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The Status Syndrome: How Social Standing Affects Our Health and Longevity Hardcover – August 9, 2004

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Editorial Reviews

From Publishers Weekly

With 30 years of research and a catchy name for his theory, epidemiologist Marmot gives a wake-up call to those of us in the wealthy industrialized world who think our social status has no impact on our health: whether you look at wealth, education, upbringing or job, health steadily worsens as one descends the social ladder, even within the upper and middle classes. Beyond a simple explanation of how the deprivation of extreme poverty leads to disease, Marmot shows that life expectancy declines gradually from the upper crust to the impoverished. The odds are that your boss will live longer than you and that Donald Trump will outlive us all. Marmot bases his conclusions on his study of British civil servants, but backs up his theory at every turn with mountains of other research, from experiments on rhesus monkeys to studies of cigarette factory workers in India. For a book based on statistics, the text contains only a few graphs, but Marmot still provides a comprehensive overview of the current understanding of how our health depends on the society around us, and particularly on the sense of autonomy and control one has over one's life. As an adviser to the World Health Organization, Marmot has had the opportunity to make policy recommendations based on his theory. The Status Syndrome may not be a page-turner, but it will make readers look at the rat race in a whole new way.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

From The New England Journal of Medicine

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 dynamics that Marmot unveils start their overwhelming early in life. Our well-being, he shows, is directly related to where our parents stood on the ladder of hierarchy. In this area, Marmot considers intergenerational phenomena surrounding mothering behaviors that are transmitted nongenetically and influence our health -- and presents data showing that divorce is bad for children's health. In one of the book's lighter moments, he describes a judge asking a 95-year-old couple who want to separate, "Why divorce now?" The couple's reply: "We had to wait till the children died, your Honor." Marmot, as a member of the Scientific Advisory Group, helped produce the Acheson Report, which described inequalities in health in the United Kingdom. Although the group laid out 39 recommendations for reducing health inequalities, only 3 of them actually pertained to health care. The rest all involved enhancing people's status and narrowing the gaps that leave some of us considerably farther behind than others. Margaret Thatcher and Ronald Reagan, Marmot notes, turned "individualism" into a political credo. We now live amid the greed this credo has nurtured. Is that greed good for us? In this book, Marmot presents the general public with all the information it needs to answer that most important of questions. Stephen Bezruchka, M.D., M.P.H.
Copyright © 2005 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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Product Details

  • Hardcover: 336 pages
  • Publisher: Times Books (August 9, 2004)
  • Language: English
  • ISBN-10: 0805073701
  • ISBN-13: 978-0805073706
  • Product Dimensions: 6.4 x 1.2 x 9.6 inches
  • Shipping Weight: 1.4 pounds
  • Average Customer Review: 4.2 out of 5 stars  See all reviews (11 customer reviews)
  • Amazon Best Sellers Rank: #1,020,439 in Books (See Top 100 in Books)

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Most Helpful Customer Reviews

66 of 72 people found the following review helpful By N N Taleb on September 28, 2004
Format: Hardcover
You are a hot shot in a company, though not the boss. You are paid extremely well, but, again you have plenty of bosses above you (say the partners of an investment firm). Is it better than deriving a modest income being your own boss? The counterintuive answer is NO. You will live longer in the second situation, even controlling for diet, lifestyle, and genetic predispositions.

Marmot spent years poring over data; he left no stone unturned and is well read in the general literature on human nature. This idea of people living longer when they exert control over their lives has not spread yet. That people lead longer lives when they trust their neighbors and feel part of a community is far reaching. Just think of the implications on social justice etc. Also think that everything you learn on human preferences and well-being in both economics and medicine is either incomplete (medicine) or bogus (economics).

The book is well written, humorous at times, and rigorous --it reads like a well-translated scientific paper. But it feels that it is just the introduction to a topic. Please, write the continuation.
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27 of 29 people found the following review helpful By Nicholas in Moscow on December 20, 2005
Format: Hardcover
Marmot began his important work on social determinants of health with two long term studies of the British Civil Service finding that those who enjoyed higher status roles had better health and longer life expectancy than those who had lower status roles. This gradient from higher to lower applied throughout the service. Why was it so? And did it apply in other social and cultural contexts?

This book is a compelling exploration of the commonality of this phenomenum throughout both developed/transitional and developing country contexts, exploring the evidence and sifting the reasons for it. Status is found to be crucial - people with more opportunity to control their lives are more resiliant to stress and enjoy better health as a result (I simplify). It is not that healthier people enjoy better status because they are healthier - an argument carefully considered and dismissed - but people enjoying social contexts that enable them to secure status will enjoy better health and longer life. This applies as much to the rich social opportunities of Kerala in India as it does to an upper middle class suburb in the United States. Poverty, in itself, once basic needs are met, is not the issue as long as it is equally shared with all, what matters is the disequilibrium between people's status and being in the population denied access to opportunity to control one's life. The book is well-written, closely argued, and could change how you see the world for good.
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20 of 24 people found the following review helpful By Professor Woody Caan on October 3, 2005
Format: Paperback
This book is the perfect introduction to the study of Health Inequalities, especially in the context of occupational health. Students are gripped.
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11 of 15 people found the following review helpful By C. Griffith on September 2, 2011
Format: Hardcover
Michael Marmot's book, The Status Syndrome, is about how a person's social rank influences his or her health. The book's focus is on conditions in the richer countries, as opposed to those nations so poor that one would expect poor health. Social rank may be measured in a number of different ways, such as education, or income. Marmot, a British health researcher trained as a medical doctor, did much of his research on the British civil service, which ranks its employees with some precision. He emphasizes that rank does not act like a binary variable, leaving the poorest in poor health and everyone else in reasonably good health, but rather in a continuous fashion, with those of middling rank having health outcomes midway between those of the lowest and highest social ranks.

The great difficulty with social science research such as this is to disentangle confounding hypotheses in circumstances where an experiment is impossible. Here, besides the hypothesis that social rank has direct effects on health, there are at least two other major alternative hypotheses, first that its a sickly nature that reduces ones social rank, and second that those at the top of the pyramid are just generally more able people than those lower down. Studies of social mobility indicate a direct effect of one's current circumstances on health. Furthermore, experimental studies with non-human primates also show that the animal's place in the social hierarchy effects health in the same way observed in human populations. What an ecologist would call a natural experiment, the fall of communism in eastern Europe and the economic disruption that subsequently occurred, also provides evidence that a person's place in the social hierarchy affects his or her health.
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This very well written book addresses 4 hugely important issues, one each of fact, theory, policy and morality. A MATTER of FACT: The higher an individual's socio-economic status, the better their odds of a long and healthy life. Among populations, health and longevity rise as socio-economic status rise, and fall as it falls. "In other words, health follows a social gradient. I call this the status syndrome (Marmot:1)." The status syndrome is scientifically established fact and Marmot lays out an accessible summary of the scientific case based on decades of research from around the world. A QUESTION of THEORY: The status syndrome is fact: the theoretic question it raises is, WHY? Marmot advances an elegant and plausible theory for WHY socio-economic status so greatly affects health: socio-economic status affects (1) people's control over their lives AND (2) the density of their social networks, both of which, in turn, affect people's levels of chronic stress, which, in turn, greatly affects health & longevity. Most of "The Status Syndrome" is dedicated to the preceding issues. Towards the end Marmot address issues of policy and morality. POSSIBILITIES of POLICY: given the preceding, *IF* societies could reduce socio-economic inequality *THEN* they could reduce health inequality -- and *IF* they could eliminate the former *THEN* they could reduce whatever degree of the later is part of the status syndrome (not all health inequality is). The POLICY question raised by the epidemiological science is, to what degree CAN societies reduce socio-economic inequality?Read more ›
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