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'Punchily written ... He leaves the reader with a sense of the gross injustice of a world where health outcomes are so unevenly distributed' Times Literary Supplement 'Splendid and necessary' Henry Marsh, author of Do No Harm, New Statesman There are dramatic differences in health between countries and within countries. But this is not a simple matter of rich and poor. A poor man in Glasgow is rich compared to the average Indian, but the Glaswegian's life expectancy is 8 years shorter. The Indian is dying of infectious disease linked to his poverty; the Glaswegian of violent death, suicide, heart disease linked to a rich country's version of disadvantage. In all countries, people at relative social disadvantage suffer health disadvantage, dramatically so. Within countries, the higher the social status of individuals the better is their health. These health inequalities defy usual explanations. Conventional approaches to improving health have emphasised access to technical solutions - improved medical care, sanitation, and control of disease vectors; or behaviours - smoking, drinking - obesity, linked to diabetes, heart disease and cancer. These approaches only go so far. Creating the conditions for people to lead flourishing lives, and thus empowering individuals and communities, is key to reduction of health inequalities. In addition to the scale of material success, your position in the social hierarchy also directly affects your health, the higher you are on the social scale, the longer you will live and the better your health will be. As people change rank, so their health risk changes. What makes these health inequalities unjust is that evidence from round the world shows we know what to do to make them smaller. This new evidence is compelling. It has the potential to change radically the way we think about health, and indeed society.
Why do Oscar winners live for an average of four years longer than other Hollywood actors? Who experiences the most stress - the decision-makers or those who carry out their orders? Why do the Japanese have better health than other rich populations, and Keralans in India have better health than other poor populations - and what do they have in common? In this eye-opening book, internationally renowned epidemiologist Michael Marmot sets out to answer these and many other fascinating questions in order to understand the relationship between where we stand in the social hierarchy and our health and longevity. It is based on more than thirty years of front-line research between health and social circumstances. Marmot's work has taken him round the world showing the similar patterns that could be affecting the length of your life - and how you can change it.
The Strategy of Preventive Medicine by Geoffrey Rose, first
published in 1993, remains a key text for anyone involved in
preventive medicine. Rose's insights into the inextricable
relationship between ill health, or deviance, in individuals and
populations they come from, have transformed our whole approach to
strategies for improving health. His personal and unique book,
based on many years research, sets out the case that the essential
determinants of the health of society are to be found in its mass
characteristics. The deviant minority can only be understood when
seen in its societal context, and effective prevention requires
changes which involve the population as a whole. He explores the
options for prevention, considering them from various viewpoints -
theoretical and scientific, sociological and political, practical
and ethical. The applications of his ideas are illustrated by a
variety of examples ranging from heart disease to alcoholism to
road accidents. His pioneering work focused on a population wide
approach to the prevention of common medical and behavioral
disorders has become the classic text on the subject.
Health inequalities according to people's social standing are persisting, or even growing, in modern societies. Recent decades have revealed evidence of strong variations in life expectancy, both between countries and within them. This widening of social inequalities has developed despite considerable progress in medical science and an increase in health care spending. The reasons behind this are complex, and the implications considerable. This book provides a summary of the major achievements of a five-year European Science Foundation (ESF) Programme on 'Social Variations in Health Expectancy in Europe'. The contributors are major figures in their subjects, and combine state of the art reviews with the latest results from interdisciplinary research in epidemiology, sociology, psychology and biomedicine. Three conceptual frameworks of life course influences, health effects of stressful environments, and macro social determinants of health, are unified, while each chapter addresses the policy implications and recommendations derived from currently available evidence. The major topics covered include the role of family in early life, social integration and health, work stress and job security, successful ways of facing adversity, and the impact of the larger environment on health. Epidemiologists, public health research and policy makers, and students of related public health and sociology courses wlll find the results of this research fascinating.
Coronary heart disease is the leading cause of death worldwide affecting millions of people in both developed and developing countries. The dual aims of this book are to review the well-established and emerging risk factors in coronary heart disease and to apply this knowledge to public health approaches to disease prevention. The book includes authoritative accounts of studies within a single population and international studies, important areas of methodological development, trials to test preventive strategies, and the application of epidemiological and other knowledge to the development of public health policy for the prevention of widespread disease. It is an all-encompassing work containing contributions from the world authorities in the field. The book is divided into four sections. The introduction reviews advances in the understanding of, and the current status, of risk factors for CHD. Section 2 looks at recent global trends and emerging patterns of CHD morbidity and mortality in several countries, and includes chapters on work done under the auspices of WHO on the global burden of disease in relation to smoking and blood pressure. Section 3 focuses on advances in understanding the aetiology of CHD with each chapter focused on a particular risk factor. Section 4 explores measures of prevention and intervention in terms of public health policy with specific examples from around the world.
Social Determinants of Health, 2E gives an authoritative overview
of the social and economic factors which are known to be the most
powerful determinants of population health in modern societies.
Written by acknowledged experts in each field, it provides
accessible summaries of the scientific justification for isolating
different aspects of social and economic life as the primary
determinants of a population's health.
There are dramatic differences in health between countries and within countries. But this is not a simple matter of rich and poor. A poor man in Glasgow is rich compared to the average Indian, but the Glaswegian's life expectancy is 8 years shorter. The Indian is dying of infectious disease linked to his poverty; the Glaswegian of violent death, suicide, heart disease linked to a rich country's version of disadvantage. In all countries, people at relative social disadvantage suffer health disadvantage, dramatically so. Within countries, the higher the social status of individuals the better is their health. These health inequalities defy usual explanations. Conventional approaches to improving health have emphasised access to technical solutions - improved medical care, sanitation, and control of disease vectors; or behaviours - smoking, drinking - obesity, linked to diabetes, heart disease and cancer. These approaches only go so far. Creating the conditions for people to lead flourishing lives, and thus empowering individuals and communities, is key to reduction of health inequalities. In addition to the scale of material success, your position in the social hierarchy also directly affects your health, the higher you are on the social scale, the longer you will live and the better your health will be. As people change rank, so their health risk changes. What makes these health inequalities unjust is that evidence from round the world shows we know what to do to make them smaller. This new evidence is compelling. It has the potential to change radically the way we think about health, and indeed society.
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