Ask the Doctor: Packaging science to change policy

This probably seems like a strange title for this article. Not to worry dear reader, you will soon understand what the title means.

While most of my themes relate to chronic pain, there are times where I find other types of medical knowledge that can be useful to you. I would like to share with you some interesting segments of a recent conversation held on August 14, 2012 between Julia Belluz, a journalist for the Medical Post (one of our Canadian medical industry newspapers) and Dr. Michael Marmot.  I will paraphrase some of what was stated that it can be understood by non-medical professionals, while other times I use excerpts from the published conversation itself.

Michael Marmot had practiced medicine in the United-States and felt that people who experienced socioeconomic struggles faced poorer health than people who didn’t. To try and gain a better understanding of this phenomenon, he went to study under a well-known sociologist turned epidemiologist in the UK. As Dr. Marmot remembers, his supervisor told him: “Just because you’re a doctor, doesn’t mean you understand the causes of ill health. You understand something about biology and medical conditions but you’ve got to learn something about society if you really want to understand the causes of ill health.”

That was 30 years ago and since then, Dr. Marmot, now 67, has worked in the UK researching members of the British Civil Services. He holds the position of research professor in epidemiology and public health at the University College in London, England.  The studies that came out of these years of research are known, they are called the Whitehall Studies and have looked at the “social determinants of health” in research that spans long periods of time in large populations. These studies established a link between different determinants (such as education, income, socioeconomic status etc) and the risk to develop cardiovascular disease or die from it.

Examples of Dr. Marmot’s studies include those that explored why residents of some areas of Glasgow, Scotland have a 28-year gap in life expectancy compared to those living in other neighbourhoods, or how Japanese immigrants in America start developing increasingly similar diseases to those suffered by their adopted fellow countrymen the longer they remain in the US. The Whitehall studies showed that one’s social position precedes and determines one’s health.

The findings have been duplicated in numerous other studies around the world in Europe and North America. Not too long ago our Canadian newspapers flashed a study that showed if you live in certain areas of Toronto, you have a much higher risk of developping heart disease or diabetes. What this means is that segregation in certain areas of low socioeconomic status leads to poor dietary habits, inactivity, obesity etc that lead to poorer health.

Numerous studies in my field, i.e., “pain, connect education and lower socioeconomic status with several painful disorders. So the findings of the Whitehall studies on the impact of society and environment on different aspects of health are applicable across different countries, populations and diseases.

These studies in Britain and in other parts of the Western World help to design policy. Dr. Marmot brings the results of these studies (in other words the evidence provided by well conducted scientific studies) to the attention of policymakers, so that science can help shape these policies. The marriage of the best evidence available and policy has obvious benefits. An example is social safety-net policies (unemployment benefits, options for retraining etc) that reduce the disastrous impact of unemployment on suicides. Another example Dr. Marmot gave is how subsidizing public transport for older people, makes them move around more, create more social connections and reduce social isolation (social isolation has been linked to earlier death.  Social connections relate to both the physical and mental health of older people and therefore prolong life-expectancy.

The tireless Dr. Marmot and his team just produced a report in London about the impact of the recession on the policies affecting the health inequalities of Londoners.  They hope their study will have some impact on policies pertaining to housing, employment and related areas.  In other words as Dr. Marmot says “they keep packaging the science to show what the impact on the policies would be”, and then they work with local governments.

Dr. Marmot keeps lecturing around the world on lifestyle choices (diet and cardiovascular disease; alcohol and health) and factors affecting social inequalities. He feels that “diet, alcohol and social conditions are of vital importance to people’s health but that they threaten vested interests”.

As you may or may not know I was born and raised in Athens, Greece and came to Canada for specialization and research training after I finished medical school in Athens Greece. You are probably aware of the great difficulties that my homeland and Greek people have been enduring for the last 3-4 years.

Similar difficulties are now engulfing other southern European countries. Unemployment is very high and jobs are sparse, salaries and pensions have dramatically shrunk while the cost of everything from food to utilities, transportation and the cost of living in general has increased exponentially.  People are falling into serious depression, suicide rates have doubled and tripled, standard of living has taken a vertical dive, kids go hungry, sick people can not buy their medications and the list goes on. Clearly life expectancy under these circumstances has been shown to decrease by many years.

Using the evidence from science to connect the dots between social determinants of health and policies, is an immensely important concept. Our world is huge but remains interconnected. Looking simply at the biology of a disease without seeing the influence of society and environment on disease and health, is short sighted.


Angela Mailis Gagnon, MD, MSc, FRCPC(PhysMed)

Director, Comprehensive Pain Program,

Senior Investigator, Krembil Neuroscience Centre

Toronto Western Hospital,

Chair ACTION Ontario