Marmot – Whitehall study

The thing about the Whitehall study of British civil servants, Whitehall and Whitehall II, the two studies we’ve done, is it excludes the richest people in society, and it excludes the poorest people in society, and Britain of course on a world scale is a very rich society. And yet we’ve found this remarkable social gradient. And that’s when I coined the term “social gradient in health”. So people second from the top who have university educations, stable jobs, reasonable housing, reasonable salaries, good job prospects for the future, have worse health than those above them. And so it is, all the way down in the social hierarchy. 

And when we first found that, in the Whitehall Studies, people said “well there’s something odd about civil servants”.  But in fact, everywhere we look in the national figures in Britain, and now, I’ve been sitting through a conference on early child development where people were presenting data from Canada, from Chile, from Australia, from Cuba, from elsewhere – other parts of Latin America, everywhere you look, you find this gradient. 

And the implications of the gradient are quite profound. Everybody’s against poverty. They may not want to do anything about it but everybody knows poverty’s a bad thing, and conceptually, it doesn’t sound very complicated, poverty? Well people don’t have enough money, and they don’t have housing, and in the developing world they don’t have clean water of sufficient food or shelter – fix it and health will improve. And so it will. But the gradient means that we’ve got to deal not only with the poorest of the poor, but people in the middle who have worse health than those above. The gradient means we’re all involved.  And that means that action’s got to be across the whole of society, not simply, as if it were simple, the poorest of the poor.