- Michael Marmot, director
- International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, London WC1E 6BT
Autonomy, self esteem, and health are linked together
The starting point for Richard Sennett's recent book, Respect in a World of Inequality, is that society is riddled with inequality: of natural endowment and talent, of opportunities and life chances, and of achievement.1 We respect achievement. Hence these inequalities will be accompanied by inequality of respect. This, in turn, will be accompanied by inequalities in self esteem. Do such inequalities in self esteem matter? And if they do, is there anything to be done given that there will always be individual differences in earned respect?
The answer to both questions is probably yes—they do matter, and something can be done. There is a view that human needs form a hierarchy: keeping life and limb together takes precedence over such concerns as self esteem and respect. Doyal and Gough criticise this concept of hierarchy of needs and replace it with the idea that there are two basic human needs—health and autonomy.2 Autonomy is closely linked with self esteem and the earning of respect.1 Individuals do not worry about the means of achieving good health and only then concern themselves with autonomy. Both are basic and, I …