Is Status a Key to Longevity?
Oscar winners, on average, live four years longer than other Hollywood actors. Could social status be a key to human longevity?
The influence of status on health and longevity is the important question raised by Professor Sir Michael Marmot, Professor of Epidemiology at University College London, in his book Status Syndrome(2004).
An expert in his field, Professor Marmot undertook further research on the topic as head of the UK government’s national review of health inequalities: Fair Society, Healthy Lives, which was published in 2010.
Why status matters
In over 30 years of research Professor Marmot found a recurring pattern, from Hollywood actors to Whitehall civil servants. This pattern led him to conclude that social status influences how long we live.
His explanation for this is 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.
Here is a selection of findings from his research:
- High ranking civil servants in the UK live longer than lower ranking ones, who suffer more from heart disease than those at the very top (even when smoking and cholesterol are factored out).
- As social inequality increased in the countries of the former Soviet Union, life expectancy decreased (a long term trend confirmed in a 2011 report).
- People tend to live longer in Kerala (where there are more educational opportunities and lower levels of social inequality) than other parts of India and other poor countries.
More than just poverty?
Professor Marmot believes both psychological and social factors are at work here. He 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.
In this sense he distinguishes between poverty and inequality, seeing inequality as the more damaging to health. He observes that in developed countries most people have the basic resources necessary 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 Professor Marmot’s 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, as regards 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. Some of the examples here include Prince, Michael Jackson, Marilyn Monroe and George Best.
However, studies published in 2015, 2016 and 2017 appear to support his finding that status affects how long we live.
- One study, published in 2015, looked at 4,190 scientists nominated for election to the Chinese Academies of Science or Engineering. Being elected had limited financial benefit. The main benefit was enhanced status. However, those elected lived an average of 1.2 years longer than those who weren't.
- In 2016 BMJ Open published a systematic review of ten published studies into the association between subjective socal status (what status we feel we have) and the chances of health risks like coronary artery disease (CAD), diabetes and obesity. It concluded that lower subjective social status is associated with significantly increased odds of CAD, hypertension (high blood pressure), diabetes and dyslipidaemia (abnormally high levels of fats in the blood), with a trend towards increased odds of obesity. Taking other factors into account 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. It found that 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
Professor Marmot recognises that a number of other factors also affect 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 - a point confirmed by The Lancet study above).
This fits with our own review of the research into where, how and why some people live longer - which suggests a complex mix of factors, including genes, gender, lifestyle and personality.
However, his identification of status as an independent factor affecting health and longevity has added a new dimension, which is being increasingly confirmed by research.
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 may seem controversial to some and may be easier said than done. However, if he is correct, this could have significant public health benefits if achieved. So this is something that both governments and the people who elect them might consider worth exploring 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?
In a linked article we also look at what individuals can do to reduce the potential health risks of low status.
Published February 2014, Reviewed and updated by Diana Harvey January 2017, Next review date January 2020.