Taskforce: Michael Marmot's introduction

Look at a paper at random on international comparisons on mortality in Europe – I just looked at two – and you will find ischaemic heart disease, cerebrovascular disease, cancer(s) and ‘other’ or ‘non-cancer, non CVD’.

It is entirely appropriate that ischaemic heart disease, cerebrovascular disease and cancer(s) should be there. But something huge is missing: lung diseases. They are just ‘other’.  

The World Health Organisation (WHO) reports that in 2015 there were 56 million deaths globally. The two biggest killers were indeed ischaemic heart disease and stroke, accounting for about 15 million deaths annually. The next three in the top ten, though, were diseases of the lungs, with lower respiratory infections, influenza and pneumonia accounting for 3.2 million deaths; chronic obstructive pulmonary disease, 3.2 million deaths; and cancer of the trachea, bronchus and lung, 1.6 million.  

Paying attention to prevention and treatment must be a global priority, but in the UK too, where one in five people live with lung disease, we must do more to understand the causes, prevention, treatment and management of people with lung disease, and put in place appropriate actions.  

Inequalities have long been a striking feature of lung diseases in the UK. Since Victorian times we have spoken of Dickensian conditions. People living and working in conditions of foul air and infections, those relatively poor, had an appalling burden of lung disease. As conditions have improved markedly, and the population become healthier, there is still a clear social gradient – the more deprived the area in which people live, the higher the mortality and morbidity from lung diseases. Of the many indignities associated with being poor, or relatively so, having increased risk of chronic obstructive pulmonary disease or dying of lung cancer or pneumonia are among the worst.  

The tragedy of it is that we know quite a bit about what to do to prevent this needless suffering. This report highlights causes of lung disease – smoking, air pollution, occupational exposures – along with lack of access to treatment and care. I talk of ‘the causes of the causes’. Smoking and air pollution are causes of lung disease. We need to pay attention to why people lower in the hierarchy are more exposed to these causes. Simply blaming the poor is not just useless in achieving change, it does not fit with the evidence.  

There is much in the report that has the potential not only to improve health for the whole population, but to reduce inequalities in health. The specific recommendations are very welcome. They should be acted on along with broader actions to reduce social and economic inequalities in society.