Prolog: När jag i våras skrev om Wilkinson & Picket (The spirit level) fick jag en del mail med innebörden att jag borde läsa Michael Marmot. Det gjorde jag inte i någon större utsträckning, men jag stötte på en festlig prick vid namn David Canning, som då pysslade med att skriva om Marmots bok Fair Society, Healthy Lives till Social Science and Medicine.
Några nyckelcitat ur recensionen:
We view the socioeconomic gradient in health to be large part the result of differentials in health, reversing the direction of causality put forward in the Marmot reports. Direct health interventions, particularly in child health, are therefore mechanisms for improving both health and socioeconomic outcomes. ...
Economists have been guilty in the past of focusing too much on income per capita as a measure of wellbeing. A more plausible view ... is that wellbeing is multidimensional ... If we combine health and income into a single welfare measure, over half of the gains in welfare in the last 50 years ... come from health rather than income improvement ...
There is no doubt that some of this link is causal running from socio-economic status to health ... The health story is not really about moving along a fixed income-health relationship, rather it is the upward shift of the whole curve with rising levels of health at each income level over time.
This rising level of health in developing countries has been due to public health measures such as clean water, sanitation, vaccination, oral rehydration, and targeted programs ...These health technologies were originally implemented in rich countries, widening world health inequalities, but since the 1960s have spread around the world leading to rising levels of health even in very poor countries.
We see the rise in life expectancy between 1970 and 2005 as a major welfare gain for the United States, Marmot would presumable see it as a failure since the health-income gradient has become steeper and the standard deviation in life expectancy has increased ... Marmot is implicitly arguing for a shift away from economic growth, and new technologies as the driving force for health improvements to a focus on social fairness as a mechanism. ...
All of this debate however misses the key point that the health-income link is to a large extent driven by the effect of health on income. Our view is that ... investments in early child health in developing countries can have large effects on their physical and cognitive development and health as adults. For example, nutritional supplements, deworming, and the prevention of malaria, can lead to large gains in educational attainments and adult earnings ...
In developed countries the intergenerational transmission seems to run from low socio-economic status parents, to poor health as a child, to low socio-economic status as an adult ... Marmot argues for breaking this chain by intervening on socioeconomic status, while we see childhood health interventions as an easier way of breaking the destructive cycle. We therefore see investments in ... early childhood health, as a method of improving the socio-economic status ... the health-income relationship reflects, in large part, causality running from health to income
Källa: Canning, D., Bowser, D. Investing in Health to Improve the Wellbeing of the Disadvantaged: Reversing the Argument of Fair Society, Healthy Lives (The Marmot Review), Social Science & Medicine(2010), doi: 10.1016/j.socscimed.2010.07.009