'Status syndrome'

Review by 
Helen Joyce
September 2004

Status syndrome

By Michael Marmot

This book from Professor Sir Michael Marmot (knighted for his services to epidemiology and understanding health inequalities) is concerned with a very simple question: why do people of higher status have better health and live longer than those of lower status?

It is well known that that poorer, or less-educated, people are more likely to live in unsanitary conditions, to smoke, to eat unhealthily, and to live sedentary lives. Marmot has spent his working life showing that this is nowhere near the whole story. Using copious amounts of supporting data, including longitudinal studies of civil servants in the UK and obervational studies of primate social groupings, he proposes a simple solution to the conundrum: it is the status itself that matters. We are accustomed to thinking in binary terms: rich/poor, educated/uneducated, high status/low status. But Marmot provides a wealth of evidence to show that we do better to think in terms of a gradient: a social gradient where the multi-millionaire has better health and lives longer, on average, than someone only a little less well off, and the CEO does better than a mere Head of Division.

According to Marmot, the better health enjoyed by higher status people is due to their greater social participation and autonomy. The primate studies clearly show that lower status animals have elevated levels of stress hormones, and these hormones can be induced by moving a high status individual to a different group, where they lose status.

Quite a few recent publications have focused on ideas of social capital, equality as a good, the weakening of social links in modern industrial societies, and so on. What sets this book apart from the rest is evidence. Marmot is no ideologue, he is a statistician, and as such prefers facts to theories. But it is ideology that is usually brought to bear on these issues. One reason is that they go to the heart of how you think about people and politics. Another is that gathering and analysing the data to distinguish between the various theories is very difficult indeed.

The social gradient exists everywhere, says Marmot, but in some countries it is steeper than others. So it is not simply a question of the poor always being with us: there are things that we, or our governments, can do to mitigate the effects of the social gradient. It is better to be poor in the relatively egalitarian Nordic states than in the richer US; should we be doing things differently here too?

As Marmot reminds us, this is an issue that effects practically everyone. Unless you are Bill Gates there is always someone better off, and unless you are George W. Bush, there is someone more powerful. So even if you are wildly successful, well educated, rich and powerful, it is a matter of self-interest to work towards a shallower social gradient, by making things better for those further down the scale.

This is a great introduction to modern social statistics, with insightful examples and clear explanations of how to use statistical analyses to answer questions in this field where designed experiments are nigh impossible. It may also be an important book; Marmot has the ear of the current UK government and what he thinks therefore may have practical consequences for policy. It could even mean that you will live a longer and healthier life.

Book details:
Status syndrome
Michael Marmot
paperback - 320 pages (2004)
ISBN: 0747570493