Episode 2: Is Disease a Failure of Prevention?
Health is often perceived as a matter of personal responsibility—eat well, exercise, avoid smoking, and visit the doctor when necessary. But what if health outcomes were largely determined by factors beyond individual control? This was the central theme of Monash University Malaysia's Future Conversations podcast, where Professor Meera Siva Soathy spoke with Professor Sir Michael G. Marmot, a global authority on health equity and the social determinants of health.
Sir Michael, an epidemiologist at University College London and the Director of the UCL Institute of Health Equity, has spent decades researching how social conditions shape health. His work challenges the traditional notion that economic success leads to better health. Instead, it's the other way around—better health enables economic success. His landmark 2010 Marmot Review continues to shape policies worldwide, advocating that social disadvantage leads to poor health and must be addressed systematically.
From his early days as a medical student, Sir Michael questioned the reactive nature of healthcare. "Disease is failed prevention," he reflected. "Why wait until someone has cancer or heart disease when we could prevent these conditions in the first place?"
Yet, despite evidence supporting preventive measures, societies remain largely focused on treatment. Governments prioritise hospitals over health-promoting policies, and the conversation often stalls at access to healthcare. While universal healthcare is crucial, Sir Michael argues that it only scratches the surface. Addressing the root causes (poverty, education, housing and employment) would yield far greater improvements in public health.
The Six (Now Eight) Marmot Principles
Sir Michael's research culminated in the 2010 Marmot Review, which identified six areas for enhancing health equity. Following the COVID-19 pandemic, he expanded the framework to include two additional domains:
- Give every child the best start in life.
- Enable all children, young people and adults to maximise their capabilities and have control over their lives.
- Create fair employment and good work for all.
- Ensure a healthy standard of living for all.
- Create and develop healthy and sustainable places and communities.
- Strengthen the role and impact of ill health prevention.
- Tackle racism, discrimination and their outcomes.
- Pursue environmental sustainability and health equity together.
These principles recognise that health disparities arise not from individual choices alone but from societal structures that systematically disadvantage certain groups. A glaring example was the disproportionate impact of COVID-19 on ethnic minorities, which underscored the need for sustained attention to racial and socio-economic inequalities.
One of the biggest challenges in implementing these principles is governmental fragmentation. Ministries operate in silos. Health departments focus on hospitals, education departments on schools, and transport departments on roads—rarely coordinating efforts. Sir Michael highlighted that local governments often demonstrate better cross-sector collaboration. In places like Coventry, which adopted the Marmot approach, policymakers, healthcare providers, educators, and social services work together to improve community health.
A decade after the 2010 Marmot Review, Sir Michael revisited its findings. The results were alarming. Life expectancy improvements had stalled, health inequalities had widened, and in the poorest areas, life expectancy had actually declined. Government austerity measures slashed funding for local services, exacerbating social inequalities.
For instance, cuts to early childhood programs led to rising child poverty, while reductions in local government budgets (by up to 59 per cent) strained public services. Predictably, these factors contributed to worsening health outcomes. Yet, rather than addressing the evidence, policymakers dismissed it. "They rejected it not because it was wrong but because they didn't like it," Sir Michael noted.
Malaysia faces its own unique challenges, particularly in health funding. Public healthcare spending remains below 5 per cent of GDP, a figure Sir Michael suggests is inadequate. However, he cautions against equating health spending with health outcomes. "It's not just about healthcare budgets. It's about investing in education, housing, social protection and fair wages," he explained.
A Call to Action
Sir Michael remains committed to turning research into action. He stressed that monitoring progress is critical. Places like Coventry use Marmot Monitoring Tools to track improvements. He also highlighted the power of local initiatives, noting that nearly 50 cities across the UK have now adopted Marmot principles.
Becoming a "Marmot city" or even a "Marmot nation" is an exciting possibility for Malaysia. However, achieving true health equity requires more than dialogue. It demands political will, coordinated policy changes, and community engagement.
As the interview concluded, Sir Michael left listeners with a powerful message: "Put equity of health and well-being at the heart of all policymaking. What we're trying to do is create a fairer society where everyone can flourish."
Tune into the podcast for deeper insights and the full spectrum of ideas discussed. This is one conversation you won't want to miss! Click here to watch the full podcast.
Monash University Malaysia's Future Conversations promises to be a vital platform for engaging with the big questions shaping our world.