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A good nanny makes a difference

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The health gap: the challenge of an unequal world. Michael Marmot. London: Bloomsbury Publishing, 2015 (400 pp, $35). ISBN 9781408857991.

Any person proposing interventions that change the lived environment, with the intention of improving health, will encounter the “nanny state” argument. This is the case be it John Snow removing the pump-handle from a cholera-infected water source in Victorian London or Nicola Roxon proposing plain packaging of cigarettes in modern Australia. Similarly, most general practitioners have experienced that sinking feeling on seeing the patient whose health issues arise from home or work environments over which the hapless GP has little sway. This book provides ammunition to defend the former and food for thought for responding to the latter. At the same time, Michael Marmot manages, in his inimitable style, to make his case both entertaining and accessible.

Marmot argues that empowerment is the key for reducing health inequalities and improving health across nations. But empowerment cannot be achieved by any magic bullet. One of the most revealing stories in the book is where Marmot, approached by a journalist — hard on the release of the World Health Organization Commission on Social Determinants…