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The richest live, on average, longer than adults of upper middle class income levels, who in turn live longer than members of the middle class, and so on. How and why does this happen, when middle class families in any developed nation could hardly be considered poverty-stricken? The same phenomenon occurs with the level of education; adults with Ph.D.s live longer than those with a master's degree, master's longer than bachelor's, and so on again. This richer understanding of poverty and health is Michael Marmot's brilliant and arresting focus in The Health Gap as he approaches what he calls the "social gradient in health" and its complicated relationship to health and poverty. As Marmot shows, improvement in the health of people who are relatively disadvantaged--i.e. most of us, compared to concentrations of wealth at the very top of the income ladder--is built on two intertwining pillars: material conditions for good health, and control of life circumstances or empowerment. Addressing these issues is the only path to improved health and healthcare for people of all income brackets around the world.
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