The Status Syndrome

by Harry on December 14, 2004

A while ago Chris reported that Michael Marmot was the star of one of the Priority in Practice conferences that Jo Wolff has been organizing. Marmot’s book The Status Syndrome has now been out for a few months, and lives up to Chris’s billing: even for those who were aware of the Whitehall studies and have been thinking through their significance for how to think both about egalitarianism in theory and social policy in practice will find it a very valuable read. Bill Gardner, who guested here in the week before the election, has an initial post reviewing the book at his excellent Maternal and Child Health site, and promises more. A taste:

Marmot’s fundamental empirical finding is that there is a social gradient in health, that is, when you group people according to their places in social hierarchies, you find better health and greater longevity in each successively higher class. His classic work studied the British civil service. He placed civil servants into four grades: administrators who set policy, executives who carry it out, clerical staff, and support personnel. There was a four-fold greater mortality rate from ages 40-64 for support personnel versus administrators. This was a large effect, and much larger than the difference in mortality rates related to conventional measures of social class. Why should the gradient in mortality be larger within one organization than within society as a whole? In Marmot’s view, the British civil service organization chart allowed him to measure individuals’ control over their own lives and their subjection to the control of others more precisely than conventional measures of social-economic status.
Marmot argues that the principal explanation for the status syndrome is not relative income, not higher rates of health-risk behaviors among the lower classes, and not status-related differences in genes. Income, heath-related behavior, and genes are all important determinants of health, but their effects are largely independent of the effect of your place in the social hierarchy and only partially explain the social gradient. What matters is autonomy:
for people above a certain material threshold of well-being, another sort of well-being is central. Autonomy – how much control you have over your life – and the opportunities you have for full social engagement and participation are crucial for health, well-being, and longevity. It is inequality in these that plays a big part in the social gradient in health. Degrees in control and participation underlie the status syndrome.