GA-2016-Valedictory-Marmot-Oct2016

Valedictory Speech
WMA President Sir Michael Marmot October 2016

This year I have been ever more vigorous in promoting my two key messages on health
equity: evidence based policy and the central role of social justice. It seemed ever more
urgent given the rise of some rather nasty political movements with scant regard for the
truth, which has led to the notion of ‘post-fact’ politics.

Martin Luther King said it rather better than I:

I believe that unarmed truth and unconditional love will have the final word in reality. This is
why right, temporarily defeated, is stronger than evil triumphant.

My mission as WMA President, stated clearly from the outset, was to encourage doctors’
involvement in social determinants of health and health equity. ‘Encouraging doctors’
includes individual doctors, National Medical Associations and other bodies, and the World
Medical Association.

To support this mission, I set out three aims:

• WMA issue a statement on social determinants of health and health equity; and
produce a supporting publication that would answer the question: “what do we
do?”
• Support post-graduate education and training.
• Promote regional networking on social determinants of health

WMA Statement and Publication

The Declaration of Oslo, agreed at the Council meeting in Oslo in April 2015, was passed by
the General Medical Assembly in Moscow. It sets out the importance of social determinants
of health (SDH) and principles of action for WMA, NMAs and individual doctors.

A question commonly put, sometimes even a cri de coeur, is of the form: “I am convinced
but what do you want me to do?” My colleagues at the UCL Institute of Health Equity have
prepared a document, Doctors for Health Equity, which seeks to answer that question. We
emphasise five domains of activity:

• Education and training
• Seeing the patient in broader perspective
• The health service as employer and its impact on the local community
• Working in Partnership
• Advocacy

In addition, there is the crucial issue of measurement of health equity and key determinants.

The report is as a way of developing communities of action, sharing knowledge and a source
of material for budding partnerships at local level. It is an opportunity for the WMA to show
by their actions what they are doing. Sharing through the report and the web site are good
ways of helping each other in each of our member’s countries.

We see this publication as continuing to develop with the addition of case studies. We have
invited NMA’s to contribute examples.

During the year WMA put out statements consistent with this SDH theme. In particular,
following the meeting in Istanbul on War, Migration and Health, WMA issued a declaration.

Training

We run a Summer School at UCL in London on social determinants of health. In addition, we
are planning one or more workshops with the International Association of Academies of
Medical Science (IAMP). The first was in Trieste. We conducted a regional workshop at the
University of Brasilia in Brazil.

With BMJ Publishing we have developed a MOOC, Mass Online Open Course on Social
Determinants of Health. It was launched in October 2016, and is running at the same time as
the WMA General Medical Assembly.

Networking

My agenda for the year was clear, involving doctors in social determinants of health and
health equity. It is part of my broader, longer term mission promoting the importance of
social determinants of health in research, training, policy and practice. Accordingly, my
choice for the year, was to attend those meetings that had the prospect of advancing that
agenda. And proudly wearing the WMA hat while doing so. The networking has taken three
forms.

1. Country visits

These visits have included:

• BMA House London
• Livingston Zambia
• Helsinki
• Alpbach Austria
• USA, various cities
• Suriname
• Taipei
• Sweden – Commissions++
• Kolkata
• Bangkok
• Istanbul
• Tashkent, Uzbekistan
• Montevideo
• Buenos Aires
• Ghent and Brussels
• Trinidad and Tobago
• Panama
• Canada various cities
• German MA, Hamburg
• Geneva
• Tel Aviv
• Tokyo
• Australia
• Malta
• Sri Lanka

I single out Sweden from this list to make the point that action on social determinants of
health and health equity can be at city level as well as at country level. Sweden has now set
up a national commission on social determinants of health. But prior to that it had several
city commissions to plan city level action.

Similarly in the UK, we have had action at city level which is very encouraging.

We did a report for the government of Taiwan on health inequalities. We recommended
cross government action on the social determinants of health.

2. Networking with groups

My general strategy has been to probe gently to see where interest is to be found. I have
spoken at meetings of CONFEMEL, the confederation of Latin American Medical Societies,
CMAAO, confederation of medical associations of Asia and Oceania, the Commonwealth
Medical Association, and the World Health Professionals Alliance. I spoke at the EFMA
meeting in Uzbekistan, which involved doctors from the Eastern part of the WHO European
Region.

We have a partnership which includes the constituent countries of the UK – England,
Scotland, Wales and Northern Ireland – as well as the Republic of Ireland.

We held a side event with the International Committee of the Red Cross at the World Health
Assembly. We will now be working with them to bring a social determinants of health
framework to their work.

3. Commission on Equity and Health Inequalities in the Americas

I have been asked by the Pan American Health Organisation, PAHO, to lead a review of social
justice and health in the Americas. It will focus on social determinants of health putting
equity and human rights, gender and ethnic differences, at the heart of social action to
improve health. I will seek to engage the active cooperation of medical societies. We have
now had our second meeting of Commissioners. We are due to report in Spring 2018.

Fourteen countries will become active partners in this PAHO Commission.

While in Washington DC, I came across this quotation from President FD Roosevelt:

In these days of difficulties, we Americans must and shall choose the path of social
justice…the path of faith, the path of hope, and the path of love toward our fellow man.

Inspiring words for our Commission on Equity.

Fantasy Land?

I was in Australia giving lectures for the ABC. On a Television programme I described
extreme inequalities in income. I used the example that the top 25 hedge fund managers in
New York, with a combined annual income of $25 billion, had the same combined income as
the 48 million people of Tanzania. When I mused about what a fairer distribution of income
could achieve, I was told I was in Fantasy Land.

In my lecture I responded. When Martin Luther King rose in Washington to declare: “I have a
dream that on the red hills of Georgia, the sons of former slaves and the sons of former
slave owners will be able to sit down together at the table of brotherhood”, what if he had
said: “I’ve been told I’m in Fantasy Land. We should accept the status quo”, there would
have been no civil rights act.

Let me invite you to join me in my Fantasy Land and let us seek a fairer world and more
socially just societies.

21.10.2016