Why status matters

In over 30 years of research Professor Sir Michael Marmot has found a recurring pattern, from Hollywood actors to Whitehall civil servants:

• Oscar winners, on average, live four years longer than other Hollywood actors
• High ranking civil servants in the UK live longer than lower ranking ones.
• Life expectancy fell in the countries of the former Soviet Union as social inequality increased

This suggests that social status influences how long we live.

Professor Marmot argues that the lower our status the less control we have over our working lives (resulting in greater stress) and the less opportunity for social participation (meaning less opportunity for the protection against illness that social relationships can bring) resulting, for instance, in greater risk of cardiovascular disease.

More than just poverty?

Our socio-economic status can influence our health and how long we live. This isn’t just something health researchers have found. For example, the 2012 Longevity Bulletin from the Institute and Faculty of Actuaries, notes, ‘Mortality rates worsen as socio-economic status worsens, even within small populations’. 

We tend to assume it is poverty or financial hardship which is increasing the risk of an earlier death. Professor Marmot has a different interpretation. He believes both psychological and social factors are at work here and argues that the experience of low status and inequality (e.g. being low status, feeling low status and being made to feel low status) has a significant effect on people’s lives and their health.

He sees inequality as more damaging to health than poverty. In developed countries most people have the basic resources needed for life. What they do not have, as his research into civil servants demonstrated, is control over their lives — the power to live as they want.

How reliable is Professor Marmot’s research?

Some of the evidence, for instance from civil servants in the UK, is from public sector workers rather than private sector. It is also stronger for men than for women, perhaps reflecting the historic significance of work for a man’s status and identity. The factors described are also interrelated. For example, when it comes to poverty and psychosocial disadvantage, which is cause and which is effect?

We can probably also all think of well-publicised exceptions, where celebrities from fields such as popular music, film and sport have abused their status and have died young due to drug or alcohol consumption.

However, larger scale health studies published in 2016 and 2017 appear to support the finding that status affects how long we live.

• In 2016 BMJ Open reviewed the evidence and found an association between subjective social status (what status we feel we have) and the chances of health risks like coronary artery disease (CAD), diabetes and obesity. It suggested that how we perceive our own status has health effects above and above our actual income, occupation and education.
• In 2017 The Lancet published a global study into the association between socio-economic status and longevity among 1.7 million people studied. Participants with low socioeconomic status died 2.1 years earlier than participants with higher social status - a bigger effect than for high alcohol intake, obesity and high blood pressure, although lower than for physical inactivity, diabetes or smoking.

Other factors effecting longevity

We all know a number of other factors affect our health, in particular:

• genetic factors
• access to healthcare
• lifestyle (including whether or not people smoke, how healthy their diet is and whether they exercise regularly).

This fits with wider research into where, how and why some people live longer - which suggests a complex mix of factors, including genes, gender, lifestyle and personality.

However, the identification of status as an independent factor affecting health and longevity has added an important new dimension.

What are the implications?

If Professor Marmot’s analysis is correct, we risk increased ill health and lower life expectancy in some sections of society unless greater social equality can be achieved or some other way can be found to counter the health risks associated with lower perceived social status.

So, what can be done? 

Professor Marmot suggests governments need to help reduce social inequality and nurture social participation. This could have significant public health benefits if achieved, so is something that both governments and the people who elect them need to explore further.

For example, do socio-economic factors have more impact on health outcomes than medical treatment, as some evidence suggests? If so, what are the implications for current government policies and priorities, which are typically fixated on the NHS?   

Is Status a Life Sentence?

We have no control over our status at birth. Does this dictate our lives or can we change our status? While we’re waiting for government to do more to reduce social inequality is there anything we can do ourselves as individuals?

What can we do to avoid status becoming a life sentence?

• Between 1924 and 1984 there were five General Secretaries of the Trades Union Congress (TUC). They lived to an average age of 80 – well above average for that time. All were from working class backgrounds, such as Len Murray the son of a farmworker, yet went on to achieve higher status through career progression. This is a small sample but suggests that one option is to improve our status through what we achieve in life.
• Being part of a social network may help protect us from poor health. For example a 2015 review of four long term studies found that social integration had a number of physical health benefits - while being socially isolated had adverse effects on health, being worse than diabetes for blood pressure when people get older.
• Volunteering could benefit our status, by providing a new role and new social networks. Early research suggests volunteering improves longevity – while a study in England, involving 10,324 participants over nearly 11 years, found volunteering was associated with increased survival, at least for able-bodied volunteers.
• The creative arts may also have a protective effect. A study of 6,000 people over 14 years in England found that people who engaged with receptive arts activities on a frequent basis (every few months or more) had a 31% lower risk of dying.
• The four pillars of good health are clearly important too i.e. not smoking, drinking alcohol in moderation, eating a healthy diet and getting enough exercise.

The value of education

Education has long been known to increase our chances of living longer. Actuaries, who advise the insurance industry on how long pensioners are likely to live, have known this for some time. The Longevity Bulletin 2012, from the Institute and Faculty of Actuaries, noted: ‘The evidence that education acts directly to improve mortality independent of socio-economic status is said to be under-appreciated outside of demography’.

Not everyone may have the same educational opportunities early in life. However, in the UK there are opportunities to return to education later in life, as a mature student. One study suggested (with some possible caveats) that men and women who leave school without any qualifications may be able to ‘catch up’ to some extent with more qualified people in terms of lowered coronary heart disease risk (like heart attack and stroke), if they obtain qualifications later on in life.

This applies internationally. For instance, Professor Marmot reports that Kerala (in southern India), Cuba, Costa Rica and Sri Lanka have all invested in education, including education for girls, and people there enjoy greater longevity than in most other developing countries.

Conclusions  

 Michael Baber  August 2020

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