Oscar winners, on average, live four years longer than other Holywood actors. Could career success be one key to human longevity?

The influence of status on health and longevity is the important question raised by Sir Michael Marmot, Professor of Epidemiology at University College, London, in his 2004 book, ‘Status Syndrome.’ Sir Michael is an expert in his field, chosen by the UK government to head up a national review of Health Inequalities, which reported in 2010, so his ideas are probably worth exploring further.

In over thirty years of research Professor Marmot has found a recurring pattern, from Hollywood actors to Whitehall civil servants, from post Soviet Russia to modern Kerala.

For example:

• Oscar winners, on average, live four years longer than other Hollywood actors.
• The higher ranking the civil servants in the UK, the longer they live (with the lowest ranking civil servants significantly more likely to die from heart disease than those at the very top, even when smoking and cholesterol are factored out – with a health gradient running through the different levels in the civil service, mirroring the status/grades of the civil servants).
• Life expectancy fell in Russia and other Eastern European countries, as inequality (real and perceived) rose.
• People tend to live longer in Kerala than in other poor countries (with Kerala providing more educational opportunities than many other parts of India, in particular for girls, resulting in a lower levels of social inequality). There is a similar picture in countries like Cuba, Costa Rica and Sri Lanka.

This has led Professor Marmot 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.

He sees a psychosocial dimension here ie that the experience of low status and inequality (eg being low status, feeling low status and being made to feel low status) has a significant effect on people’s lives and our health.

In this sense he distinguishes between poverty and inequality, seeing the latter as the more damaging to health. He observes that, in developed countries, most people have the basic resources necessary for life. But they do not have, as his research into civil servants demonstrated, control over their lives — the power to live as they want.

In this context, in the West, while poverty can result in material deprivation it is arguably more important as an indicator of the problems people are likely to see themselves facing in controlling their lives and participating fully in society.

Autonomy, a sense of control over your life and social connectedness - rather than actual financial resources or access to medical services. According to ‘Status Syndrome’ these have the greatest impact on your health and life expectancy.

And this is where the degree of equality or inequality in a society comes in to play. For example Professor Marmot gives the example of post war Eastern Europe, where people were not materially well off but there was perceived to be a fair amount of social equality, where life expectancy was similar to that in Western Europe – only to fall as inequality became more apparent in the latter Communist period and even more so in the immediate post Communist era (the time of the oligarchs). In other words, someone’s health could conceivably be affected by someone else’s wealth (and its associated status).

He also gives the example of Kerala in India, a relatively poor area but one where educational opportunities are widely available, including for girls, contributing to a more equal society and to life expectancy above the norm for a poor country.

Does this mean status is the only factor affecting longevity?

Professor Marmot recognises that status is one of a number of variables impacting on health, alongside genetic factors, access to healthcare and lifestyle (including whether or not people smoke, how healthy their diet is and whether they exercise regularly)

Are there other limitations to the Status Syndrome?

Some of the evidence, for instance relating to civil servants, is stronger for men than for women, perhaps reflecting the fact that work was traditionally a more significant part of a man’s identity and status.

Also, the factors he describes are often interrelated, for example as regards material deprivation and psychosocial disadvantage. This raises possible questions as to what is cause and what is effect. If material possessions enable people to exercise more control in their lives and to participate more fully in society, might this in turn help provide access to greater material resources and therefore more control in their lives and fuller social participation ie a continuing interaction and a multiplier effect. Further research may be helpful here.

What are the implications if the Status Syndrome is an accurate analysis?

One implication is that governments in developed nations may need to focus less on simply reducing poverty and material deprivation and focus more on reducing psychosocial deprivation. This is an era when, in the UK and USA for instance, bankers’ bonuses and executive pay have soared while many people have experienced job insecurity and a fall in living standards. If Sir Michael’s analysis is correct, unless greater social equality can be achieved we risk increased ill health and falling longevity in some sections of society. Employee membership of the remuneration committees which decide senior executive pay might be one practical step here from a psychosocial perspective.

The example of Kerala suggests the importance of educational opportunity and starting young; whilst the importance of social participation and relationships suggests the value of support systems for older people and communities in general.

Published 07/12/2011, Review date May 2014