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Social Status Affects Health and Longevity, Research Says

February 23, 2007 at 6:45 PM EST
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PAUL SOLMAN, NewsHour Economics Correspondent: Peter O’Toole, nominated for a ninth Academy Award this year. Finally winning best actor, it turns out, could be a matter of life and death.

For nominee Meryl Streep, however, who’s won twice already, there may be little to fear.

MERYL STREEP, Actress: You have no style or a sense of fashion.

ANNE HATHAWAY, Actress: I think that depends on what your…

MERYL STREEP No, no, that wasn’t a question.

PAUL SOLMAN: You see, a recent Canadian study suggests that, when you win an acting Oscar, you live longer, like Bette Davis, who made it to 81, or Jimmy Stewart, who died at 89. John Gielgud and Katharine Hepburn both lived to 96.

KATHARINE HEPBURN, Actress: The loon, the loons, they’re welcoming us back.

JOHN GIELGUD, Actor: I don’t hear a thing.

Oscar winners live longer?

PAUL SOLMAN: Sure, there were Academy Award winners who died younger, even Henry Fonda, who won for "On Golden Pond" in 1981, died the next year at age 77. But on average, actors who take Oscar home seem to live four years longer, 79.7 years, when compared with those who remain statue-less, 75.8.

Now, one might be skeptical of the Oscar effect. The sample is modest, and though the results also hold for directors, they don't for writers.

But consider this: The same pattern is true of Nobel laureates. They outlive their peers on average by two years.

To Michael Marmot, who's done groundbreaking research on social hierarchies and health, the Oscar and Nobel findings suggest a troubling truth. In a world of growing inequality, status determines longevity, from the very bottom of the pecking order to the tippy-top.

MICHAEL MARMOT, Author, "The Status Syndrome": I wouldn't shed too many tears for the actor who was nominated and didn't win. She or he is still doing very well and much better than the person waiting tables.

But the fact that you see this huge gap means that that sense of loss and disappointment and lack of self-esteem, lack of esteem from others, is just as important if you're right up there and miss out on the big prize than if you're down at the other end of the scale and are missing out on the prize that's relevant to you.

PAUL SOLMAN: For most people, the relevant prize is not a fake gold statuette, but real money. And while losing the Oscar race may take four years off your life, losing the economic race may take even more.

Thus the news of this piece: The growing economic inequality in the U.S. and elsewhere is not only painful, it can be fatal, a finding summarized in Marmot's book, "The Status Syndrome," based on 30 years of now widely replicated research.

MICHAEL MARMOT: What my research shows and research all over the world confirms is that where you are in the social hierarchy is intimately related to your risk of health and disease. And by that, I mean, people second from the top have worse health than people at the top. People third from the top have worse health than people second from the top. And it runs all the way from top to bottom.

Life expectancy gaps in the U.K.

PAUL SOLMAN: Dr. Marmot first noticed the phenomenon in the United Kingdom.

MICHAEL MARMOT: In England and Wales, for example, in the early 1970s, the gap in life expectancy for men between people at the top and people on the bottom occupational groups was five-and-a-half years.

PAUL SOLMAN: Doctors, janitors.

MICHAEL MARMOT: Doctors, janitors or unskilled manual workers, exactly. And 20 years later, in the early 1990s, that five-and-a-half-year gap had increased to nine-and-a-half years. So in only 20 years, we went from five-and-a-half years to a nine-and-a-half-year gap between top and bottom.

PAUL SOLMAN: And what else happened while the life expectancy gap between doctors and janitors doubled? The pay gap doubled, too.

In a major study of the British Civil Service, Marmot found a similar widening in the longevity gap as inequality grew, a four-and-a-half-year difference in longevity between those in the top tier and those in the bottom.

MICHAEL MARMOT: No one is poor in the British Civil Service, all doing office-based jobs. Where you are in the employment hierarchy is intimately related to your chance of dropping dead.

PAUL SOLMAN: Now, there could be an alternative explanation. The lower your earnings, the worse your medical care. Not so in Great Britain, however.

MICHAEL MARMOT: Everybody has access to the National Health Service.

PAUL SOLMAN: Well, then, what about bad habits? Don't those lower on the ladder smoke more, eat more, exercise less, and thus die sooner?

MICHAEL MARMOT: We can explain about a quarter of that gap in life expectancy on the basis of smoking, cholesterol, overweight, lack of physical activity, the usual culprits. Three quarters is unexplained by the usual risk factors.

Longevity and socioeconomic status

PAUL SOLMAN: Meaning most of the difference in longevity is due to a risk factor we don't usually think of, says Marmot: your socioeconomic status.

MICHAEL MARMOT: Health and disease are the good and bad effects of where you are in the hierarchy, mediated by the effects of chronic stress. And we can then see it for a whole range of diseases, of specific diseases. We see it for heart disease; we see it for some cancers; we see it for gastrointestinal disease; we see it for violent deaths.

PAUL SOLMAN: What exactly is going on? And why are you as a doctor convinced that it's stress that's doing it?

MICHAEL MARMOT: Lack of control over your own life activates chronic stress pathways which increase risk of disease. So that's one influence: autonomy, control.

But a second is full social engagement. The society works for me, and I am part of the society. Whether it's being able to send my children to reasonable schools, to live in a reasonable neighborhood with fear of crime removed, all the things that we think of as being a full social participant.

And both of these, autonomy and control, are intimately related to where you are in the social hierarchy. The lower you are, the less control, the less opportunity for full social engagement.

PAUL SOLMAN: Now, in countries like Sweden, where economic inequality is less pronounced, so is the gap in life expectancy.

MICHAEL MARMOT: Considerably smaller in Sweden than it is, for example, in neighboring Finland, or England and Wales, or France.

Income inequality in the U.S.

PAUL SOLMAN: Meanwhile in the U.S., inequality has been accelerating for decades. Since 1979, inflation-adjusted income at the bottom has barely budged. By contrast, the income of the top 1 percent since the '70s has at least doubled. The top tenth of a percent, tripled. The highest paid 100th of a percent, multiplied six-fold.

And in a recent study comparing the health of Americans and Britons, Marmot identified an ominous trend.

MICHAEL MARMOT: Every social level, the Americans are sicker than the English, and this is despite the fact that you spend two-and-a-half times as much on health care per person as we do. So then the question is, why?

And the answer is, we don't know, because we didn't study it, but we're now in the realm of speculation. And I would speculate that the social conditions that are related to the social gradient in health, in fact, affect everybody.

PAUL SOLMAN: But wait a second. Doesn't inequality have a good side? Doesn't it spur competition, which in turn spurs economic growth? "Avis, we try harder." Number two is recognized in this country as a goad to being number one and achieving more. Meanwhile, we're pulling the whole train up, we're moving the whole society up in the process.

MICHAEL MARMOT: Well, the degree to which you're moving the whole society up in the process needs to be examined quite closely. I think you could argue the reason that inequality and increasing inequality is tolerated in the society is the system, in principle, allows me to be higher up.

I think the problem is, is that turns out to be an illusion that actually isn't very good for people's well-being, and it's not very good for their health. So they tolerate this system that they think gives them opportunities, but, in fact, what we see is the opportunities in practice are not huge.

PAUL SOLMAN: This is, of course, Dr. Marmot's point of view. It's not shared by everyone.

But the character played by one of this year's Oscar nominees, Will Smith, is a pretty clear case of how hard it is for many folks to make it in modern America, and how obvious it is when they don't.

WILL SMITH, Actor: Man, I got two questions for you: What do you do? And how do you do it?

PAUL SOLMAN: If 38-year-old Will Smith wins an Oscar, people may be asking him how he does it for a very long time to come.