Be as Healthy as the Wealthy

Social class is simply the best predictor of health. If you could know only one thing about a person and predict that person's health and longevity, you'd ask about social class. It's even more important than family history.

In cases where someone has bothered asking poor people about their health, research confirms the trend: the poorer you are, the less healthy you're likely to feel. That's the finding of a recent Columbia University study. And results of the United States Centers for Disease Control and Prevention's National Health Interview Survey make the case even stronger. In 2006, nearly nine times as many lower-income adults reported being in fair or poor health as affluent adults. Wealth and health go hand in hand.

Here's epidemiologist and author of The Status Syndrome Dr Michael Marmot's way of thinking about it: our society is a gigantic Titanic. First-class passengers on that ship disproportionately survived. In second class, fewer did. Third-class passengers... yikes. Many died before their time. And many of their modern counterparts still do.

The connections between status and health are hugely complex and only partly understood. No matter where you are, money and status make it easier for you to live in a restful place, go out for a Saturday morning jog and buy lean protein instead of fast food. It's more likely you'll enjoy a wide circle of friends, more job opportunities and more control over your schedule. And there's more social pressure to stay away from blood-sucking vices like alcohol, tobacco and drugs.

If socio-economic status tells us so much about health, why didn't we know this? In the past, many researchers felt obliged to avoid questions about socio-economic status when they designed public-health surveys. As a result, they had very little data until about a decade ago. Then the field exploded.

Adler recalls the study that got her hooked. It was one of Marmot's, a landmark British study that scientists refer to by its shorthand, Whitehall I. Whitehall is the wide street in London where many key government departments are located, and the name is synonymous with the British civil service. In 1967, Marmot's team began a huge survey of 18 000 male civil servants. The men were grouped into quadrants based on office hierarchy, with administrators who set policy at the top, followed by executives, clerical workers and finally office messengers at the bottom. All the workers had safe office jobs and high job security. The most surprising finding of the study was that not much about the disparity in health outcomes could be explained away by nasty habits or access to care. And in a follow-up study 25 years later in the Nineties, the men at the bottom were found to be not only unhealthier as a group, but three times as likely to die an early death as the men at the top.

Those results started Adler thinking. What is it about higher social class that matters? How does class affect the body? With that, she switched her field from adolescent risk behavior to class and health. (As she notes, ‘I switched taboos from sex to money.’) In 1997 she gathered a dozen like-minded researchers together into the MacArthur Research Network on Socio-economic Status and Health, and became its chairwoman. Since that time, network members have used nearly $9-million in grant money to swop ideas, start pilot studies and tack their questions onto larger, longitudinal studies. Their collective research provides much of the scientific basis for the information you're reading here.

Can you take enough action to save yourself from the ill effects of social class? The researchers can't say for sure. But they'll encourage you to try your damnedest. After all, small lifestyle changes accomplish a lot. A whole lot. They're simple, they're easy, they're appallingly obvious - and they have a stunning impact on longevity and health.

The latest proof comes from a 2008 Cambridge study published in the journal Public Library of Science Medicine, which examined 20 244 men and women, ages 45 to 79, living in the same English county. The researchers gathered baseline data in the mid-Nineties, asking the participants if they engaged in any combination of four common healthy habits: exercise, moderate alcohol use, daily fruit and vegetable intake and abstention from tobacco. Eleven years later, they followed up to see who died in the interim. Result: the people who engaged in none of the healthy behaviors were four times as likely to have died as those who engaged in all four, regardless of social class.

Practicing four simple healthy habits, concluded the researchers, ‘was equivalent to being 14 years younger in chronological age’. Be mindful about one or two things you can't do anything about - your parents, for instance. You can't choose your mother's social class. And low birth weight, which is more common on lower rungs of the ladder, increases the risk of slow cognitive development in early life and heart disease decades later. Socio-economic status even affects physical strength and function. In one British study, men born in 1946 were contacted at age 53 and presented with a few challenges, including this one: close your eyes and stand on one leg for 30 seconds. Sound easy? Less than half of the men were able to do this for longer than five seconds. Disproportionately, their fathers were working-class blokes.

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