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A Challenge to Medicine

Michael G. Marmot, MBBS, MPH, PhD, FRCP, FFPHM

JAMA. 2006;295:1304-1307.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The poor have poor health. At first blush that is neither new nor surprising. Perhaps it should be more surprising than it is. In rich countries, such as the United States, the nature of poverty has changed—people do not die from lack of clean water and sanitary facilities or from famine—and yet, persistently, those at the bottom of the socioeconomic scale have worse health than those above them in the hierarchy. Even more challenging is that socioeconomic differences in health are not confined to poor health for those at the bottom and good health for everyone else. Rather, there is a social gradient in health in individuals who are not poor: the higher the social position, the better the health. I have labeled this "the status syndrome."¹

When we first drew attention to the phenomenon of the social gradient in coronary heart . . . [Full Text of this Article]

The Social Gradient in Health Is Widespread

Author Affiliation: International Institute for Society and Health, Department of Epidemiology and Public Health, University College London, London, England.

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