Sir Michael Marmot on why all matters are health matters
By Julia Belluz - Tuesday, August 14, 2012 - 0 Comments
Photo: Colin Leslie/The Medical Post
By the age of 25, Sir Michael Marmot, the first in his family to go to university, was already a practicing doctor with a secure future ahead of him. He should have been a contented man. But he wasn’t. As he tells it, he felt there were limits to how he could help his patients in his work as an MD. He saw people every day who were dealing with what he calls “problems in living” that seemed to lead to their poor health.
“At this inner-city hospital where I was working, we had a lot of immigrants at this time, and they would come in with pain in the tummy,” he told Science-ish in a gentle, grandfatherly whisper. “We’d give them some white mixture and send them home. And I’d think to myself, ‘they’ve come in with problems in living and we’ve given them a bottle of white mixture and told them to go back to the problems in living that they had before’.” For Marmot, it seemed like a futile approach: Patients’ problems needed to be addressed outside the walls of the clinic as well.
That’s why he left his secure job to move to California to study epidemiology, looking at disease trends in well-defined populations and how they correlated with people’s life circumstances. As Marmot recalls, his supervisor at the time— sociologist-turned-epidemiologist Leonard Syme—told him, “Just because you’re a doctor, doesn’t mean you understand the causes of ill health. You understand something about biology and medical conditions but you’ve got to learn something about society if you really want to understand the causes of ill health.”
Since then, Marmot, now 67, has led some of the world’s most compelling studies on the “social determinants of health.” In some 30 years of research on members of the British Civil Service, known as the Whitehall Studies, he established a link between their relative rank and risk of cardiovascular disease and death (the lower the status, the higher the risk). This, despite the fact that they were all relatively well off.
Marmot has looked at other health oddities, such as why residents of some areas of Glasgow, Scotland have a 28-year gap in life expectancy compared to those living in other neighbourhoods, and how the disease patterns of Japanese migrants in America transform to resemble those in their adopted fellow countrymen over time.
This research has shed light on the intuitions he had as a young doctor: There are real, tangible ways in which seemingly non-health related matters—where you live, your rank at work—impact human health. Now, the self-described “evidence-based optimist” is bringing his message to Canada’s doctors. Yesterday, Marmot, a research professor in epidemiology and public health at the University College London, was the special lecturer at the Canadian Medical Association general council meeting in Yellowknife.
During his address to what’s known as the Canadian parliament of medicine, Marmot won Science-ish’s heart when he said: “Let’s have a dream of a fairer world but let’s harness the evidence to have the pragmatism to achieve it.” Later on, he sat down with Science-ish to share insights about his life in science, the nature of evidence in policy, and the impact he hopes his research will have. Here’s an excerpt:
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The Insite ruling
By Aaron Wherry - Friday, September 30, 2011 at 9:53 AM - 41 Comments
Brian Howell/Maclean's
(This post last updated at 7:46pm)
The Supreme Court’s ruling on the Insite safe injection facility—a unanimous ruling in the facility’s favour—is here.
The Minister made a decision not to extend the exemption from the application of the federal drug laws to Insite. The effect of that decision, but for the trial judge’s interim order, would have been to prevent injection drug users from accessing the health services offered by Insite, threatening the health and indeed the lives of the potential clients. The Minister’s decision thus engages the claimants’ s. 7 interests and constitutes a limit on their s. 7 rights. Based on the information available to the Minister, this limit is not in accordance with the principles of fundamental justice. It is arbitrary, undermining the very purposes of the CDSA, which include public health and safety. It is also grossly disproportionate: the potential denial of health services and the correlative increase in the risk of death and disease to injection drug users outweigh any benefit that might be derived from maintaining an absolute prohibition on possession of illegal drugs on Insite’s premises.
Early reads from the Globe, Canadian Press, Postmedia, Star and CBC.
10:33am. Libby Davies, whose riding includes the Insite facility, applauds. Three years ago she lectured Tony Clement and called on him to abandon the government’s appeal.
10:46am. Liberal health critic Hedy Fry applauds.
10:51am. The Canadian Public Health Association applauds.
11:37am. Ms. Davies raised the court’s decision in QP just now, provoking a response from Health Minister Leona Aglukkaq. Continue…
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Is MMA as dangerous as it looks?
By Cathy Gulli - Wednesday, September 28, 2011 at 12:10 PM - 0 Comments
Two Calgary trauma doctors who oppose the MMA ban want better data to know the true dangers
Felipe Dana/AP
Horseback riding and mixed martial arts have little in common, except to Dr. Chad Ball. A few years ago, he conducted a study revealing how injured Canadian riders are different from those described by researchers in places such as New Zealand and Australia, where the typical patient is a young, inexperienced female practising English-style riding. In Canada, it is a man in his 40s with decades of western-style experience and a veteran horse. “Cowboys,” says Ball, a Calgary trauma surgeon. “They’re all over.”
So too are mixed martial arts fighters: Alberta has several promoters and leagues devoted to the full-contact combat sport, which combines boxing, wrestling and martial arts. The Ultimate Fighting Championship (UFC), which promotes MMA internationally, drew more than 55,000 fans to Toronto in April for a series of bloody matches. Knowing the sport’s popularity, and recalling how his equestrian study presented a different reality than previous research, Ball was skeptical when the Canadian Medical Association proposed banning MMA last year. Is this sport “savage and brutal,” like the CMA claims, or is it just perceived that way because the matches are gory? Is it really more dangerous than other sports, wondered Ball?
With this in mind, he and fellow surgeon Dr. Elijah Dixon wrote a response to the CMA published in the Canadian Journal of Surgery in February. They argue the proposal is based on “emotion, not evidence,” and note the dearth of long-term studies. The best data shows fighters get concussions in three per cent of matches, and a quarter of matches are stopped for head shots. At Foothills Medical Centre, where Ball and Dixon work, none of the eight trauma surgeons have admitted an MMA fighter—despite seeing 1,100 severely injured patients a year.
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Defending our moderately well-regarded name
By Aaron Wherry - Tuesday, July 28, 2009 at 1:54 PM - 7 Comments
Ujjal Dosanjh, now pretty much a member of the Obama administration, keeps up his efforts to defend the nation, this time on NPR. The full discussion, including the former head of the Canadian Medical Association, can be found here. Dosanjh has uploaded his contribution to YouTube.
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'Efficient integration'
By Aaron Wherry - Tuesday, April 7, 2009 at 11:10 AM - 52 Comments
Keith Martin wants to reform the health care system.
If we fail to modernize our health care system and live with the illusion that we have the “best” system, more and more people, particularly those of modest means, will fail to receive the care they need. This would be a national disgrace — and an entirely avoidable one at that. We can have the best health care system in the world, but we must adopt those solutions that will allow us to achieve this noble goal. We must have courage and we must not fear change.
