The Status Syndrome (e-book) (used book) | Michael Marmot | bookbook.eu

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"In this book, Michael Marmot, an internationally renowned epidemiologist, marshals evidence from around the world and from nearly thirty years of his own research to demonstrate the importance of status in our health, well-being, and longevity. For years we have focused merely on how advances in technology and genetics can extend our lives and cure disease. But, Marmot argues, we are looking at the issue backwards. In the past, we have viewed social inequalities as a footnote to the real causes of ill-health; in fact, they are a major cause. He calls this effect the "status syndrome."" "The status syndrome is pervasive. It determines the chances that you will succumb to heart disease, stroke, lung cancer, infectious diseases, even suicide and homicide. And the issue, as Marmot shows, is not simply one of income. Nor is it a case of differences in lifestyle - the likelihood that you are a smoker, or that you eat a high-cholesterol cheeseburger every day. It is the psychological experience of inequality - how much control you have over your life and the opportunities you have for full social participation - that has a profound effect on your health." For instance, by investing in early child development and the education system, we can give children a better chance of improving their status and thus their health as adults. By creating secure jobs that give employees some control over the way they manage their careers and reward them for their efforts, we can diminish the social inequalities and health risks of the workplace. By providing older people, and communities in general, with support systems that increase social contact, we can improve health as well. While these are not the usual routes to curing disease, Marmot shows that they are critical ones.

Michael Marmot's book offers a drink from the fire hose of social epidemiology. If you want to understand why the health of people living in the United States, the richest and most powerful country in world history, lags far behind the health of people in other rich nations, then be prepared to wet your whistle here. Marmot, a British doctor who received his epidemiologic training in the United States, directed the Whitehall II studies of British civil servants. His Whitehall research was built on earlier studies that had examined health disparities among various occupational grades of civil servants. Marmot found that in nearly all settings, the lower in a socioeconomic hierarchy a person is ranked, the worse is that person's health. And that maxim holds for almost any disease or health risk factor. Those who stand higher up on the ladder of life are always healthier than those even a few steps below. This health "gradient" has become accepted in public health circles during the past two decades, thanks in no small part to Marmot's work. (Marmot even received a knighthood, a rare accolade for a public health researcher.) However, the health-gradient concept remains largely unfamiliar in the United States. Americans speak about health disparities but typically are referring to differences in health outcomes between whites and minority groups. Conventional wisdom considers these disparities a consequence of unequal access to health care -- or a product of unhealthy personal behavior. But in this book, Marmot demonstrates clearly that this myopic view significantly limits what we see about our society. The Status Syndrome explores a wide range of instances in which differences in status generate differences in health outcomes. Although average incomes serve as a useful predictor of who is healthy and who is not, Marmot shows us that a health gradient even shows up among successful actors and actresses who have won Oscars and those who haven't. Here, Marmot distinguishes between poverty and inequality. Poverty, he explains, deprives people of the capabilities to lead the lives they would wish to lead. If you have little money, "more money would benefit health, but if you have more of it, then it is how much more you have compared to other people in your society that is more important for health." Poverty doesn't drive ill health, he writes. Inequality does. In rich countries, Marmot continues, most people have the basic resources necessary for life. But they do not have, as the Whitehall II studies demonstrated, control over their lives -- the power to live as they want. The lower that people stand in the hierarchy, the less they have a sense of controlling their own destiny. Low control leads to chronic stress. High-status work, on the other hand, tends to be associated with greater control, more power, and better health. Stress, of course, isn't always a bad thing. Our quick response to a short-term stressor -- our flight from an attacker, say -- may sometimes save our lives. But studies of other primates have helped researchers understand how chronic stress overwhelms our systems and leads to most of the diseases of modern life. And the chronic status...