Dr Marisa Miraldo discusses how good public health policy can serve wider society and why addressing existing inequalities should be a priority for us all
The importance of health economics has perhaps never been quite so apparent as it is now. And while the coronavirus (COVID-19) pandemic is a major reason for the subject stealing the limelight – and headlines – it is far from the only one.
“We all want to be healthy and healthy societies are also more productive,” says Dr Miraldo, Associate Professor in Health Economics, who joined the Business School in 2008. “The health sector is one of the most R&D intensive sectors, it is one of the largest employers and has a huge impact on the way we function.”
She says her passion for health economics comes from her desire for her work to make an impact. One area of research she focuses on is the obesity pandemic, a subject she finds fascinating because it is so “complex”.
Individual vs. state
The issue of obesity and unhealthy diets has sparked heated debate in many countries across the world, with some arguing the crisis is all down to individuals making bad choices. Up until the COVID-19 pandemic, British Prime Minister Boris Johnson was among them, believing that the problem wasn’t a question for the state.
Dr Miraldo says many people still wrongly think obesity and an unhealthy diet is an individual’s fault, adding that when it comes to eating, multiple factors determine the choices we make. Some of these, she says, are linked to a person’s socioeconomic status, including where they live and their time constraints, as well as the built environment they are exposed to around their homes, schools or workplaces.
For example, if someone has two jobs, it will be harder for them to source the ingredients necessary to prepare a healthy meal from scratch and therefore increasingly likely they will make the easy, less healthy choice of eating a ready meal or takeaway. This situation is frequently compounded by the fact that junk food is often cheaper than healthy food, and in low-income areas, can be easier to find.
Additionally, if a person makes their daily commute on public transport then they would be more exposed to unhealthy food advertising than those that drive.
These are just a few examples of what contributes to how and what we consume but Dr Miraldo points out that we still don’t completely understand why some people behave differently when it comes to food. However, we do know the effects of eradicating it would be remarkable.
According to the UK government, the overall cost of obesity to wider society is estimated at £27 billion. By 2050, the UK-wide NHS costs attributable to obesity are projected to reach £9.7 billion, with wider costs to society estimated to reach £49.9 billion per year.
Luckily, companies in the food and beverage industry are finally starting to listen to research showing just how negatively their products affect those who consume them and beginning to take the right steps to proactively contribute to better nutrition. This change is happening “slowly but surely” says Dr Miraldo.
COVID-19 and the vulnerable
Like obesity, the COVID-19 pandemic has disproportionately affected vulnerable communities. The pandemic is exacerbating existing health disparities, with socially marginalised populations reported to have higher infection rates and poorer outcomes.
BAME groups are more likely to catch and die of the virus and while we don’t have a full understanding of why some ethnic groups are more affected by the pandemic than others, Dr Miraldo points out that socioeconomic and labour market factors are among the reasons. These populations may also be more vulnerable because maintaining physical distancing is a privilege. The effectiveness of social distancing policies, for example, is conditional on voluntary compliance by encouraging individuals to stay at home, however, not all individuals can work remotely.
Dr Miraldo argues governments should do better in protecting these groups, both with regards to their risk of infection but also in mitigating the disproportionate socioeconomic impact the pandemic has on them.
“We are failing enormously, and this is across all countries,” she says. “People are losing their jobs, they are getting infected and they are dying prematurely, and this affects certain groups in society disproportionately”.
“In the same way that we have historically done too little, in my view, to curb socioeconomic inequalities and health inequalities, we are not – and will not be – doing enough to help these people and bring them to the same level of opportunity as everybody else. And that is essential.”
This concern for unaddressed inequalities in society is reflected in the work Dr Miraldo has put into her work on diversity within the Business School and across the College. Highlighting issues such as the dearth of people of colour, women and members of the LGBTQ+ community in academic positions, she describes the situation in academia as “appalling”.
“We really need to make a bigger effort to give equal opportunities to everybody and also treat people with respect and value them for what they do and who they are. I think we are miles away from being at any acceptable level in our endeavor to be inclusive, nurture diversity and end discrimination.
“We are special at Imperial, in that a lot is happening to make the College a more diverse and inclusive university,” she says, adding that many other institutions are also making an effort to improve.
Nevertheless, she says, “It is a slow process, and what we need is a breakthrough change” if we are to see real and meaningful difference in higher education.
Organisations are living things that have processes that are not always pro-diversity
“I think it’s not only about people not wanting to change but discrimination is so culturally embedded in our organisations and at a wider societal structure that it is challenging to make progress. However, I think we could, and should, do better.”
Raising the issue of fewer black people in faculty positions, she suggests more drastic measures such as setting a five-year target with more accountability if it is not reached, as well as ending cultural references to discrimination and racism, and believes we can do more, more quickly.
“Sometimes people aren’t aware they are not treating people in a fair way. Organisations are living things that have processes that are not always pro-diversity,” she says. Above all, she believes the education sector has “a bigger responsibility” as well as “a huge opportunity” to address these issues which plague society as a whole.
“We are privileged to have the opportunity to enact change for many people through our research, through our teaching and our outreach activities.
“I really think we should take up this challenge to improve society. After all, the education sector reflects – or should reflect – our societal fabric so changing it can create a ripple effect.”