According to the first international research study examining the links between social rank and mind/body health, every increase in socioeconomic status brings an elevation in physical health and sanity. In other words, a corporate CEO is invariably healthier in body and mind than his middle manager. An administrative assistant is bound to be less fit and more frazzled than her boss, but far more likely to be in better physical and mental shape than a factory worker.
Although most of us realize that the poor, unemployed and less educated are in relatively poor health compared with those in the middle and upper classes, it is largely unknown that the association of socioeconomic status (SES) and health occurs at all levels. In fact, scientists have only recently confirmed that at every rung on the SES ladder, health improves, and this improvement steadily increases right up to the top.
"What the data are showing that we never knew before is that the situation with socioeconomic status and health is linear-- it doesn't stop at a threshold," says Nancy Adler, Ph.D., a professor of medical psychology at the University of California, San Francisco, and director of the MacArthur Foundation Research Network on Socioeconomic Status (SES) and Health. "If it were just poverty involved," Dr. Adler explains, "you'd have a plateau effect, but the news is, there's really no plateau with SES. The higher you go, the higher your chances of improved health and mental well-being."
It's also worth noting that SES has been found to affect recovery from disease. "There are SES differences in recovery after myocardial infarction, or heart attacks, as well as after coronary bypass surgery," says Dr. Adler. What's more, to put this study in global perspective, Adler notes that researcher Richard Wilkinson has previously illustrated that the countries with the most inequality in income distribution have the shortest life spans, and vice versa. While these findings about social hierarchy and health carry haunting echoes of Charles Darwin's "survival of the fittest" theory, they also prompt some disturbing questions, such as why and how does social rank doom us to varying degrees of morbidity and mortality? Why do the upper classes get to live better and longer than the middle and lower classes? How can we ensure long and healthy lives for ourselves even if we're small business owners, secretaries, salespeople or customer service representatives? The international research group has come up with some solid leads. "Research shows that the higher you go in socioeconomic status, the fewer negative health habits the people have," says Dr. Adler. "But that factor only accounts for about one third of the impact of SES," she says. The MacArthur team is focusing largely on the impact of stress on the body, or the biology of stress, over time. While humans are programmed to adapt to what scientists call "allostatic load," or stress, Dr. Adler says that, "Over time, stress can exact a quantifiable toll on physical organs, body systems and cognitive functions." Dr. Adler adds that one group of study subjects in their 70s who had higher allostatic loads and lower SES than other groups "showed more physical and cognitive decline when measured two years later."
Noting that low-level office workers and manual laborers report far more subjective stress than, say, construction company executives, Dr. Adler explains that this is because "those on the lower rungs of the social ladder tend to experience stresses that are piled up one on top of the other...they often have less control over the home and work environments than those who are higher in social status." For example, imagine that the roof is leaking in a bricklayer's house, but he can't afford to fix it. While some of his walls and floors are stained and damaged from the rain, and he feels overwhelmed, this stressful situation is magnified by the fact that his car is in the shop. Thus he must rise two hours earlier than normal to catch the bus to reach his job site on time. And since the job happens to be behind schedule, the bricklayer's supervisor continually pressures him to work faster. These obstacles are causing his blood pressure to skyrocket, rendering his regular medication ineffective. Dr. Adler says, "While the construction company executive and other people with high SES often experience enormous stress in their professional and personal lives, they can afford to relieve it on a daily basis." Indeed, they can readily obtain medical care and medicines; they can alleviate accumulated stress by exercising in health clubs or with personal trainers in their at-home gyms. Middle- and upper-middle-class individuals may also buffer themselves from stress via counseling from mental health professionals or by receiving regular therapeutic massages. Unlike the working masses, more socially elevated individuals often choose to nourish themselves with healthy and fresh foods prepared for them by fine markets, restaurants, personal chefs or housekeepers.
While Dr. Adler predicts that, "There is not going to be one single, clear explanation of why SES has such a profound affect on health," she hopes that the MacArthur SES and Health study findings to date will encourage people with middle and lower levels of SES to exercise regularly and eat as healthy a diet as possible. "People with lower SES need to start adopting the health behaviors of those who have high social status," she says. "You can take good care of yourself and thus improve your health even if you work hard and feel overwhelmed by the demands of job, family and your environment."