Laureation Address: Professor Sir Michael Marmot CH MBBS MPH PhD FRCP FFPHM FMedSci FBA

Graduation Office
Friday 14 June 2024

Honorary Degree of Doctor of Medicine
Laureation by Professor David Crossman, Dean of Medicine

Friday 14 June 2024 – morning ceremony

Vice-Chancellor, it is my privilege to present for the degree of Doctor of Medicine, honoris causa, Sir Michael Marmot.

“It’s a fourth-rate discipline for second rate minds” was a greeting that the newly appointed Professor of Epidemiology and Public Health at University College London (UCL) was given by a senior and unnamed faculty member. The appointee was Sir Michael Marmot who has displayed through the course of his life his first-rate mind and has (if it needed it) lifted epidemiology to a discipline that now directs policy, and influences politics across the world.

Marmot is synonymous with social inequality in health and social determinants of health. Indeed, some do not know that Marmot is a person – perhaps a verb or adjective. Personally, I like to think of it as a movement – Marmotism if you like – but it is most definitely the individual who is with us today.

He tracks this notoriety to his publication in 1978 which described the social gradient of health, where he discovered the polar opposite of conventional wisdom at the time in a study of Whitehall civil servants, who had been recruited over the prior ten years; now called Whitehall 1, this study showed that the lower an individual’s social status the worse their health outcomes – particularly ischaemic heart disease. But further, and most importantly for the area Sir Michael has defined, that the risk acquired by low social status could not be entirely explained by known risk factors that tracked with social status, such as obesity and smoking, but that 60% went unexplained and was attributable to the consequences of social status directly.

This in turn led Marmot to identify that the health inequality was beyond a consequence of financial poverty, and he presses the case for psychosocial factors and factors that impact on childhood development. He communicated this to an audience beyond academia in his publication, The Status Syndrome, in 2004.

In 2010 Marmot published Fair Society, Healthy Lives – the Marmot Review. It is, for many, the publication that defines Sir Michael in our minds. The report clings to those who worry about health and health improvement – it cannot be shaken off. The salutation at the beginning “Rise up with me against the organsiation of misery”, quoting Pablo Neruda, is powerful and memorable enough, but it is the data-driven depiction of rampant unfairness in society manifesting in poor health that sears.

Biblical numbers of lost life years are described. The introductory sentences sum up the drive for Marmotism:

“People with higher socioeconomic position in society have a greater array of life chances and more opportunity to lead a flourishing life. They also have better health. The two are linked: the more favoured people are, socially and economically, the better their health.”

He goes on:

“This link between social conditions is not a footnote to the real concerns with health – healthcare and unhealthy behaviours – it should be the main focus.”

Throughout this report the word fairness appears and reappears to haunt. Fairness is important to Sir Michael – it drives him. He wondered to me if it is something to do with his upbringing.

Michael Marmot lives in north London five miles from where he as was born in 1945 into a Jewish immigrant family. In his life he has moved around the world, starting with his father taking the family to Sydney Australia, where he went to university and qualified as a doctor. He was already, as a student and junior doctor, identifying himself as an academic, asking difficult questions of his teachers and asking the “but why” question of illness and symptom presentation in those he treated, especially those who came from deprived backgrounds.

He moved to Berkley California, where he worked with Len Syme, the father of social epidemiology.

Len made a big impression on the young Marmot. It was obviously an exciting time, and he says of it:

“Epidemiology was the fringe part of medicine, and social epidemiology was the fringe part of epidemiology

Len made respectable the idea that social and psychosocial influences on disease, cardiovascular disease in particular, could be important.”

He returned to the UK, to UCL and the London School of Hygiene and Tropical Medicine, falling under the spell of, and sharing an office with, Geoffrey Rose, author of Sick Individuals and Sick Populations.

Geoffrey reinforced in him the drive to take nothing on trust but only based on evidence. Marmot also worked with Fraser Mustard at McMaster University in Canada. Mustard, who was the first to publish the benefit of aspirin on heart attacks, was to lead research on the importance of early childhood development and encouraged Marmot to explore this area in his work on social determinants of health. This idea shines through in the recommendations of the Marmot Report.

Asked by many “are you political” his varied responses give one message:

“No, I am not political, I bring evidence not politics, but that evidence brings the need for action.”

Sir Michael has been recognised by many awards and honours and many honorary degrees – this will be the 21st. There are too many accolades to individually mention, but of his national honours he divides the two – the Knighthood was for his research and the award of Companion of Honour was for his work on policy. Those are two distinct phases of the way he sees the achievements of his life.

Sir Michael Marmot, Companion of Honour, world leading academic, driven by data and a desire to see fairness, you are truly an example to us all and especially those who work with the sick and wish for a healthier world.

Vice-Chancellor, in recognition of his major contribution to medicine, I invite you to confer the degree of Doctor of Medicine, honoris causa, on Sir Michael Marmot.

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