ONLINE EXCLUSIVE

Engaging with health
May 2007

The number of children living in relative poverty in the UK has risen by 200,000 over the last year, and campaigners across the country are predicting that the Government is doomed to fail in its pledge to halve child poverty by 2010. Jacob Lonsdale asks Professor Sir Michael Marmot - renowned academic, author of Status Syndrome, chair of the WHO's Commission on Social Determinants of Health and Principal Investigator of the Whitehall studies of British civil servants - how we might better engage with Government and other stakeholders to further the health inequalities agenda.

Is the Government not then responsive to your message?
I think on the health inequalities agenda it's just been incredibly encouraging. The fact that it's been a priority for Government, they've taken it seriously, successive Secretaries of State for Health have all seen this as important. One has to keep pushing, but they are receptive to the pushing! Elections don't get fought on what the government is doing about obesity. Elections get fought on whether somebody had to wait to get their heart operated on - a child didn't get treatment for heart disease, or an old person didn't have their cancer treated, or whatever.

Do you think that is all changing?
It might be. I used to do this with new groups of students; I would just look at the newspapers for a week before the group started. Almost all the health issues covered in the newspapers were public health issues - without stretching the definition of public health too far. It was a way of saying to them, that's what people are interested in. They're interested in getting treated if they get sick, and they're interested in how well they get treated when they get sick, but there's a lot of media interest in public health issues, whether it's the environment, obesity, lifestyle or drinking. The inequalities agenda, which I've been engaged in for a long time… there is media interest, of course, but it's slightly more amorphous. To say that, look, the differences in education by local education authority are crucial if for no other reason than that they… These differences we see in education according to degrees of deprivation are very important for health. So there's lots of media coverage of things that are relevant to health, but they don't always make the link with health inequalities.

Is media coverage a useful tool for pushing the health agenda?
I don't pursue it. I think it is a useful tool, so I don't flee it the way I used to! I used to flee when journalists came around, and now I think our research is publicly funded, we have a responsibility to communicate the findings, we publish in medical journals, but it's important to get it out there. The second thing is that I'm much more interested now in influencing the agenda than I used to be. I haven't got to the extent of pursuing media coverage, but at least not turning my back when they come calling.

Do you not think you have an increasing celebrity?
Well, I'm not aware of it. If it's true someone forgot to inform me!

Have you worked with business as well as government?
No, I haven't really. It's not that I think business is irrelevant to health - I mean, on the food agenda, for example, they're potentially very important. But they do have different aims, and the question is can you align aims or not? I suppose you could make the same case about government, but putting the argument that everything we are trying to do is to improve health and reduce inequalities, it's hard for somebody in government to say no, we don't to do that. Industry, whatever else they may say, they'd say 'that's not our number one priority'. Their priority is profit.

So is that something you might do in future?
Um… Not necessarily! If I'd wanted to, when I started to produce evidence that moderate consumption of alcohol is protective against heart disease, I had people from industry knock on my door. I just thought, it's important to keep a respectable distance.

How have you worked with NGOs in the past?
I think NGOs are absolutely crucial in public health because they play a very important role in influencing the agenda and creating public discussion. I mean, the more it becomes something the public talk about, the more likely it is that politicians will take it seriously. And in the end, the more likely is industry to take it seriously. So NGOs have a very important role to play in changing the climate of understanding.