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Published on Sunday, November 29, 2009 by the Sunday Gazette-Mail (West Virginia)

Social Status Has Measurable Effect on Health

by Rick Wilson

In recent years, a growing body of scientific research indicates that human health and longevity aren't just matters of genes and habits. Rather, they seem to have a lot to do with our relative status or position in society.

The wonky term for this kind of thing is "the social determinants of health," which was recently the topic of a presentation to the West Virginia Legislature by epidemiologist and physician Dr. Camara Jones of the U.S. Centers for Disease Control. While the focus of Dr. Jones' presentation was on racial disparities, she said that inequalities and inequities affect the health of all people, regardless of racial or ethnic backgrounds.

A pioneer in this field of research is the British epidemiologist Michael Marmot, who among other things studied English civil servants over a period of decades. Here's the short version of his findings: people higher up the ladder lived longer and were less sick than those lower down, even when we take individual behavior into account.

This was true despite the fact that England has universal health care. Without it, the differences would no doubt have been even worse.

Most of us probably wouldn't be surprised to learn that poor people have shorter and sicker lives than those who are better off, but Marmot found the effect or "social gradient" to be constant throughout the hierarchy. That is, people just below the highest levels tended to have shorter lives and be sicker than those just above them and so on all the way down. Marmot's findings about the social gradient occur among other groups as well.

One interesting study even found that actors who win Academy Awards lived an average four years longer than those who were nominated but didn't win. No wonder they always thank the Academy ...

Part of what seems to be going on is that as social animals, we measure our own well being in terms of those around us. In Marmot's book The Status Syndrome: How Social Standing Affects Our Health and Longevity, he finds two variables that seem to have a great impact on our health and well being: a sense of autonomy or control over one's life and work, and the ability to fully participate in the society in which we live.

In our society, people with higher incomes and education levels tend to have more control and be less subject to shocks and setbacks than those with fewer resources. A car that breaks down, for example, is no big deal if you can afford to fix it and rent another, but it can trigger a disastrous chain of events for low-wage workers. Ditto a family illness, job loss or any of the "thousand natural shocks the flesh is heir to," as Hamlet put it.

People with more resources are also more able to fully participate in social activities. For the less fortunate, it's often a struggle to provide decent clothing for school-aged children, let alone pay for extracurricular activities that others take for granted.

It seems that jobs and situations that give people low levels of control and impose high demands and low rewards are particularly toxic for health. Outside of the workplace, such situations might include living in bad housing or in unsafe or toxic neighborhoods or in violent family situations.

These kinds of situations seem to activate the body's stress response, which was designed to deal with short-term threats and dangers but can lead to higher risks of various kinds of diseases when the stress is prolonged or chronic. This can lead to a great susceptibility to such illnesses as diabetes and heart disease as well as greater risk of infectious disease.

A startling finding of this kind of research is that relative deprivation in early life can have lasting impacts on health years later. In one experiment, healthy adults were exposed to two kinds of rhinoviruses, which cause common colds. They were asked a series of questions about their socio-economic status. It turned out that people whose parents owned their homes when they were children were significantly less likely to get sick than those whose parents didn't.

The findings of Marmot and other researchers is pretty sobering in the context of the current recession. Based on solid research, it's sadly safe to say that some people are going to die sooner than they otherwise would have because of it. Marmot's research on jobless workers in Britain found that "people who became unemployed had 20 percent higher mortality than those who remained employed at the same social class level."

He argues that this is because there are two aspects to economic hardships and loss of material resources. The first is "a lack of basic material conditions for life," or what social scientists call absolute poverty. The second is "insufficient resources, private or public, to participate in society," or what is called relative poverty, which has more of an impact than previously imagined. Obviously loss of income is a major blow, but even if an unemployed person has some resources or savings to fall back on, such people still "have worse health than those still employed in the same occupational social class."

Add to the mix the other key factor: being involuntarily unemployed also reduces one's sense of autonomy and control over one's life. Taken together, loss of control and inability to fully participate in society are a recipe for trouble.

That's why policies that create or save jobs or provide basic supports in hard times are particularly important. As a report by the World Health Organization on the social determinants of health put it, "Social justice is a matter of life and death."

© 2009 The Charleston Gazette
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