The Status Syndrome

For a number of years, a British physician and epidemiologist, Michael Marmot, has been studying health disparities throughout the United Kingdom and the world. In a book published a couple of years ago,The Status Syndrome, and in a recent article in JAMA, he outlines a phenomenon that he names the "Status Syndrome."

What is it, exactly? It is a disparity in health that relates to discrepancies in social standing, money, power, influence and level of self-esteem. Apparently, Academy Award winners live a few years longer on average than nominees. Independent of salary, higher educated individuals live longer than less educated people. However, money is not the only issue. There is something else, something intangible yet familiar to all of us that is embodied in the idea of "status" or social worth. The JAMA study showed that class for class, individuals in the UK had better health outcomes than their socioeconomic peers in the US despite our spending TRILLIONS more per year on health care. Countries with much, much lower GDPs per capita such as Greece or Israel have higher life expectancies than we do. Furthermore, the point has been made by Marmot and others that countries with little income disparity, such as Canada, Japan and Sweden, have better overall health than countries with wide and gaping disparities in income.

What is behind this phenomenon? Well, no one knows, quite honestly. But, science and pop culture have merged a bit in the past decade on the concept of stress. Since time immemorial, humans have noticed that less anxious, more socially integrated, happier people who feel good about themselves and their lives seem to do well. People under dramatic stress or trauma or who have suffered a loss often seem to have more medical problems or die sooner. Almost any of us can point to a friend or a family or an urban legend about so-and-so dying after his or her spouse died or of someone who "aged so quickly in a year" and on and on.

Well, research is catching up with this. There are studies that look at telomeres, the endings on chromosomes, which shorten with each replication of DNA. Some of these studies have shown correlation between more rapid telomere shortening and a history of stress or trauma. We are learning more about "inflammation" and its role in heart disease, cancer and other medical problems. Inflammation is driven by diet and activity but also hormones and our own bodies’ reactions to events. Some of our most effective medications, such as aspirin, decrease inflammation and it's thought that this may underlie the role of anti-inflammatory drugs in prevention and treatment of illness.

What's the bottom line? Well, I suppose there are really two bottom lines, at least. One is a personal bottom line. Namely, that we as individuals, in wanting to promote our own health and longevity and quality of life, should seek out behaviors that reduce stress, provide meaning to our lives and give us a sense of direction and autonomy. We should promote the usual healthful behaviors of diet, exercise and social interaction. Also, that money alone and the accumulation of wealth is not the answer. At least on a personal level. Rather, it is the satisfaction that comes with self-esteem, purpose and usefulness that may improve both our psychological and medical well-being.

From a societal standpoint, we have only to look at countries such as Sweden or Canada or Japan. Granted, they are more homogeneous populations than the US, but philosophically, there is something different between those countries and US. One aspect, in my opinion, is LESS of an emphasis on self-importance. Whether it is Canada's universal health system, Sweden's social safety net or Japan's stereotyped philosophy of "the nail that sticks out gets hammered down", there is on many levels more of an emphasis on community and group responsibility in those countries than in the US. While this allows for dynamite corporations and fabulously wealthy and entrepreneurial individuals in our country, it also accepts and allows for a much larger population of downtrodden and dispossessed people.

As a nation, I suppose we should aim to promote policies that reward innovation but at the same time attempt to reduce broad income and social disparities. Whether it's universal health or balancing our budget or providing for a social safety net, I think that our government at every level can enact policies that not only save money and provide services but also can actually save lives and help us live longer and healthier. I believe the data is becoming clearer and clearer in that, although the US allows for enormous success personally, our American way of life fractures us socially and widens both our financial as well as our physical health. In social policy as well as in science, it is not enough to simply look at single variables and outcomes. Humans are complex organisms and societies multiply that complexity many-fold. By focusing on the overall goal of longer life, better well-being and more equality in our health care delivery as well as being honest in looking at our neighbor countries and peers for what they are "doing right", maybe our government and ourselves (we make our government) can actually wake up and realize that there are better ways to live. It will probably save a few bucks also.