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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EImagine a world where there was equality in health care. Imagine that access to a doctor and treatment was unrelated to race, skin color, native country, employment, or the social circumstance into which one was born. This is the world Sir Michael Marmot, FRCP, University College, London, United Kingdom, asked Scientific Sessions 2007 attendees to work toward, in the Lewis A. Conner Memorial Lecture.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eaffordability of care\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eprevention \u0026amp; screening\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003E\n            \u003Cem\u003E\u201cRise up with me against the organization of misery.\u201d\u003C\/em\u003E \u223cPablo Neruda\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EImagine a world where there was equality in health care. Imagine that access to a doctor and treatment was unrelated to race, skin color, native country, employment, or the social circumstance into which one was born. This is the world Sir Michael Marmot, FRCP, University College, London, United Kingdom, asked Scientific Sessions attendees to work toward, in the Lewis A. Conner Memorial Lecture. \u201cThe issue of disparity in health, or as we call them inequalities or inequities of health, is one of key concern, and it is one that an audience such as this will find central to their activities,\u201d said Dr. Marmot. Such inequalities arise not only from inadequate processes but also social situations, education, and employment. That the level of education of people is related to their mortality has previously been demonstrated. \u201c[Health inequity] is a gradient that runs across the whole of society,\u201d and is not solely a problem of poverty. This difference is evident even within a single country. For example, in Glasgow, Scotland, \u201cdeprived\u201d social classes have a life expectancy of 54 years, whereas more affluent people can live to be 82. Such inequalities are not inevitable\u2014changes in life expectancy occur over time; therefore they can be changed. Some countries see improvement over time, while others may experience decline (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/7\/5\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Trends in Life Expectancy \u0026#x2013; Regions.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-690983254\u0022 data-figure-caption=\u0022Trends in Life Expectancy \u0026#x2013; Regions.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/7\/5\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/7\/5\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/7\/5\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10938\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003ETrends in Life Expectancy \u2013 Regions.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-5\u0022\u003ESir Marmot has been involved in the large Whitehall epidemiological studies of British civil servants for over 30 years, which have yielded important insights regarding improved health and life expectancy. One of the key messages is that it is not just money and health insurance that drive the equation. \u201cWe need to look at poverty in a different way; it\u0027s not simply poverty of material conditions, and it\u0027s not simply low income. Indeed, among richer countries, income shows very little relationship to life expectancy,\u201d said Dr. Marmot.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EHe gave as an example a recent study that evaluated the relative health of residents in the United States compared with a similar sample in the United Kingdom. Data were extracted from large epidemiological surveys in both countries\u2014the US Health and Retirement Survey and National Health and Nutrition Examination Survey in the US, and the English Longitudinal Study of Aging and Health Survey for the UK. The US spends nearly double per capita what is spent on health care in the UK. However, the results of this study indicate that Americans are by and large less healthy than their UK counterparts, as illustrated in the table below:\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/10941\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/10941\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10941\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EThese findings were consistent in both self-reported and biological measures. Additionally, 94% of Americans in this sample had health insurance coverage; yet they had higher rates of chronic illness such as cardiovascular disease, obesity, and cancer. \u201cAs important as health care is, it\u0027s not the whole story,\u201d commented Sir Marmot. In terms of the probability of living to age 65, the US ranks 33\u003Csup\u003Erd\u003C\/sup\u003E in the world for men, and 36\u003Csup\u003Eth\u003C\/sup\u003E in the world for women (United Nations Development Program 2005), despite spending 15% of the gross domestic product on health care. \u201cWhy don\u0027t you drop everything else and ask why are Americans so unhealthy despite the phenomenal amount that you spend on health care?\u201d asked Sir Marmot.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003ETraditional risk factors such as smoking, drinking, and obesity did not account for the great health differences between the US and the UK, indicating that other factors are involved. The circumstances in which people live and work may hold the key. Job strain, defined as a combination of highly stressful work with a lack of job control, was found to be significantly associated with cardiovascular disease in the Whitehall II study (Kivimaki et al. \u003Cem\u003EAm J Hypertens\u003C\/em\u003E 2007). De Vogli et al (\u003Cem\u003EJ Epidemiol Community Health\u003C\/em\u003E 2007) also found a strong relationship between unfairness in the workplace and the incidence of cardiovascular events (hazard ratio 1.55, 95% CI 1.11\u20132.17) and poor physical (odds ratio 1.46, 95% CI 1.20\u20131.77) and mental (odds ratio 1.54, 95% CI 1.19\u20131.99) health in the Whitehall II survey. \u201cWe think that people having control over their own lives is vital,\u201d emphasized Sir Marmot.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003ESir Marmot currently chairs a World Health Organization commission on social determinants. He told of a successful example of giving people living in poverty more control over their own jobs and lives, leading to better health outcomes. The organization is called the Self-Employed Women\u0027s Association (SEWA), which was established in Gujarat, India, to help the 600,000 marginalized women in India who sell vegetables. Through this organization, women have received microcredit, childcare, health care, and the removal of barriers to fair business practices. The SEWA program has been so successful, that they are now focusing on pensions for the participants. \u201cWe work under the assumption that health care is central to our lives, that health is a value that everyone has. Health equity is a matter of social justice. If there are inequalities in health care that could be put right if we took appropriate action, then it is unfair and unjust that we do not do it,\u201d concluded Sir Marmot.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EFor more information visit \u003Ca href=\u0022http:\/\/www.sewa.org\u0022\u003Ewww.sewa.org\u003C\/a\u003E\n         \u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/7\/5.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzm6j1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm6j1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzm6j1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}