Written by Helen Stedeford (UCL Life & Medical Sciences)

Public health expert Sir Michael Marmot introduced his book The Health Gap by sharing the story of Mary, a First Nations Canadian who hanged herself aged 14. Every case is tragically unique, however the suicide rate among young First Nations members is five times higher than for other young Canadians – why? The suicide rate for Indian cotton farmers is much higher than for Indians in other rural occupations – why? Poverty – at least that’s part of the answer.

Using case studies and population statistics, Marmot illustrated the social gradient in health, which is found in all societies; those at the top of the income ladder have low levels of disease and long lives, and with each step down the ladder the chance of physical and mental illness, and early death, increases. So began a fascinating evening of discussion between Marmot, The Lancet’s Tamara Lucas and audience members.

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My friend was sceptical. “I don’t know, I think opt-out is too much. There’s enough information out there for people to make a decision.”

“But there clearly isn’t enough,” I said. “People are still dying!”

We were arguing about organ donation in the UK, and the hundreds of people a year that die waiting for a transplant. Should we introduce an opt-out system, so that those who do not elect to be removed from the register are considered donors?

I had been strongly in favour. The apathy of millions with no need for their organs after death, I thought, was leaving potential recipients to die.

But an event at the Cheltenham Science Festival challenged me to think again and consider new facets of organ donation. In Organs for Sale, Emily Thackray told her compelling story of the cystic fibrosis that devastated her lungs, and the transplant that eventually saved her life. Ethicist Bobbie Farsides and surgeon Keith Rigg joined in to discuss the wider issues.

The problem we face is effectively one of supply and demand. When organs deteriorate, medical technology may be able to step in – renal dialysis for kidney problems, for example – but in some cases only another human organ will suffice. And we don’t have enough: three people in the UK die waiting for an organ transplant every day. How do we reconcile the organs available with the numbers who need them?

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Thursday 8 March saw worldwide celebrations for International Women’s Day, one of which was held at Stanmore College. The College linked into a live stream of the UCL lunch hour lecture titled ‘Having it all – dispelling the myths about work and motherhood’ which was delivered by Dr Anne McMunn (UCL Department of Epidemiology & Public Health).

Dr McMunn presented fascinating data which indicated that there are significant behavioral differences between daughters of mothers who work and those who stay at home; the behavior of those whose mothers go out to work being more positive. Interestingly, the significance was not as high with regard to sons. Data was also provided to show that the BMI (body mass index) for mothers who work tends to be healthier than for those who remain at home.

Watch the full lunch hour lecture below

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Far from ‘closing the gap’ in life expectancy, health inequalities in Europe have deepened further. Drawing upon his forthcoming review of health inequalities in Europe, Michael Marmotargued that social inequalities, with their impact on life expectancy, should be at the top of the public agenda and we should place fairness at the heart of decision-making for health.

Integral to Marmot’s work is the graded relationship between social deprivation and a multitude of health outcomes. He reports that male life expectancy in the Russian Federation is 20 years less than in Iceland, but also highlights “huge differences within countries” and that “the gradient is increasing”.

Alcohol use: a cause or consequence of inequality?
What is driving the social gradient in health? Panel member Christopher Gerry stressed that “Alcohol matters”, and quoting Richard Peto said: “More than half of all deaths of people of working age in Russia are caused by alcohol.” But importantly, Gerry identified alcohol as just the proximate cause: “What makes people drink in the way that they do is the real question.”

Marmot was quick to distinguish between immediate causes and the underlying psychosocial mechanisms that drive unhealthy behaviours. In the case of Russia: “Some people are utterly convinced that alcohol plays a role, the main role” in health inequalities. But he disagreed, while acknowledging its role in violent deaths.

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