Among the most intriguing aspect of Marmot’s work is the fact that he changes the focus from advances in technology and genetics as to how these lengthen our lives and remedy disease. Instead, the author dwells on his belief that health follows the relationship of the individual’s autonomy and opportunities in the realms of social engagement and participation. The contents provide the reader with means to understand the circumstances in which we live and work so that one can enhance opportunities for self-realization and social integration. And through these understanding the steps we can take to lead to healthier and fulfilling lives.

This book is a thorough synthesis of the author’s important research efforts of more than thirty years. From this, suggestions on how an individual can enhance one’s well being and longevity are offered in understandable and doable ways. Marmot’s background enables us to have confidence in his pronouncements. He is a professor of epidemiology and public health at the University College at London. Included in his achievements is his service as an advisor to the World Health Organization.

Among his previous endeavors were his long term involvements with his Whitehall Studies. An important finding there was that a person’s health is a major predictor of the place of an individual in the social hierarchy. With this outcome Marmot was encouraged to investigate this phenomenon. His intensive investigations have led to findings that clearly demonstrate that relatively small differences in the categories of education, title of one’s job, income, and size of where one lives, are closely tied in with and individual’s chances of remaining in good health and having a long life.

The author’s findings, which are well documented, have found that contrary to old beliefs, advances in technology and genetics are not the basic ground for longer lives and curing disease. His contention shows the individual’s personal health is determined by a social gradient that has one’s autonomy and social participation in its center.

In many places in this book, Marmot shows that persons who enjoy the higher status in the pecking order are those that are most likely to be better off all around. Health clearly follows a social gradient which he calls the status syndrome. In addition to being above the threshold of material well being, another key ingredient is how much control one has over their life (autonomy). He points out that our health is likely to be better than those below us and not as well as those above us.

The author points out that the roots of the social gradient in health are found in our set of social arrangements. The way we function in our daily lives in work, homes, and neighborhoods determine our social arrangements. The psychological feelings of inequality have deep effects on our body systems. Problems that we have in our lives can make us ill. A flourishing person is one who lives a fulfilling and longer life. He continually stressed the point that one’s health determines where one will end up, not the other way around. The author cites a number of books that develop the theme that people, in addition to valuing the notion of living well also have control over their lives. Marmot stresses early in this book that a large segment of our population fail in achieving their potential in health and length of life because of suffering from outcomes of the status syndrome.

The author progresses through the development of the status syndrome in a step by step fashion. He devotes an entire chapter on how autonomy has clear effects on ones health He points out that poverty is more than lack of money. The critical elements in life are control over one’s life, having love and important social relationships. These are the real riches that tie in with when and how we die.

In conclusion, Mormot has written an important book with a minimum of scientific language. This makes it easier for the average reader to enjoy this work on a chapter by chapter basis. For individuals seeking more details and background, a useful Appendix is provided. This is followed by notes, cited by chapter. Also useful for those seeking more details, a generous Bibliography is provided. A section of Acknowledgements follows. For those seeking pages dealing information on a term or subtopic, a thorough Index is found.