The Status Syndrome

I went to a very interesting book launch and seminar on 30 May. Sir Michael Marmot presented his book The Status Syndrome - How our social position affects our health and life expectancy.

Genes, lifestyle and access to healthcare are important for health, but other factors matter even more; how we live in society and what our situation at work is like. Michael Marmot has examined the relation between status and health - the status syndrome - and highlights the importance of e.g. education, income, parents' background and occupation. Based on three decades of research he presents evidence for how subtle differences in social position can lead to important differences in health and life expectancy.

The Status Syndrome is not about illness for the poor and good health for everybody else, but about a continuous variation, a so-called health gradient. Already in the 1970s Marmot studied British civil servants and found that illness frequency and mortality increased the further down the social ladder he looked. The same pattern is found all around the world, including in Sweden. (Marmot also studied baboons and found a similar pattern of mortality depending on dominance or subordinance.) In Washington D.C. the average life expectancy between a black person in the inner city is over 20 years shorter than a rich white person 15 metro stops away in Maryland. In the industrialised countries we think that we have solved everything, but we have huge inequalities in health. The so-called Swedish paradox is that Sweden has the widest inequalities in health in Europe (except in absolute terms), e.g. the mortality of manual v. non-manual labour.

Over a certain level of resources it is what people have in comparison to others that is decisive for their health. Money by itself does not matter - it is what you can do with the money relative to other people that matters. According to Marmot's research people prefer relative standing rather than more money in absolute terms. One anecdote from Marmot's studies is that Oscar winners on average live four years longer than colleagues who have been "just" nominated. Another example is that mortality is higher among people with a Masters than among people with a Doctorate.

Supporting relations in the private sphere and the degree of trust and social solidarity in the society are central dimensions for health. Control, social participation and health are fundamental needs that are linked. As people are different, inequalities will always exist, but the scope of their effects on health can be controlled according to Marmot. If we understand the link between inequalities and health, we can do something about it.

** Sir Michael Marmot is Professor in Epidemiology and Public Health at UCL and Head of the International Centre for Health and Society. He is also Chairman of the WHO's Global Commission on Social Determinants of Health. In 2004 he was awarded the Balzan Prize in epidemiology and in 2000 he was knighted for his efforts within epidemiology and the understanding of inequalities in health.