Mind the Gap: A Review of The Health Gap: The Challenge of an Unequal World by Sir Michael Marmot

The Health Gap documents the large and persistent health gaps that exist across and within relatively rich countries today. Marmot argues that in developed countries, poor health does not cause low incomes; rather, low socioeconomic status leads to poor health, but not because of proximate factors like differential health care access, which can explain only a small portion of these gaps. Therefore, to eliminate health gaps, policy should focus on the deep causes of disease: poverty, education, and occupational mobility, among others. While Marmot's ethical arguments are quite compelling, his recommendations are too strong given the current evidence. Policies need to be based on a clearer understanding of why things work, when, and for whom.