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Social causes of the slowdown in health improvement
  1. Michael Marmot
  1. Correspondence to Professor Michael Marmot, Department of Epidemiology and Public Health UCL, Institute of Health Equity, London WC1E 6BT, UK; m.marmot{at}

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The abiding view of the second half of the 20th century is that societies improve, health and social care improve and, as a result, health improves. We can argue, and do, as to who holds the pump handle. How much was it modern medicine, how much organised public health, how much improved social and economic conditions. I argue for social conditions.1 Others argue for medicine and public health.2 Whatever the relative contributions, we are used to health improving year on year, in high-income, middle-income and most, but not all, low-income countries.

We can no longer take such improvement for granted. In England and Wales, Hiam and colleagues3 first drew attention to the possibility that mortality rates may actually be increasing in older people. At the Institute of Health Equity, we have been monitoring health and its social determinants since the publication of my Review of Health Inequalities, Fair Society Healthy Lives.4 Stimulated by the report of Hiam and colleagues, in 2017, we published results for trends in life expectancy. ( We said, that since about 1950, life expectancy had been rising by 1 year every 3.5 years among men, and 1 year every 5 years among women. From 2011 to 2015, this rate of increase halved. Our message was that this should be treated with the same urgency …

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