Yesterday evening I attended the inaugural Windsor Ethics Lecture at Cumberland Lodge, delivered by Professor Sir Michael Marmot. He spoke with great passion about the relationship between health and wealth, arguing from an evidence base of extensive global research that health is largely determined by social conditions (and not, contra the arguments of many an eminent economist, vice versa). Prof. Marmot was refreshingly open about his rhetorical intentions, taking a prior accusation that he was presenting “ideology with evidence” as a compliment rather than a criticism. The ideology simply being that avoidable health inequalities are wrong, with evidence employed to reduce health inequalities and not cause further harms. It is well documented that there are significant differences in average life expectancies across the globe, and even within cities, where the differences between populations are primarily social (in Glasgow, there is a difference of 28 years average life expectancy for men, in areas only 11km apart). Prof. Marmot firmly believes that his mission to understand and ultimately reduce these inequalities is a profoundly ethical one, based on the moral claim that the value of human life is (and should be) non-monetised and equal across all people.
This anchoring in the valuation of human life helped me spot an obvious connection I had previously missed when reading around literature on the social determinants of health, and that drew on much of my recent thinking. Lately, I have been considering the potential role the medical humanities might have to play in public discourses around health and illness. Prof. Marmot’s lecture prompted me to realise that thinking about the relationship between social conditions and health (and illness) might help provide a framework for the medical humanities, to structure its engagement with the public, clinicians, policy makers and funders, as well as other academic disciplines. The medical humanities does, after all, aim to get at health and illness from the inside, as it were, tackling such profound questions as what it means to have dignity and wellbeing in one’s life and health, how coping and resilience can be developed through illness, and how social and cultural structures can influence the experience of being well and being ill over time. If health is to a large extent a matter of social determination, then the medical humanities should have a prominent role to play in articulating some of the ways in which these social factors operate in human behaviour and capabilities concerning health.
Whilst thinking along these lines during the lecture, I was struck by the illustrative power of the literary references that peppered Prof. Marmot’s talk: from vivid descriptions the choking, noxious Coketown in Dickens’ Hard Times, to the poignant social insights of poverty-stricken Arthur Doolittle in George Bernard Shaw’s Pygmalion, Prof. Marmot presented a compelling argument that poor social conditions lead to poor health. The examples, although fictitious, enriched the narrative power of his claim that that the steep gradient of health inequality between richer and poorer is a moral wrong. Furthermore, they buttressed his position against a tide of economic opinion that financially correct decisions in health are necessarily the right ones, as these are not always the kinds of decisions that make us human, or happy, or fulfilled. Prof. Marmot made a persuasive case for bringing the human back into healthcare and discourse around the social determinants of health: I believe medical humanities scholars will be gratified to have such an ally in their endeavours to humanise health.