Sir Michael Marmot has been Professor of Epidemiology at University College London since 1985, and is Director of the UCL Institute of Health Equity. He is the author of The Health Gap: the challenge of an unequal world (Bloomsbury: 2015), and Status Syndrome (Bloomsbury: 2004).

Professor Marmot was a Distinguished Visiting Professor at Chinese University of Hong Kong (2019-2024), and co-Director of the of the CUHK Institute of Health Equity. He is the recipient of the WHO Global Hero Award; the Harvard Lown Professorship (2014-2017); the Prince Mahidol Award for Public Health (2015), and 21 honorary doctorates.

Marmot has led research groups on health inequalities for nearly 50 years. He chaired the WHO Commission on Social Determinants of Health, several WHO Regional Commissions, and reviews on tackling health inequality for governments in the UK. He served as President of the British Medical Association (BMA) in 2010-2011, and as President of the World Medical Association in 2015. He is President of the Asthma + Lung UK. He is a Fellow of the Academy of Medical Sciences and Honorary Fellow of the American College of Epidemiology and of the Faculty of Public Health; an Honorary Fellow of the British Academy; and of the Royal Colleges of Obstetrics and Gynaecology, Psychiatry, Paediatrics and Child Health, and General Practitioners. He is an elected member of the US National Academy of Medicine, the National Academy of Medicine of Mexico and the Brazilian Academy of Medicine.

He was knighted by Her Majesty The Queen, for services to epidemiology and the understanding of health inequalities. He was appointed a Companion of Honour in recognition of his services to public health in the King’s 2023 New Year Honours.

*VIDEO PRESENTATION*

Taking action to reduce health inequalities is a matter of social justice. In developing strategies for tackling health inequalities we need to confront the social gradient in health not just the difference between the worst off and everybody else.

There is clear evidence when we look across countries that national policies make a difference and that much can be done in cities, towns and local areas. But policies and interventions must not be confined to the health care system; they need to address the conditions in which people are born, grow, live, work and age.

The evidence shows that economic circumstances are important but are not the only drivers of health inequalities. Tackling the health gap will take action, based on sound evidence, across the whole of society.

We must focus on the causes of the causes. Our approach to this is the Marmot Eight principles. These are: 

1. Give every child the best start in life.
2. Enable all children, young people and adults to maximise their capabilities and have control over their lives. 
3. Create fair employment and good work for all.
4. Ensure a healthy standard of living for all.
5. Create and develop healthy and sustainable places and communities.
6. Strengthen the role and impact of ill health prevention.
7. Tackle racism, discrimination and their outcomes.
8. Pursue environmental sustainability and health equity together.

Reija Klemetti is a public health researcher and associate professor specializing in sexual and reproductive health, with a focus on perinatal health and evidence‑based service development. She serves as Director of the Children and Young People Unit at the Ministry of Social Affairs and Health in Finland, overseeing national guidance for maternity and child health clinic services. She has extensive experience in researching, developing and evaluating these services. Reija has led and contributed to numerous national and international projects, including the FinChildren survey, integration of maternity care in Finland’s health and social services reform, development of free contraceptive services for under‑25s, the CHIMACA project in rural China, and the MIDA FINNSOM maternal health programme in Somaliland.

Pregnancy and early childhood are decisive periods for shaping health, wellbeing and long‑term life trajectories. Finland’s Neuvola (maternal and child health clinic) system offers a comprehensive, preventive and relationship‑based model that has contributed to strong child and family health outcomes across the population. By combining universal access with support that is responsive to differing levels of need, Neuvola provides a practical framework for advancing equity from the very beginning of life.

This presentation examines how Neuvola functions as a population‑level platform for promoting fairness and reducing disparities. The system is built on continuity, scheduled follow‑up, and early identification of vulnerabilities in both children and parents. It also places emphasis on integrating health, psychosocial and social support within a single, trusted service pathway.

Key lessons learned:

1. Universality ensures access and near‑total uptake.
   By offering services to all families without cost or eligibility thresholds, Neuvola removes barriers to participation. Nearly all pregnant women and families with young children use the service, allowing it to reach the full population and support equity at scale.
2. Regular, structured follow‑up enables early support and early intervention.
   Systematic visits provide opportunities to identify developmental, health‑related or psychosocial concerns at an early stage, ensuring timely assistance and preventing problems from escalating.
3. Services must evolve in response to changing needs.
   As family circumstances shift—due to demographic trends, mental and physical health needs, migration or socioeconomic pressures—maternal and child health services must continuously adapt to remain relevant and effective.
4. Integrated service models produce the strongest outcomes.
   Finland’s Family Centre (perhekeskus) model demonstrates the benefits of linking health services with social support, parenting services and early education within a coordinated structure.
5. Equity requires both universal provision and proportionately greater support for those with higher needs.
   Universal services create a foundation of fairness and trust, while scaling support according to individual and family needs ensures that those facing greater challenges receive more intensive help. This dual structure—universal access combined with proportionate support—is essential for reducing disparities and supporting all children to thrive.

Together, these features illustrate how early childhood systems can combine universality with responsiveness, ensuring that every child receives a fair start in life.

Dr. Katsunori Kondo is a Professor of social epidemiology and health policy at the Center for Preventive Medical Sciences, Chiba University, Japan. He also serves as the Director of the Department of Research, Institute for Health Economics and Policy through a cross-appointment.

He is the author of "Health Gap Society - what is undermining mental health and society?" and Igaku-Shoin, 2nd edition 2022, both of which were awarded by The Japan Association of Social Relations in 2024. He also edited and wrote "Advancing universal health coverage through knowledge translation for healthy ageing: lessons learned from the Japan Gerontological Evaluation Study“ (World Health Organization, Geneva, 2018).

He has been honored with the Medical Award 2020 of the Japan Medical Association, and 2025 with the Awards for Science and Technology by the Minister of Education, Culture, Sports, Science and Technology of Japan.

Background:

In Japan, the world’s most advanced super-aging society, healthy ageing has long been a critical public health challenge. Initially, a high-risk approach was adopted, in which individuals identified through health screening were invited to three months health education programs. However, this strategy proved ineffective. Older adults with lower income and lower educational attainment were often unable to attend health checkups due to competing life demands and lacked transportation to program venues, raising concerns that health inequalities would be worsened. Moreover, after the completion of three-month programs, many participants lost opportunities for continued exercise or social interactions and experienced subsequent functional decline.

Policy Shift and new Intervention:

In response to these limitations, Japan’s long-term care prevention policy shifted toward a population-based approach. Without screening or exclusion criteria, a preventive form of social prescribing was introduced that targeted all older adults. Community-operated gathering places, known as kayoi-no-ba, were developed and established within walking distance of residential areas. They were located close to participants’ homes, allowing easy access on foot. Because these sites are locally managed, participation is not time-limited, enabling sustained participation beyond three-month interventions.

Results:

Empirical evaluations revealed that in many municipalities, participation rates were higher among older adults with lower income and lower educational attainment - groups that previously had few opportunities for social participation - compared with their higher-income and higher-educated counterparts. These findings indicate that equity was maintained or could be improved and that socially disadvantaged populations were successfully accessed.

Scale and Impact:

To date, kayoi-no-ba have been established in 98% of municipalities across Japan, totaling approximately 150,000 sites nationwide, with around 2.5 million older adults participating. Since the nationwide expansion of this preventive social prescribing approach, a decline has been observed in the proportion of older adults experiencing functional decline and being certified as eligible for long-term care insurance benefits.

Conclusions:

Japan’s population-based social prescribing model demonstrates a scalable and equitable strategy for promoting healthy ageing and reducing functional decline in a super-aging society.