I would not blame you if you immediately thought this article to be some anti-establishment, sensationalist ‘fake news’ – conjured from a construed amalgamation of conspiracy and dystopian fantasy. Yet on the 9th of November, Sir Michael Marmot, director of the University College London Institute of Health Equity, presented his vision of Making health fairer in the year 2027 as part of Imagine2027’s series of talks. Why? Because as the 2008 World Health Organisation Commission on Social Determinants of Health report chaired by Marmot reasons: “social injustice is killing people on a grand scale”.

Amidst remarkable wit and humour, the professor of epidemiology narrated the life of Jimmy, a man from Calton — one of the most socially deprived districts in Glasgow. When Jimmy was a child, he was raised by a single mother who was perpetually ensnared in abusive relationships. When Jimmy started school, he already possessed behavioural problems and soon became registered with the police as a delinquent. When Jimmy left school, he could never find a proper job and funnelled all his earnings into drugs, alcohol, and fast food. Jimmy’s life expectancy is 54 - almost three decades lower than the male average in Lenzie which lies a mere 15 minutes’ drive away. Jimmy may only be a personification of the average Calton man, and the statistics Marmot references may be over a decade old. Yet many inequalities are still growing and form the dystopian reality of numerous individuals across the world.

According to Professor Ian Buchan’s research in the Journal of Epidemiology & Community Health, compared to the south, northern England’s excess mortality has risen among aged 25-44 since the mid-1990s. In the United States, widening health disparities that accompany economic inequality have been illustrated by Dr Samuel Dickman’s recent The Lancet article. So, if we and our governments merely stand aside and observe as such health gaps continue to rise, are we not intentionally severing lives short - killing through the poison of social disadvantage?

"It is not what you have that is important for health, but what you can do with what you have"

Sir Michael Marmot

So even though the politics of health reform may be a hateful chasm of despair, what else can we morally do but brave its depths? Some, no doubt, will argue that our government is doing their best. But Marmot begs to differ. “It’s so easy, conceptually, to address these problems,” reasoned the World Medical Association ex-president. According to his 2015 viewpoint published in The Lancet: “The poor of Glasgow are rich compared with the average in India, for example, but their health is worse…It is not what you have that is important for health, but what you can do with what you have.” How else can a community with less resources attain comparatively better health outcomes? What can we learn from the overperformers to improve our underperforming areas?

Lack of healthcare access is not the problem here. Marmot claims instead that it is the disempowering social gradient – in education, in employment, in living, working and social conditions – that corrodes mental and physical health starting from childhood. “But intervention at any stage of the life course can make a difference.” Marmot therefore proposes six solutions. Firstly, give all children the best start in life and alleviate child poverty. Secondly, maximise the potential of all individuals through skills training and whole school approaches. Thirdly, create fair employment and work – for example through improving active labour market policies. Fourthly, ensure healthy standards of living for everyone by tackling minimum income standards, minimum wages and benefit caps. Fifthly, develop healthy communities though environmental and housing policies, preventing social isolation. Lastly, strengthen the impact of preventative health priorities by addressing cost inflation, resource allocation and demographic pressures.

I understand that health equity may never truly be achievable. I understand that our governments do contribute towards healthcare – mortality is decreasing overall, and weeks ago I even reported a breakthrough in artificial cornea research that is funded by the British government. I understand that our governments have innumerable priorities: from preserving our safety and freedoms, to allowing the rich to grow richer through a paradise of tax loopholes even whilst the poor grow poorer. Nevertheless, we must ask ourselves whether we are doing all we can for these unfortunate individuals and families and communities. We must understand that every piece of neglect and inaction we offer from the comfort of our privilege is killing real human lives. Only then I believe, can we ensure that in ten years, we will not live in 1984. But you tell me