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  1. Spotlight on Policy
21 September 2023

The Policy Ask with Michael Marmot: “Listen to advice from older people, but feel free to ignore it”

The professor of health inequalities on telling the truth, knowing the numbers, and staying close to the evidence.

By Spotlight

Sir Michael Marmot is professor of epidemiology at University College London and the director of the UCL Institute of Health Equity. In 2010 he authored the Marmot Review of health inequalities, which has shaped policy discussions for over a decade. His follow-up review a decade on, published just before the Covid-19 pandemic, highlighted the impact of a decade of austerity on health disparities in the UK.

How do you start your working day?

On a good day, by 9am I’ve made progress on the piece that I’m working on writing, I’ve had some lovely exercise and green space and had a nice breakfast and I’m ready to go again. Not all days are as good as that!

What has been your career high?

Chairing the World Health Organisation (WHO) commission on social determinants of health was a high in a way. I found myself chairing this commission with the former president of Chile, the former prime minister of Mozambique and former ministers of health, women, and social development from Senegal. The high was in getting this very disparate group of really experienced, influential people to look at the world in a unified way.

What’s been the most challenging moment of your career?

They go together, the highs and the challenges. The WHO global commission was extremely challenging because of the enormous task and at the same time there were political challenges because we were upsetting people. I think I’ve probably upset people in the current government because I tell the truth and I refer to the facts that show they’ve been messing up.

If you could give your younger self career advice, what would it be?

Don’t listen to advice from older people, or maybe listen to advice from older people but feel no compunction about ignoring it.

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Which political figure inspires you?

There are two that come to mind. It was an absolute privilege to work with President Lagos of Chile on my WHO commission when he stepped down from the presidency. I felt he had integrity. He was also close to the evidence and the detail and knew how to communicate it very effectively. The second is Gordon Brown. I didn’t know him, but he was prime minister when I did the Marmot Review, and so it was his premiership that got me to do it. He knows the numbers and I have great respect for somebody who knows the numbers and stays close to the evidence, but who also has a broader vision.

What policy or fund is the UK government getting right?

They’re not doing very well and I’m afraid it’s a good deal easier to point to the policies that they’ve got wrong than the ones that they’re getting right. They did have an energy price guarantee, which last winter made a difference in people’s lives.

And what policy should be the UK government scrap?

The most recent one is the Illegal Migration Act. What does it say about us as a country and who do we want to be? People are cynical about politicians and politicians have worked hard to create that cynicism.

What upcoming UK policy or law are you most looking forward to?

I would like the government to take my six domains of recommendations as the basis for social policy for the country. I have now added two: deal with racism, discrimination and their consequences; and tackle the climate emergency and health equity together.

What piece of international government policy could the UK learn from? 

At the request of the Norwegian government we wrote a report on social determinants and health equity in Norway. Proportionate universalism is fundamental to Norwegian social policy.

If you could pass a law this year, what would it be?

As part of its health mission, Labour has promised to build on the Marmot City movement and make England a “Marmot Country”. That means action on the social determinants of health.

[See also: How London and Boston are using their financial muscle to divest from fossil fuels]

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