self-esteem

What are social determinants of health?

The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.


Sir Michael Gideon Marmot, FBA, FMedSci, FRCP (born 26 January 1945)[1] is Professor of Epidemiology and Public Health atUniversity College London

Marmot conducted ground-breaking studies of heart disease and stroke, comparing Japanese people in Japan (high stroke rates, low heart attack rates) with those in Hawaii and California, where, especially in later generations, the disease patterns became reversed after adopting lifestyle, stress and diet changes.[12] He has more recently led theWhitehall Studies of British civil servants, again focusing on heart disease and other disease patterns. His department includes the MRC National Survey of Health & Development, a longitudinal study directed by Professor Michael Wadsworth of people born in Britain in 1946 and followed up since. There are 120 other academic staff in the department.[14][15][16][17][18]

He has worked closely with the Office for National Statistics and its predecessor the Office of Population Censuses and Surveys, and especially with Abraham Manie Adelsteinand John Fox.

Sir Michael Marmot has a special interest in inequalities in health and their causes and has been a government advisor in seeking to identify ways to mitigate them. He served on the Scientific Advisory Group of the Independent Inquiry into Inequalities in Health chaired by Sir Donald Acheson, the former UK chief medical officer. This reported in November 1998. In 2000 he was knighted by Her Majesty The Queen for services to Epidemiology and understanding health inequalities. Internationally acclaimed, Professor Marmot is a Vice President of the Academia Europaea, a Foreign Associate Member of the Institute of Medicine (IOM), and the Chair of the Commission on Social Determinants of Health set up by the World Health Organization in 2005. He won the Balzan Prize for Epidemiology in 2004, gave the Harveian Oration in 2006 and won the William B. Graham Prize for Health Services Research in 2008. [19] In 2008 he became Doctor Honoris Causa of the Université Libre de Bruxelles.

In The Status Syndrome: How your social standing directly affects your health and life expectancy, he argues that socio-economic position is an important determinant for health outcomes. This result holds even if we control for the effects of income, education and risk factors (such as smoking) on health. The causal pathway Marmot identifies concerns the psychic benefits of “being in control” of one’s life. Autonomy in this sense is related to our socio-economic position. Based on comparative studies, Marmot argues that we can make our society more participatory and inclusive in order to increase overall public health.

In 2008, Marmot appeared in Unnatural Causes: Is Inequality Making Us Sick?,[5] an American documentary series examining the social determinants of health that drew heavily from Marmot’s work on the Whitehall Studies.

On 6 November 2008, Prime Minister Gordon Brown announced that the Secretary of State for Health Alan Johnson had asked Sir Michael Marmot to chair a Review of Health Inequalities in England to inform policy making to address health inequalities from 2010. The Review was announced at the launch of the Commission on Social Determinants of Health report Closing the Gap in a Generation.

The European Office of the WHO is commissioning a European Review on the Social Determinants of Health and the Health Divide. The Review will be conducted by a Consortium of experts/institutions chaired by Professor Sir Michael Marmot.

The purpose of the review will be to identify the relevance of the findings of the WHO Commission on the Social Determinants of Health (CSDH), the Strategic Review of Health Inequalities in England post 2010 (Marmot Review), and other new evidence to the European context and specificity and translate these into policy proposals.

It will feed into the development of a renewed European Regional Health Policy and contribute to specific aspects of the policy especially where it relates to the social determinants of health. Marmot’s research has been funded by the Engineering and Physical Sciences Research Council (EPSRC), Economic and Social Research Council (ESRC) and Medical Research Council (MRC).[20]


In sociology and psychology, self-esteem reflects a person‘s overall emotional evaluation of his or her own worth. It is a judgment of oneself as well as an attitude toward the self. Self-esteem encompasses beliefs (for example, “I am competent,” “I am worthy”) and emotions such as triumph, despair, pride and shame.[1] Smith and Mackie define it by saying “The self-concept is what we think about the self; self-esteem, is the positive or negative evaluations of the self, as in how we feel about it.”[2]:107 Self-esteem is also known as the evaluative dimension of the self that includes feelings of worthiness, prides and discouragement.[3] One’s self-esteem is also closely associated with self-consciousness.[4]

Self-esteem is a disposition that a person has which represents their judgments of their own worthiness.[5] In the mid-1960s, sociologist Morris Rosenberg defined self-esteem as a feeling of self-worth and developed the Rosenberg self-esteem scale (RSES), which became the most-widely used scale to measure self-esteem in the social sciences.[6]Nathaniel Branden in 1969 defined self-esteem as “the experience of being competent to cope with the basic challenges of life and being worthy of happiness.” According to Branden, self-esteem is the sum of self-confidence (a feeling of personal capacity) and self-respect (a feeling of personal worth). It exists as a consequence of the implicit judgment that every person has of their ability to face life’s challenges, to understand and solve problems, and their right to achieve happiness, and be given respect.[7]

As a social psychological construct, self-esteem is attractive because researchers have conceptualized it as an influential predictor of relevant outcomes, such as academic achievement[8] or exercise behavior (Hagger et al. 1998)[full citation needed]. In addition, self-esteem has also been treated as an important outcome due to its close relation with psychological well-being (Marsh 1989)[full citation needed]. Self-esteem can apply specifically to a particular dimension (for example, “I believe I am a good writer and I feel happy about that”) or a global extent (for example, “I believe I am a bad person, and feel bad about myself in general”). Psychologists usually regard self-esteem as an enduring personality characteristic (“trait” self-esteem), though normal, short-term variations (“state” self-esteem) also exist. Synonyms or near-synonyms of self-esteem include: self-worth,[9] self-regard,[10] self-respect,[11][12] and self-integrity.

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