MARMOT, Michael (Gideon) 1945-

PERSONAL: Born January 26, 1945 in London, England; immigrated in 1949 to Sydney, Australia, returned to England in 1976; son of Nathan and Alice (Weiner) Marmot; married Alexi Ferster (a writer); children: Andre, Daniel, Deborah. Education: University of Sydney, B.S.C., M.B.B.S., 1968; University of California—Berkeley, M.P.H., 1972, Ph.D., 1975.

ADDRESSES: Home—London, England. Office—Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT England. E-mail—m.marmot@ucl.ac.uk

CAREER: Royal Prince Alfred Hospital, Sydney, New South Wales, Australia, resident and fellow, 1969-70; Postgraduate Medical Foundation, Australia, fellow, 1971-72; University of California—Berkeley, Department of Biomedical and Environmental Health Sciences, lecturer, 1975-76; London School of Hygiene and Tropical Medicine (LSHTM), senior lecturer, 1976-85; University College of London (UCL) and Middlesex School of Medicine, consultant in Medical Division 1980-84, professor of epidemiology and public health, 1985—. LSHTM-UCL joint chair, 1990; director of International Centre for Health and Society (ICHS) 1994—; Medical Research Council professorship, 1995—; Harvard School of Public Health, adjunct professor, 2004. Principal investigator of the landmark Whitehall studies on the health of civil servants since the 1980s, and co-Principal Investigator of the Health Surveys for England and Scotland; served on the Independent Inquiry into Inequalities in Health, as well as several international studies of social factors affecting public health, alongside researchers in Eastern Europe, Japan, Finland, and other countries; chairman of the [British] Department of Health Scientific Reference Group on health inequalities, and the [British] National Institute for Clinical Excellence Research and Development Committee; lecturer.

MEMBER: Behavioural Sciences Section of Academia Europea (vice president, 1996—), Institute of Medicine of the U.S. National Academies, Health Board of Advisors, RAND Corporation.

AWARDS, HONORS: Faculty of Public Health Medicine, fellow, 1989; Royal College of Physicians, fellow, 1996; Academy of Medical Science, founding fellow, 1998; Knighted by Queen Elizabeth II, 2000, "for services to epidemiology and understanding health inequalities; Balzan Prize for Epidemiology, 2004."

WRITINGS:

(With A. M. Adelstein, L. Bulusu, and Office of Population Censuses and Surveys) Immigrant Mortality in England and Wales, 1970-78: Causes of Death by Country of Birth, Her Majesty's Stationery Office (London, England), 1984.

(Editor, with Paul Elliott) Coronary Heart Disease Epidemiology: From Aetiology to Public Health, Oxford University Press (New York, NY), 1992.

(Editor, with Richard G. Wilkinson) Social Determinants of Health, Oxford University Press (New York, NY), 1999.

(Editor, with Stephen Stansfeld) Stress and the Heart: Psychosocial Pathways to Coronary Heart Disease, BMJ Books (London, England), 2002.

The Status Syndrome: How Social Standing Affects Our Health and Longevity, Henry Holt (New York, NY), 2004.

Contributor of over 400 papers to major medical journals, including British Medical Journal,, American Journal of Epidemiology, Lancet, and American Journal of Public Health.

SIDELIGHTS: Sir Michael Marmot has built a distinguished international career as an epidemiologist specializing in the social, behavioral, and environmental causes of disease and mortality; his greatest contributions have been in clarifying the health differences that derive from economic and social inequality. In an interview in the Conversations with History television series, Marmot attributed his success to the vital importance which his poor East London immigrant parents gave to education, and to their example of charity and community work. Although he valued the clinical work he did while earning a medical degree, he would be frustrated to recognize that "We saw this chap three months ago … we treated him…. Sent him home. Here he is back again. And I used to think that medicine and particularly surgery is just failed prevention." He refined his ideas while studying at the University of California at Berkeley, then returned to his native London where he has lived and worked ever since.

Early in his professional work Marmot became involved in the Whitehall studies, which monitored the health and mortality of 18,000 British civil servants over a period of many years. The study was originally designed to study individual risk factors for cardiovascular and respiratory disease. Marmot's analysis found that, as he told the Conversations interviewer, "people at the bottom of the hierarchy had a higher risk of heart attacks…. itwasa social gradient" that varied inversely with status; furthermore, "the social gradient applied to all the major causes of death." Subsequent research showed similar social gradients in disease and early death in the general population, and in many foreign countries as well. The second Whitehall study, set up in the 1980s, defined workers' status in terms of "how much control they had at work, how fairly they were treated at work, how interesting their work was." Subsequently, Marmot participated in the Health and Social Upheaval study on the effects of social and political change in Eastern Europe; in the English Longitudinal Study of Ageing, which examined successful ageing and healthy retirement; and in studies of Japanese immigrants to America and South Asian immigrants to Britain.

Marmot reported on these researches over the years in hundreds of scientific papers and public lectures, and he edited several anthologies. For one of these, Stress and the Heart: Psychosocial Pathways to Coronary Heart Disease, Marmot recruited experts from among his colleagues at UCL and ICHS, "an internationally recognized powerhouse of research on the social determinants of health," according to Ichiro Kawachi, who reviewed the book for the British Medical Journal. Kawachi called the book a "timely, highly readable and authoritative volume." Articles treat such subjects as "job stress; social support and social networks; and the evidence base linking specific negative emotions such as depression and anxiety to cardiovascular disease outcomes." According to Kawachi, the book also deals with social class, and with unhealthy behaviors that indirectly link stress to disease.

In 2004, Marmot synthesized decades of study with his well-received book, The Status Syndrome: How Social Standing Affects Our Health and Longevity. The book rests on "a numbing arsenal of facts and figures" derived from studies of humans—and other primates—around the world, according to New York Times reviewer Emily Eakin, who reported that Marmot conveys "the alarming message … that status has become a lethal threat." She quoted the author's summary: "Where you stand in the social hierarchy is intimately related to your chances of getting ill and your length of life." It is not necessarily money that counts, but rather, as Eakin put it, "stress that comes from having less control over our work and lives than people of higher rank." The author's reliance on the Whitehall studies may have misled him, Eakin wrote, in that "the author confuses the artificial organization of the workplace with the messy chaos of life," where, she wrote, status may be less clear. Eric Klinenberg of the Washington Post, on the other hand, had only praise for the "bold, important, and masterful new book." He stressed Marmot's call for an end to "extreme status disparities and social segregation at the national level." According to a reviewer in the Economist, the author suggests "giving people greater autonomy and social cohesion rather than raising their pay or improving their access to medical services" as the path to reducing lifespan disparities.

Marmot's most recent work relates to the actual physical, biological processes by which the social environment, and the individual's values and perceptions, can lead to various health outcomes. He is also actively engaged in joint efforts between the government and the British medical community in formulating specific policy changes that could help reduce existing disparities.

BIOGRAPHICAL AND CRITICAL SOURCES:

periodicals

British Medical Journal, January 19, 2002, Ichiro Kawachi, review of Stress and the Heart: Psychosocial Pathways to Coronary Heart Disease, p. 176.

Economist (US), June 12, 2004, review of The Status Syndrome: How Social Standing Affects Our Health and Longevity, p. 84.

Guardian, September 11, 2004, Will Hutton, review of The Status Syndrome, p. 10.

Library Journal, July, 2004, Tina Neville, review of The Status Syndrome, p. 109.

New York Times Book Review, August 22, 2004, Emily Eakin, review of The Status Syndrome, p. 16.

Publishers Weekly, May 17, 2004, review of The Status Syndrome, p. 40.

Washington Post, August 1, 2004, Eric Klinenberg, review of The Status Syndrome, section T, page 3.

online

Conversations with History, http://globetrotter.berkeley.edu/conversations/ (March 18, 2002), Harry Kreisler, interview with Michael Marmot.*