Sir Michael Marmot looks at the impact of status on health care outcomes. Hint: higher status is better for your health.
I wrote yesterday about Muriel Gillick’s call for America to stop denying aging and to shift radically its thinking about health care and the policies that flow from that different approach.
Today, also at my father’s suggestion, I read Michael Marmot’s The Status Syndrome: How Social Standing Affects Our Health and Longevity, and realized that, in order to have truly meaningful impact, health care policy changes should be accompanied by changes in social policies.
Marmot is one of the most prominent of an international group of scholars and researchers who investigative and write about the social determinants of health outcomes.
What they find may surprise you.
In The Status Syndrome, Marmot marshals a host of different studies from around the globe, literary references from everyone from Leo Tolstoy to William Shakespeare to Saul Bellow, a few well-placed jokes, and his 30 years of research experience to show that one’s social standing does indeed have very real consequences for our health and life span.
The book contains entertaining nuggets, like the point that Oscar-winning actors on average live four years longer than their nominated, but non-victorious, peers.
His bigger point, though, is that there are a number of factors that are not directly to health care policy and that occur in societies where basic needs are generally met that have large influence on how long and how well people live.
One of the studies he conducted was the Whitehall Study in which he followed the health trajectories and experiences of English civil servants, most of whom had quite similar jobs and all of whom had access to public health care.
The workers’ health improved in direct proportion to their rank. The highest ranked workers had the best health outcomes, followed by the next group, and so on down the line.
This may seem logical enough, and Marmot breaks down the different components of the syndrome, showing that the amount of money one own earns relative to others, control over one’s life, and connection on individual and society wide levels all have significant and quantifiable consequences for people’s health.
Societies like Japan that have relatively high levels of social cohesion, meaning that people’s actions are characterized by consideration for, and trust of others, and that have lower levels of income inequality tend to have much better health outcomes on average than societies like the United States, which has a higher GDP, but greater levels of inequity and lower level of societal integration.
A summation of decades of work, the Status Syndrome effectively blends research findings, literary and cultural allusion-Puccini gets a nod to open a chapter, for example-with a perspective that is at once moral, practical and self-interested. While Marmot explores the idea in the book’s final sentence that full equality may never arrive, he urges societies to take specific actions to make the world more equal.
“Why not make things better?” he asks. “It’s in all our best interests.”
Marmot includes as an appendix a list of recommendations he and other members of the Independent Inquiry into Inequalities in Health developed to try to make those changes possible.
Unsurprisingly, of the 39 recommendations, only three are directly about health care policy. The other 36 focus on changing the social conditions that create those health care policies.
Marmot emphasizes that the book does not cover individuals experiences, but rather takes a nationwide vantage point, with the exception of a short section about two men who were born during the waning days of the Austro-Hungarian empire, but one lived most of his life in Austria while the other was in Hungary.
The national perspective is a valuable one. I hope that President Obama and the others looking to enact comprehensive health care reform consider the implications of Marmot’s work not to stop from going forward with the changes they seek, but rather to have those reforms be part of a larger restructuring of our nation’s priorities and policies.