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The Status Syndrome The Status Syndrome

By Mark Viney
Bristol University, UK.

I’m more important and richer than you, therefore I’ll live longer: a rather startling statement I learnt from reading this book. The discovery of this social gradient in health is based on two long-term ‘Whitehall studies’ of health and lifespan of British civil servants of different grades. Higher grades have better health and live longer. This is a striking result and has since been replicated in many other studies of other groups across the world. So, why does this happen, and why should we care?

The obvious answer is that it happens because the higher grade, richer bureaucrats all eat better, are less likely to smoke and have better health care. But, the social gradient in health persists even when these are taken into account. In fact, all the explanations one might think of are carefully dealt with and then discarded, leaving one inevitable conclusion: self-perceived social status and the number of social links of an individual has a physiological effect (via a psychological route), resulting in a social gradient in health. The health effects of social links are seen in marriage: married men have better health and live longer than single men; formerly married, but now single, men have the worst health of all. These effects aren’t quite reciprocal for married women, as is so much else in life.

We need to care about this social gradient in health for two reasons. Firstly, the effects are substantial. If chemicals in food or a new bug caused such large-scale mortality, there would, quite rightly, be an enormous public outcry. We also need to care about this health gradient because it has profound effects on how a society goes about trying to improve its health. Simply put, it suggests that reducing social inequity and increasing inclusiveness has a positive health effect for those with the worst health. These studies have fed into recent Government health strategies, something one can just about see in current government policies. So, read the book: it’s very well written, it’s important and it makes you think. When I read it, I instantly wanted to become an epidemiologist, since these studies show its power of discovery.

There is even a silver lining to this cloud. That this all started with British civil servants, at last shows that bureaucrats are at least useful for something. Though, actually, it only shows that Whitehall civil servants are useful for something: there is still no evidence whatsoever to yet reject the null hypothesis that all other bureaucrats are a waste of space.

By the status syndrome today at the bookshop

[Michael Marmot, The Status Syndrome: How social standing affects our health and longevity, Bloomsbury, London, 2004]

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