On the 8th January, the LCA opened the 2020 events calendar by hosting a well attended dinner at the Athenaeum, at which Sir Michael Marmot spoke passionately about the impact of social determinants on long-term health. Sir Michael, a Professor of Epidemiology at UCL, set-up and led a number of longitudinal cohort studies, including the Whitehall Studies of British Civil Servants investigating explanations for the striking inverse social gradient in morbidity and mortality. In 2000 he was knighted in recognition of his services to epidemiology and to the understanding of health inequalities. In 2010 he undertook a strategic review of health inequalities for the government, producing the landmark study Fair Society, Healthy Lives. An expert panel of the Royal Society for Public Health selected the 2010 Marmot review as the 3rd greatest UK public health achievement of the 21st century after the ban on smoking in public spaces and workplaces, and the sugar levy on soft drinks.

On the evening, Sir Michael discussed how life expectancy in England had improved ‘about one year every four years since the end of World War One,’ but that this improvement stopped in 2011. The majority of people in poverty are in a household where at least one adult is working. There been a rise in mortality from what he described as ‘deaths of despair’. Sir Michael used the Royal Borough of Kensington & Chelsea, which has one of the widest inequalities in income, to illustrate his point. There is a fourteen year difference in average lifespan between the highest and lowest income families within this borough. Childhood deprivation has a long-term effect not only on life span, but also on attainment and productivity. Successive governments focus on care delivery at the expense of social care funding and have contributed to an unequal society in which choices are dictated by social circumstance.

Sir Michael ended his talk by stressing the need for a social determinant approach to prevention so to allow for a more equal and meritorious society. His talk was the followed by a lively Q&A in which it was argued that there should be de-stigmatisation of privately-funded healthcare, and that this would allow for publicly funded resources to be deployed to those in greater need.