Health follows a social gradient: the lower a person's rank in a hierarchy, the worse their health tends to be, at every step and not only at the bottom.
Marmot's Whitehall studies of British civil servants, begun in 1967 and again in 1985, found that mortality from heart disease rose step by step down the grades of the service, among people who all had jobs, pensions and the same health service. He named the pattern the status syndrome in 2004 and attributed much of it to how much control people had over their work.
In practice
- A hospital trust finds that sickness absence rises grade by grade down its staff structure, including among well-paid middle managers.
- A junior employee with no say over his schedule suffers more stress-related illness than his busier but more autonomous boss.
- Possible explanations
- One explanation is control: lower grades have less say over their work, and low control is linked to chronic stress. Others are income and material conditions, differences in smoking and diet, and reverse causation, in which poor health moves people into lower positions.
- In its favour
- The gradient is among the most replicated findings in social epidemiology, observed across many countries and in primates with social hierarchies.
- Against it
- Separating cause from association is hard: health selection, early-life circumstances and behaviour all contribute, and how much is due to status itself rather than what accompanies it is debated.
- Standing
- Compare the Hispanic paradox, a case in which the gradient appears not to hold.
- Subject
- Sociology & Culture
- Essay
- The measured patterns of social life