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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