‘Well-behaved advocates rarely make history’

“I would like for you to dream with me, to dream of a world where social justice is taken seriously.”

— Michael Marmot, chair, World Health Organization’s Commission on Social Determinants of Health

The heart and soul of public health was on display today during the Annual Meeting’s opening session, as speakers called on their colleagues to stand up, speak out and fight back.

Of course, standing up, speaking out and fighting back isn’t without its risks and slight embarrassments. Just a few advocacy hazards, according to opening session speaker and outgoing APHA President Linda Degutis: you might get labeled the “safety nerd,” your kids could starting wearing helmets to bed, you may get skipped over for promotion or tenure, and there never seems to be enough room on your car for all those bumper stickers. But then again, “well-behaved advocates rarely make history,” Degutis proclaimed.

“There’s strength in numbers and we have those numbers,” said Degutis before a crowd of 6,000, noting that her fellow public health workers are often “too modest and too quiet.”

One public health worker who certainly doesn’t hold his tongue is Sir Michael Marmot, the opening session’s keynote speaker and a globally known expert in health inequities. A leader in the worldwide movement to close the health disparity gap, Marmot didn’t hide his frustration, lamenting that while the world has the knowledge to close the health inequity gap within a generation, it probably won’t. But Marmot didn’t veil his hope either, reminding audience members that “there is a tide running in our favor at the moment.”

While Marmot called for health reform in the United States, he was also quick to remind us that health inequities will not disappear with universal coverage. In Glasgow, Scotland, where everyone has access to care, he reported that the life expectancy gap between men in different regions still ranges from age 54 to 82. Within our own nation, life expectancy for men in Washington, D.C., averages about 63, while for men just a few miles away in Montgomery County, Md., the life expectancy average is 82. How do we account for such pronounced differences: the social determinants of health.

In his work with WHO’s Commission on Social Determinants of Health, Marmot — like Degutis noted before him — has faced his share of criticism and push back. People say that by trying to close the health inequity gap, advocates would be taking away a person’s individual responsibility to maintain their health. Not so, Marmot argued. In our work, we’ll be creating the social conditions that indeed make it possible for a person to take responsibility for her or his health, he said. And when faced with suggestions that he argue why closing the gap is good for the economy (or he was warned: no government will take the commission’s recommendations seriously), Marmot fought back again. Improving health is a matter of social justice, he said, it’s the right thing to do.

— K.K.