Marmot, M; (2017) Capabilities, Human Flourishing and the Health Gap. Journal of Human Development and Capabilities , 18 (3) pp. 370-383. 10.1080/19452829.2017.1342362.

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Abstract

Amartya Sen’s insights have been important to my work in at least four ways: providing intellectual justification for my empirical findings that health can be an “outcome” of social and economic processes; providing insight into the debate on relative or absolute inequality; emphasising the central place of freedoms or agency in human well-being; and alerting me to the importance of the question of “inequality of what”. This last is shameful to admit for someone, me, who had been pursuing research on inequalities in health for two decades before I met Sen in person and in his writings. Could I really be obsessed with health inequalities without recognising that there was more than one way to think about inequality? In this Amartya Sen lecture, I will start by sketching briefly how these seminal ideas of Sen influence what I do. More accurately, I should say how Sen’s ideas influence how I think about what I do. For, as just stated, I had been doing it for some time before I encountered Sen’s fundamental contributions—I am a doctor and medical scientist, after all. In particular, my research on health inequalities has focussed on the social gradient in health, its generalisability, how to understand its causes and what to do about it. I have pursued this research since 1976 when I began work on the first Whitehall study (Marmot, M. G., G. Rose, M. Shipley, and P. J. Hamilton. 1978b. “Employment Grade and Coronary Heart Disease in British Civil Servants.” Journal of Epidemiology and Community Health. 32: 244–9), and to think about health inequalities more generally (Marmot, M. G., A. M. Adelstein, N. Robinson, and G. A. Rose. 1978a. “Changing Social-Class Distribution of Heart Disease.” British Medical Journal. 2: 1109–1112). Although I had not used the term, “social determinants of health” until later (Marmot, M., J. Siegrist, T. Theorell, and A. Feeney. 1999. “Health and the Psychosocial Environment at Work.” In Social Determinants of Health, edited by M. Marmot and R. G. Wilkinson, 105–131), my research on health inequalities fitted that description, along with the research on health of migrants (Marmot and Syme 1976. “Acculturation and Coronary Heart Disease in Japanese Americans.” American Journal of Epidemiology. 104: 225–247; Marmot, M. G., A. M. Adelstein, and L. Bulusu. 1984. “Lessons From the Study of Immigrant Mortality.” Lancet. 323: 1455–1458.) I will then illustrate the approach in more detail, drawing on my book, The Health Gap (M M 2015).

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