall Studies and stark life-expectancy gaps between nearby neighbourhoods, Marmot argues that to improve public health, society must tackle inequities in education, employment, housing, income, and community empowerment.
To close the health gap, Marmot proposes a holistic, justice-driven policy agenda rooted in proportionate universalism-universal services calibrated to needs-spanning early childhood support, quality education, fair work, healthy living conditions, prevention strategies, and empowering communities. He emphasizes that evidence and interventions exist, but political determination and cross-sector collaboration are essential. Marmot’s core message: health equity is an issue of social justice, and addressing it demands coordinated societal action, not merely healthcare improvements.