Sir Michael Marmot

Presenter0:00

Hello, I'm Kirsty Young. Thank you for downloading this podcast of Desert Island Discs from BBC Radio 4. For rights reasons the music choices are shorter than in the radio broadcast.

Presenter0:10

For more information about the programme, please visit bbc.co.uk/slash radio four.

Presenter0:35

My castaway this week is Sir Michael Marmot, Professor of Epidemiology and Public Health and Director of the Institute of Health Equity at University College London. He specialises in what are known as the social determinants of health. That's to say, how where we are in the wealth and status pecking order directly influences our chances of illness, disease, and lifespan. Why is it, for example, that in twenty fourteen in the same British city, the average life expectancy for a man in one postcode will be eighty two, but just a few miles away it's fifty four?

Presenter1:10

Born in London just after the war to Jewish immigrants, his father then decided to move his wife and young children across the world to Australia.

Presenter1:18

The first in his family to go to university, it was during his training as a young doctor in Sydney that it occurred to him that medicine was failed prevention, and that in order to really understand disease you have to look at the society people live in.

Presenter1:32

Up until then he claims he didn't actually know what epidemiology was.

Presenter1:36

His pioneering research is often at odds with wider societal concerns over what are known these days as lifestyle choices, like smoking, not taking any exercise, or eating junk. But he says simply What I contribute to the policy debate is that I bring evidence. I don't do the skullduggery of politics.

Presenter1:57

Can you really do what you do then, Sir Michael, and avoid the scullduggery of politics, I wonder?

Sir Michael Marmot2:03

I maintain the fiction to myself that what I do is not political.

Sir Michael Marmot2:08

A colleague in Sweden said to me recently, What you do is highly political, because there are clear political implications of the evidence that you bring.

Sir Michael Marmot2:18

I say it as clearly as I know how.

Sir Michael Marmot2:20

What I don't do is get into backrooms and trade it and

Sir Michael Marmot2:25

all those sorts of things. But I do bring the evidence and I do present it in a way that I hope has clear policy implications, and policy implications ultimately become political.

Presenter2:37

At the heart of what you do is the belief, the evidence. You would say that social injustice is killing on a grand scale, and that is a very strong statement. Are you able to sum it up in a nutshell for listeners?

Sir Michael Marmot2:50

What we said in the report of the WHO Commission on Social Determinants of Health.

Presenter2:55

That's the world health.

Sir Michael Marmot2:56

The World Health Organization is the conditions in which people are born.

Sir Michael Marmot3:01

Grow, live.

Sir Michael Marmot3:03

Work and age are fundamental to health and health inequalities, and inequities in power.

Sir Michael Marmot3:11

Money and resources drive those inequities in daily life.

Sir Michael Marmot3:16

And that's why I say social injustice is killing on a grand scale.

Presenter3:21

Doubtless we're going to get into a bit more of the detail of much of the fascinating research that you've spent your life working on, but for now tell me about this first disc we're going to hear this morning.

Sir Michael Marmot3:30

Well, the very first piece of research I did was a study of men of Japanese ancestry living in Japan, Hawaii and California. So I got very interested in Japanese culture. But I was doing that in Berkeley, California, and that's where I discovered opera. My wife and I could get ushers' tickets for $5 and go across to San Francisco Opera, which is one of the great opera houses in the US, and for $5 we could hear this wonderful opera.

Sir Michael Marmot3:59

It had to be Puccini's Madame Butterfly.

Speaker 24:43

Only on

Presenter4:57

Une Beldi from Madam Butterfly by Puccini sung there by Mirella Freni with the Vianaphilharmonic conducted by Herbert von Karrigan.

Presenter5:05

So, Professor Sir Michael Marmot, let's talk a little bit more about your work then. You are well known for something called the White Hole Studies. They threw up compelling evidence.

Presenter5:14

Of something called the health gradient theory. Can you explain to me what that is?

Sir Michael Marmot5:18

Yeah.

Sir Michael Marmot5:19

At the time I started working on this study of British civil servants, the first Whitehall study,

Sir Michael Marmot5:25

Everybody knew that stress caused heart attacks, and everybody knew that the people who were stressed were people who had highly responsible jobs, were managers, people at the top.

Sir Michael Marmot5:37

What I showed in the Whitehall study is that was completely wrong.

Sir Michael Marmot5:41

The lower people were in the hierarchy, the higher the mortality from heart disease, and a whole range of other diseases. People said, well, civil servants, they wouldn't know what it was like to be stressed. But what we found in civil servants turned out to be true everywhere else we looked. The lower people were in the hierarchy, the higher their rate of heart disease, and a range of other diseases. And that led me to say, whoever put out the rumour that it was more stressful to be at the top? That was presumably put across by people at the top.

Presenter6:15

Possibility then that those who as they were higher up in the stratas of management and so on in the civil service presumably were on a higher income and were better educated and therefore were more likely to simply look after themselves better, you know, to smoke fewer cigarettes, to eat better food, to consume less booze and so on and so on.

Sir Michael Marmot6:36

Well, the booze actually goes the other way. People consume more booze the higher up they are, and that's been a general finding in Britain. And forgive me, that's even more true of women than it is true of men.

Presenter6:50

I don't know why you're looking at me.

Sir Michael Marmot6:52

The higher the status, the more likely people are to drink. But the other things you say are correct.

Presenter6:52

I have this

Presenter6:55

Right.

Sir Michael Marmot6:57

But what we found in people who were not smokers, who were not having a terrible diet, who were not obese, we still found the social gradient. So that was not the whole explanation. Now, people are not randomly allocated to positions in the hierarchy, so education is clearly important. And my later work has put great emphasis on early child development and education. But nevertheless, what we showed, actually studying it in the second Whitehall study, is that stressful circumstances at work a combination of low control.

Sir Michael Marmot7:32

High demand.

Sir Michael Marmot7:33

and low support at work.

Sir Michael Marmot7:36

increased risk of heart disease and mental illness.

Presenter7:39

The difficulty there is that somebody always has to be in charge and there always has to be a structure. Now we can think of probably off the top of our heads, you know, working environments, some of us will have experienced them, where there's this sort of gloss of participation. We're listening to you, of course, your view is as important as the managing director's view. But actually in the end, somebody's got to run the business and somebody's got to be underneath them doing the stressful work. How on earth do we reconfigure workplaces to make them less stressful and still productive?

Sir Michael Marmot8:08

What the evidence shows is that all workplaces are hierarchical, but the link between where you are in the hierarchy and

Sir Michael Marmot8:18

this stress of high demand, low control or imbalance between effort and reward, that link can be broken. You can actually run a workplace that says the beating won't stop until morale improves.

Sir Michael Marmot8:34

Or you can run a workplace that puts real emphasis on morale and involvement, and I would say that the evidence suggests a happier workforce is a more productive and a healthier workforce.

Presenter8:47

Who is listening? Where have you noted that actually there are maybe specific industries or specific companies where they've said this makes sense to us?

Presenter8:55

And we're gonna change things.

Sir Michael Marmot8:56

Well in the Nordic countries they really have listened.

Sir Michael Marmot9:01

that stress at work.

Sir Michael Marmot9:03

is seen as bad as physical and chemical hazards at work.

Sir Michael Marmot9:09

And they have mechanisms for actually dealing with these kinds of stressful circumstances at work. More generally, on the social determinants of health. I can point and I point to evidence, of course, that's what I do.

Sir Michael Marmot9:25

The review that I did in England, the so-called Marmot Review,

Sir Michael Marmot9:29

Three quarters of local authorities in England have Marmot implementation plans. They are not only listening, they're saying how can we look at the six domains of recommendations that I made and put them into action.

Presenter9:45

It's the case, I believe, that once when you came across somebody that was implementing the the Marmot recommendations, he said, Oh, Marmot's actually a person, is he at?

Presenter9:54

Did that seem odd to you that people didn't connect all the way?

Sir Michael Marmot9:55

That I'd become a verb, they were marmatizing.

Presenter10:02

You're very much a person, you're very much here, and let's listen to your second choice of the morning then. What is it? Disc two, tell us about that.

Sir Michael Marmot10:09

The first piece of music I owned was Sibelius.

Sir Michael Marmot10:14

When I think about the work that I'd been doing firstly as a researcher and now much more involved in policy and talking to governments, I travel a great deal. So I go to Sweden, to Norway, to Finland, Denmark, Iceland, half a dozen times a year. I had to have something from that part of the world.

Presenter10:33

Let's hear it.

Presenter11:25

That was part of the third movement of Sebelius' violin concerto played there by Maxime Wengeroff with the Chicago Symphony Orchestra conducted by Daniel Baramborn.

Presenter11:34

Let's take a little journey back then to where and when you were born. It was uh just directly after the war, nineteen forty five. You were born in North London to uh Jewish immigrant parents. What what are your earliest memories of life at home? I think the words

Sir Michael Marmot11:48

Little class were invented to describe my family, and because my parents had both left school at fourteen and felt they'd been denied the opportunity to have an education, education was emphasized very greatly. You will have the opportunities that we didn't.

Presenter12:04

You will.

Presenter12:08

And a kosher house was Jewishness important to the rituals and the ebb and flow of life at home?

Sir Michael Marmot12:13

Yes, I always felt I had a cultural richness. There was something extra that life brought other than

Sir Michael Marmot12:21

the humdrum of going to school.

Presenter12:23

Your father then had a bit of a restless soul. He wanted to take his family on to was it was it bigger and better things, or he just wanted a bit of an adventure?

Sir Michael Marmot12:31

My father was rather impulsive. There was rationing after the war, things were tough, and he said

Sir Michael Marmot12:38

Let's go to Shanghai.

Sir Michael Marmot12:39

Why Shanghai? He had been in Shanghai in the late 1920s.

Sir Michael Marmot12:45

and he'd worked there. So in nineteen forty nine he thought would be a good time to set up as a petty bourgeois in Shanghai. So he said to my mother, I'm off to Shanghai.

Sir Michael Marmot12:57

And my mother got a phone call.

Sir Michael Marmot13:00

And she said, Where are you? He said, I'm in Sydney.

Sir Michael Marmot13:03

I thought you were going to China? Well, I went to China, but it wasn't a very good time. But it's great here.

Sir Michael Marmot13:08

Bring the children were settling in Sydney.

Sir Michael Marmot13:11

And my dutiful, faithful mother sold the house, brought the children, got on a steamship, sailed for six weeks, and went off to Sydney, Australia.

Presenter13:20

And what about your arrival in those first days and weeks and months? I mean, you'd gone from, you know, austerity Britain with its low grey skies and rationing to presumably a place that might have seemed a little like the promised land.

Sir Michael Marmot13:31

Uh

Sir Michael Marmot13:31

Well, I remember that we went swimming.

Sir Michael Marmot13:35

And

Sir Michael Marmot13:36

Australians said to my mother, What are you doing, letting those boys go swimming in the middle of winter?

Sir Michael Marmot13:42

It was August.

Sir Michael Marmot13:44

But in Australia August is middle of winter. It was glorious summer's day as we thought, coming from England, and we went swimming. No Australian would go in the water in August.

Presenter13:54

Let's have your third piece of music then, Sir Michael Marmot. Tell me about your

Sir Michael Marmot13:58

Yeah.

Presenter13:58

Third choice of the morning.

Sir Michael Marmot13:59

Yeah.

Presenter14:00

Yeah.

Sir Michael Marmot14:00

When my oldest brother went off to the United States, travelling as a youngster, he sent my mother some music.

Sir Michael Marmot14:08

And he sent us some Yiddish music, he sent us some Hebrew music, and he sent her filler on the roof.

Sir Michael Marmot14:15

And I'd be upstairs doing my homework, and be listening to these sounds coming from downstairs, as my mother would play this thinking of the sun that was across the ocean. But then

Sir Michael Marmot14:27

My daughter at university

Sir Michael Marmot14:29

actually performed in Fiddler on the Roof, and performed this very piece we're going to hear. And at the end of it, I went up when it was all over and I gave her a hug, and she said

Sir Michael Marmot14:40

You're not crying, are you, Daddy? she said, pleased, and I said, No, no, it's the wind in the wind in the theatre.

Speaker 314:48

Our popo make him a scholar Our mama made him rich as a king and me well I wouldn't tolerate He were as handsome as anything Matchmaker, matchmaker, make me a match Find me a fine catch me a catch Night after night in the dark I'm alone So find me a match of my own

Speaker 215:11

Yeah.

Presenter15:11

Yeah.

Speaker 215:13

Of my

Presenter15:17

Matchmaker from Fiddler on the Roof. Rosalind Harris was singing the part of decital there. Of course, my son the Doctor is an old joke, but your Jewish immigrant parents, did they

Presenter15:28

Not quite.

Presenter15:29

force you into medicine, but weren't they very keen that this young boy who got straight A's and presumably was doing as well in science as everything else, headed for a profession?

Sir Michael Marmot15:38

They were very keen that I went for profession.

Sir Michael Marmot15:42

I was really interested in science, and then when it came to enrolling in university I thought I could always change from medicine to science, not the other way, and I quite wanted to be useful. Medicine seemed like a good choice.

Presenter15:56

You qualified as a doctor then. You were working in a hospital in Sydney. Where did this it's such a powerful phrase, and I mentioned it in the introduction. You've said that it occurred to you that as you would take clinics and see patients, and so on and so on, that medicine was a failed prevention.

Sir Michael Marmot16:13

It was just seeing what I saw on the wards.

Sir Michael Marmot16:17

And there was a immigrant community close by the teaching hospital where I was working, and patients would come in who couldn't speak English very well.

Sir Michael Marmot16:27

And they'd complain of some nonspecific pain in the belly, and we'd give them a bottle of white mixture and send them home. And I thought they've come in with a problem in living.

Sir Michael Marmot16:38

and we've given them a bottle of white mixture. This seemed ridiculous. And then we were treating people with cardiac failure or chronic respiratory disease, and we'd patch them up and send them home brilliant thing to do, make people feel better, and they're back again three months later.

Sir Michael Marmot16:54

I thought there's got to be a better way.

Presenter16:55

Way of doing this. And I presume that you voiced your concerns to your superiors and said, you know, there's got to be a better way of doing this.

Sir Michael Marmot17:02

I did. And what did they say? You're a thorn in the side, or words to that effect. In my final year of medicine as an undergraduate, one surgeon said, Let me give you

Presenter17:03

And what did they say?

Sir Michael Marmot17:13

A bit of advice. You've got a lot of stuff to learn. Stop asking questions. It'll get you into trouble.

Sir Michael Marmot17:20

Let's have

Presenter17:20

Uh

Sir Michael Marmot17:21

The music, Sir Michael Marmot, what are we going to have now? Your fourth?

Sir Michael Marmot17:24

When my wife and I, or she wasn't my wife at the time, but when we left Australia, we went on the hippie trail through India and Nepal. And then we went to Berkeley, California, where we both studied. I did a PhD in epidemiology. My wife's an architect. And Indian music was a big part of our lives. And you couldn't be in Berkeley in the early 70s and not be thinking about the philosophy of the East. And I had this wonderful image of this little house we lived in. It was a funny little house, but it was perched up on a hill in Berkeley, overlooking the Golden Gate and San Francisco Bay. And on a Sunday morning, we would put on a raga. And as...

Sir Michael Marmot18:10

San Francisco woke up.

Sir Michael Marmot18:13

And the music woke up and we would be listening to this. But now I still have close contacts with India. I work with colleagues in Gujarat, in Ahmedabad, the Self-Employed Women's Association. And one of my sons has close contact with India. So for all these reasons, I had to have something Indian.

Speaker 218:44

Um

Speaker 218:53

Yupi Ducky Supply.

Presenter19:29

Ravishankar playing Raga Mishra Gara and memories for you Professor Sir Michael Marmos of being in that house on a Sunday morning.

Presenter19:38

And just briefly, the PhD that you were studying was to do with Japanese men and heart disease and how where they were affected the outcomes of their health.

Sir Michael Marmot19:46

Well, quite a remarkable natural experiment. That if you thought that heart disease was genetic, how come when Japanese migrate across the Pacific?

Sir Michael Marmot19:57

Those in Hawaii had an intermediate rate of heart disease between the low rates in Japan and the high rates in the US, and those in California had a higher rate, but not as high as the white American rate. So I did my PhD on this so-called Nihon Sand study, Nippon, Honolulu, San Francisco, but showing that the more acculturated the Japanese in California were, the more westernized they became.

Sir Michael Marmot20:26

The higher the rate of heart disease, the more they clung on to traditional Japanese culture, while making a success of being immigrants in the country, the lower the rate of heart disease. And it seemed that Japanese culture had stress reducing devices that were protecting Japanese from whatever it was about the Western lifestyle that was causing

Presenter20:47

Entirely fascinating. Time for some more music then, Michael. What are we going to hear now? Your fifth.

Sir Michael Marmot20:53

Yeah.

Presenter20:54

We came to Britain.

Sir Michael Marmot20:54

Yeah.

Sir Michael Marmot20:55

In my case, back to Britain, which has been wonderful.

Sir Michael Marmot20:58

And one of the first pieces of music we heard live was Peter Grimes at Covent Garden. My wife loves Benjamin Britton, loves Peter Grimes. So if I were stranded, I could play this and I could think this is a piece of music that my wife particularly loves.

Presenter22:18

Oh, hang at open doors the net of the court from Peter Grimes by Benjamin Britton, performed there by the chorus and orchestra of the Royal Opera House at Covent Garden, conducted by Sir Colin Davis. So, Sir Michael Marmont, you were pretty well known, it'd be fair to say, among international academic circles, when you wrote your book Status Syndrome. That was back in two thousand four. That propelled a lot of what had, up until then, been academically recognised research out into the public domain.

Presenter22:44

Was that your intention? Did you want to spark a bigger debate?

Sir Michael Marmot22:48

Yeah, very much I did. In public health, the research we do.

Sir Michael Marmot22:54

you have in mind that it might have some impact, and it's not going to have impact if it's simply published in the medical journals. You've got to get a broader public debate. So I think both publishing a book which I hoped would be read by more people than just my academic peers, and

Sir Michael Marmot23:12

the Commission on Social Determinants of Health would be a way both of getting greater public engagement and trying to package what we knew to have policy implications.

Presenter23:23

So in Status Syndrome, you go into great detail about the ways in which we can improve people's lives. You've mentioned briefly this morning more control at work, more money put into childhood development and also resources for older people, people further down the line.

Presenter23:38

Given that right now we are currently seeing in this age of austerity a lot of public services cut back to the bone, what would you say to those who think that these strategies that you talk about are all very well for a sort of utopian society, but when we're dealing with the harsh reality of finances and taxation in the twenty first century,

Presenter23:57

We've got to do what we've got to do.

Sir Michael Marmot23:59

What I would say to economists or politicians who are advised by economists is if you're having some abstruse argument over economic theory, put health equity at the heart of all policy making. If you're

Sir Michael Marmot24:13

Economic and social policies will damage children.

Sir Michael Marmot24:17

then they're indefensible.

Sir Michael Marmot24:19

I realize that I'm only one voice.

Sir Michael Marmot24:22

But

Sir Michael Marmot24:23

I'm going to say it as clearly as I know how. If your economic policies are

Sir Michael Marmot24:28

Have the potential to damage children, then they're wrong. You should be doing something different. So rather than say, yes, we've got austerity, yes, it's all very difficult.

Sir Michael Marmot24:39

Of course, we've got austerity, but these are political choices we're making, and a political choice.

Sir Michael Marmot24:46

not to put money into early child development, not to support older people. Now in fact, in Britain, we made the choice that we'll try and maintain the standards for older people.

Sir Michael Marmot24:58

while we're increasing child poverty.

Sir Michael Marmot25:01

I would say arguing from the evidence, that's a bad choice.

Presenter25:06

Much personal responsibility do you think families should have for making the best of their circumstances? You know, surely.

Presenter25:13

Nudging people, encouraging people, maybe even requiring people to take responsibility is a positive and important step. It's not to say that we the state will feed your children a healthy school breakfast when they come to school, but actually you, the parent, need to do that at home because that's part of what being a parent is about.

Sir Michael Marmot25:32

If you look at the evidence on early child development, we see two things very clearly. One is the poorer the area in which children are born and grow up, the worse the early child development in general. So relieve poverty, reduce inequality, and we will reduce inequalities in early child development. What you also see is a second phenomenon. For a given level of deprivation,

Sir Michael Marmot25:56

some families are doing better than others. And that means there's a second strategy. One is to reduce economic and social disadvantage, but the other is understand better why some families in some areas are doing better than others. And I think we know quite a good deal about that.

Presenter26:14

I mentioned the study that you often quote about um the people in a certain postcode. It happens to be Glasgow actually, within a few miles of each other, if you are born in Lenzie, an affluent part of a Glasgow suburb.

Sir Michael Marmot26:20

With an

Presenter26:26

You are likely as a man to die at the age of eighty two. If you are born just a few miles away, you are likely to die at fifty four. How do we explain, in just a few short miles, that two men living at the same time can have such radically different experiences of life expectancy?

Sir Michael Marmot26:40

A detective inspector in Glasgow told me a case study which is typical of a boy whose mother had multiple partners. He was abused by virtually every single one of his mother's multiple partners. They moved house, if not every year, every year and a half. By the time he got to school, he'd already been labelled as having behavioural problems. As soon as he was old enough, he was labelled as delinquent.

Sir Michael Marmot27:10

He got involved in gangs. He knifed somebody at age 18. He came before the judge and this dreadful case history was read out. And the judge must have been a statistician because he said nothing unusual about that. So it began at the beginning of life, right through from a disadvantaged childhood, poor education, no skills, no job, no employment.

Presenter27:37

When you say to politicians it is this early intervention and it is money that is put into childhood development that is crucial and will save you money later, whether it's in the prison system or the benefit system and so on and so on, do you get the feeling that they are listening here in Britain?

Sir Michael Marmot27:51

I know they're listening at local level.

Sir Michael Marmot27:54

Because we go around and we've got

Sir Michael Marmot27:57

Mahmood being implemented at local level.

Sir Michael Marmot28:00

But I think they're listening at national level as well. I don't think.

Sir Michael Marmot28:05

There is a politician who would say I don't care about children. They may differ as to what they're going to do about it. Time for some music. Let's hear your sixth. What are we going to hear?

Sir Michael Marmot28:15

I once had the conceit that I could write a book and begin every chapter with some opera.

Sir Michael Marmot28:23

Figure out

Sir Michael Marmot28:24

Well, it's about class, isn't it?

Sir Michael Marmot28:27

The servant class actually run r rings round the aristocracy and make them look really stupid.

Sir Michael Marmot28:35

Really the reason for choosing Figaro is the music is divine.

Speaker 228:57

Um

Speaker 229:04

I know enough.

Speaker 229:12

Okay.

Speaker 229:13

Uh quarter

Presenter29:28

De Weni Ntardar from Mozart's Marriage of Figaro, sung by Bargara Hendricks with the Academy of St. Martin in the fields, conducted there by Neville Mariner. So, Sir Michael Marmont, you're recognised, as we know, as an international authority in the field that we've been talking about this morning. You sit on a number of research panels, you've been knighted, you've received countless awards and accolades. How active are you still in researching, or has your life

Presenter29:54

Transformed into something different now after all these years of being an academic.

Sir Michael Marmot29:59

I'm not at the front line of research, although I work with younger colleagues who are at the front line. We discuss data and evidence and work on papers. But much more I'm involved in the implications of the research.

Presenter30:12

Yeah.

Presenter30:13

Tell me where is health currently best in the world?

Sir Michael Marmot30:17

Uh

Presenter30:17

Where do you see the best outcome?

Sir Michael Marmot30:19

Japan.

Sir Michael Marmot30:20

The longest life expectancy is Japanese women.

Presenter30:24

And

Sir Michael Marmot30:24

Yeah.

Presenter30:24

Quarters

Sir Michael Marmot30:24

Uh

Presenter30:24

But

Sir Michael Marmot30:24

Yeah.

Presenter30:24

They're Doing.

Sir Michael Marmot30:26

It's a very cohesive society. It's slightly uncomfortable if you don't look at the data, but you look at the situation with some prejudices and you think, how could Japanese women be the best off? They're downtrodden. Well, the fact is they have the longest life expectancy in the world. We then, rather than approach it with our prejudices, let's look at it and say exactly your question. What is it they're doing? A lot of emphasis on good early child development, a lot of emphasis on education. They have very low crime rates as a statement of their cohesive society. To the extent that I've been able to talk to Japanese women and try and ask your question, what's going on, some increasingly are in the workplace and being able to pursue their own careers, but others they have separate lives. They have these men who are called husbands who visit from time to time and they lead separate lives. They have their own friends and their own networks and their own activities and part of that social cohesion and good services plays out in good health.

Sir Michael Marmot31:36

Let's have some music. Tell me what's next. I was for a lot of my life feeling deprived. I loved listening to music, but I never played it.

Sir Michael Marmot31:45

And I took up the viola.

Sir Michael Marmot31:47

As an adult beginner, and both of those important, rank beginner as well as adult, I didn't realise how difficult it was. If I'd known how difficult it was, I probably never would have done it.

Sir Michael Marmot31:58

But it's been wonderful.

Sir Michael Marmot32:00

And one of the first serious pieces of music I tried to play were the Bach Cello Suites transcribe for Viola, so I had to have that.

Presenter33:09

That was part of Bach's cello suite number two, Alamand, played by Pablo Casals.

Presenter33:15

There is a lot of talk these days about the lack of, particularly in Britain, social mobility, that we're a less socially mobile group of people than we were forty years ago. Very surprising and certainly distressing, I would think, to most people. Do you see in the work that you and your colleagues do that this is having a profound effect on the health outcomes of people in Britain?

Sir Michael Marmot33:34

It has been called the Great Gatsby Curve.

Sir Michael Marmot33:37

The head of the US Council of Economic Advisers in the White House, Alan Kruger, made a speech where he described the great Gatsby curve the greater the income inequality, the less social mobility.

Sir Michael Marmot33:51

The more poor parents have poor children, and the more rich parents have rich children. So, in the US, in the UK.

Sir Michael Marmot33:59

We're looking more like Brazil, with big income inequalities and less social mobility. That is likely to have.

Sir Michael Marmot34:07

A deleterious effect on health inequalities in the future. It's a bit too early to tell, but what we can already see is these huge differences in the quality of early child development, the huge differences in educational performance by socioeconomic background, and that in the future is likely to play out in big differences in health.

Presenter34:32

Your enthusiasm and your commitment to your life's work is very clear talking to you this morning. You are on the the curb of being seventy, you're almost.

Sir Michael Marmot34:41

I'm sixty nine, seventy next.

Presenter34:42

Seventy next year. It doesn't sound to me like you have any intention of taking a step back.

Sir Michael Marmot34:48

I've been thinking a lot about the evidence, and I always answer that way. If you look at functioning at later ages, people with high education, high status, reach the same level of physical and mental decline

Sir Michael Marmot35:04

About 15 years later than people with less education and less status. So simply saying you're 70.

Sir Michael Marmot35:12

doesn't describe people's capabilities.

Sir Michael Marmot35:16

I can't run up and down stairs like I used to. I'm slow. If I cut myself, it heals a bit more slowly. But people of my age have different things that we can contribute. And simply to say you're a particular age, therefore you should stop functioning, is inconsistent with the evidence, and it's inconsistent with an ageing society. That that isn't the way we should organise our affairs. And the world is aging. It's not just Britain.

Sir Michael Marmot35:44

Quite apart from my own passionate commitment to what I'm doing, quite apart from the fact that I don't think it's over, I don't think, well, it's been done now, that's great, I can just relax, it's a continued struggle. And health is not only about people

Sir Michael Marmot36:02

not smoking and drinking and boozing and so on, but health is about improving society. That takes continued effort to keep that on the agenda. So I don't think the work is done by any means.

Presenter36:14

I am cruelly going to cut you off from all these things that stimulate you. I am going to send you away to this desert island all on your own. Can you imagine what life would be like for you there?

Sir Michael Marmot36:23

I had two modes of enjoyment. One is actually going and talking to people, interacting with colleagues, talking to policy makers, meeting politicians, giving talks and so on. I love it.

Sir Michael Marmot36:35

But I also love being at home, at my desk, working away, writing. For a while at least, that isolation suits me very well.

Presenter36:45

Let's have your final piece of music, then, Sir Michael Marmos. What is it?

Sir Michael Marmot36:47

Uh

Presenter36:47

Uh

Sir Michael Marmot36:48

My eldest son plays music.

Sir Michael Marmot36:51

With a very important African tinge. He read English at university, but he learnt West African drumming.

Sir Michael Marmot37:00

And this is from the group that he currently has.

Presenter37:34

That was Afriqua playing Kodoshu, and we heard your son there in the mix on Jembo on the drums at the beginning particularly. And so, Professor, it is time to send you off to this island. You are going to be able to take some books. You get the Bible and the complete works of Shakespeare.

Sir Michael Marmot37:38

Yes.

Presenter37:47

And one other book to take along, what will it be?

Sir Michael Marmot37:50

I'd like the Oxford English Dictionary, the complete.

Sir Michael Marmot37:53

thirteen volume version with the supplements.

Presenter37:56

All right, you may have that.

Sir Michael Marmot37:57

I can spend endless hours tracking from one entry to another.

Presenter38:03

It's certainly yours. And a luxury, too. What will that be?

Sir Michael Marmot38:06

To take my viola.

Presenter38:07

Uh

Sir Michael Marmot38:07

I'm going to listen to Pablo Casals and I'm going to try and learn to play the Bach Suites just like Casals does.

Presenter38:15

It's yours. And finally, of all the tracks we've listened to today, which one would you choose to save?

Sir Michael Marmot38:20

Well, it would be the Bach, because I firstly, I can listen to Bach forever. I could have had eight Bach tracks, but given that I'm going to try and learn to play it like Casal, so I have to have the Bach.

Presenter38:34

It's yours. Professor Sir Michael Marmotz, thank you very much for letting us hear your desert island discs.

Sir Michael Marmot38:38

It's been an absolute pleasure.

Presenter39:20

You've been listening to a download from the BBC.

Presenter39:23

You'll find more information on the Radio Four website bbc.co.uk slash Radio Four.