'Even the Netherlands has important differences between the health of the poor and rich. We would like to decrease these differences.’

Sam Harper is epidemiologist and associate professor at McGill University in Montreal, Canada. His focus is on the spread of diseases, including 'diseases' like obesity. His main research area is the differences in health and in diseases between rich and poor people. With this as his focus he will be working in part at Erasmus University for the next four years, in the Smarter Choices for Better Health initiative. Which difficulties have to be overcome in order to reach health equity?

What is your research about? 
‘One of the interesting things I explore is how social and economic policies influence rich and poor people’s health. My work focuses on this problem both in Canada and internationally.
I’m hoping to play a role in the field of health equity. One of the things I would like to look at is: what is happening to the health of the rich and the poor in connection with policies that have been implemented, in the Netherlands or in Rotterdam? For example, do tobacco policies have a different effect on rich and poor people?’

Are they? 
‘It is important to do these studies in different countries because the social environment is quite different. In Canada for example, the increases in the price of tobacco have been relatively small in recent years, and people were worried they weren’t big enough to really change behavior. What we found in Canada is that not only did these increases not have a different effect on rich versus poor, they don’t seem to have much of an impact at all right now,  compared to the larger tax-increases that happened in the 1990s and the early 2000s. 
We also compare changes in policies across countries like differences in maternity leave: how much time can a mother take off and, how much effect does this have on children?’

Do you think it is important to look at this theme in a multidisciplinary way?
'Yes. If you look at human behaviour, you have impacts of human sociology and decision making as well as financial consequences. This implies the need for a multidisciplinary approach. I look at the link between human diseases and social factors like poverty and education. What makes some people healthy, and what makes some people ill? Many of those things are strongly tied to people’s social circumstances. Even within epidemiology, which is more of a medical discipline, we still need to think about social circumstances.’

'What makes some people healthy, and what makes some people ill? Many of those things are strongly tied to people’s social circumstances.'

Sam Harper, epidemiologist

Why do you look at obesity as an epidemiologist? 
‘In the nineteenth to twentieth century, epidemiology was focussed on infectious diseases because that was what almost everyone was dying of. But now we’ve created a lot of medical care, clean water and hygiene and better living conditions and vaccines, so people die less frequently from infectious diseases. Now people are dying of things like smoking or obesity, so that’s why these diseases are part of my field of study as well. These things are killing poor people as well as rich people, but poor people die more often of these diseases than the rich. Even in a country like the Netherlands, where most people want equality, these differences exist.’

What is your mission? 
‘In many countries like the Netherlands as well as Canada there is a wish to narrow the gap between poor people’s health and rich people’s health. Many people feel these differences are unjust. I hope to provide good, robust, scientific evidence to give to people who are making policies, who are to decide how we should go about improving health and improving society.’

More information

Challenge Accepted is a joint campaign of Erasmus University Rotterdam and Erasmus Trustfonds that calls on all scientists, students, and alumni to contribute to advancing three ambitions to help shape the future.
Striving for Better Health and Healthcare: Erasmus University Rotterdam aims both to inform more effective health policies and help people make better lifestyle decisions. Academics from a wide range of disciplines are joining forces to make healthcare fairer, smarter, and to keep it affordable.

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