2004 Balzan Prize for Epidemiology
Sir Michael Marmot has revolutionized epidemiology by establishing hitherto unsuspected links between differences in health and life expectancy on the one hand, and social status on the other. In comparative studies of Japanese migrants in Hawaii and in California and of migrants from the Indian subcontinent to Great Britain, Sir Michael Marmot discovered the importance of a change in socio-cultural environment relative to that of the associated change in habits – dietary, alcohol, smoking – in bringing about biological changes associated with an increase in cardiovascular morbidity and mortality.
In an early study of British civil servants (Whitehall I), Sir Michael discovered an unsuspected gradient of decreasing health and life expectancy from the top to the bottom of professional hierarchies. A new study, twenty years later (Whitehall II), conducted on a different population of civil servants, identified psycho-social factors related to low control at the work place and a deficit in social integration as the principal determinants of the observed disparities in health and of potentially causative biological (metabolic and endocrine) anomalies associated with them. With large population studies in Eastern Europe before and after the fall of the Iron Curtain, which showed similar though more dramatic health disparities along gradients of decreasing social status and control over one’s fate, Sir Michael Marmot confirmed the importance of psychosocial factors related to social status and a minimum of self-determination as determinants of health.
With these observations and the scientific rigour they are based on, Sir Michael Marmot has initiated the era of “social epidemiology”. He has paved the way for the development of a wholly new concept of preventive medicine.