SCOTT SIMON, Host:
Thanks very much for being with us, Sir Michael.
SIR MICHAEL MARMOT: It's my pleasure.
SIMON: You've done quite a bit of work on studies that linked poverty and other social environmental factors for health. What are the types of health problems you've found that are linked to those circumstances in the U.S.?
MICHAEL MARMOT: So the people who aren't in poverty, but are still below the top have worse health than people at the top. It follows the whole social hierarchy from the top to the bottom of society. And the remarkable thing is that almost all the major causes of death, and of mental illness and suffering follow this social gradient.
SIMON: I think a lot of people will think that poor people should be more susceptible to illness seems self-evident, but explain to us exactly why that is.
MICHAEL MARMOT: But the other way is direct effects from the nervous system on bodily physiology, which increases susceptibility to metabolic disturbances, which increase risk of diabetes, and, we think, to other diseases as well.
SIMON: I think a lot of people listening might be inclined to say that some of the most stress-afflicted people they know are some of the most successful and, one assumes, financially well-off.
MICHAEL MARMOT: No. We used to think of stress that way, but there was really a revolution in our thinking about it and, in fact, in the evidence. It's almost stressful to be at the bottom of the pile.
SIMON: I think people in the United States have learned over really the past generation how difficult it is to fundamentally, for a lot of reasons, change access to health care. Changing the social gradient would strike me as being even more politically difficult to accomplish.
MICHAEL MARMOT: It was really very striking. I mean, Americans look at Europeans and they say what? They take those summer holidays? They spend all that pleasure time? The Europeans are in no question about the fact that they'd rather have their long holidays and perhaps be a little less productive than the Americans. I wonder if all of your listeners think they've actually got their work-life balance correct.
SIMON: Sir Michael, thank you so much.
MICHAEL MARMOT: It's a pleasure.
SIMON: Sir Michael Marmot speaking with us from London. Transcript provided by NPR, Copyright NPR.