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BookWatch: Status Syndrome

HOW YOUR SOCIAL STANDING AFFECTS YOUR HEALTH

Many of the readers of PHC RIS infonet would be familiar with the concept that health follows a social gradient. Where you stand in the social hierarchy is closely related to your chances of getting ill and your length of life. Some determinants of health – behaviour, environment – exert their influence regardless of social position. However, these do not explain the gradient. The Australian epidemiologist Sir Michael Marmot sets out the evidence that the causes of ill health are to be found in the circumstances in which we live and work. The book is about “the fact that control over life circumstances and full social engagement and participation in what society has to offer are distributed unequally and as a result health is distributed unequally”. The magnitude of the difference varies across societies and within a society at different points in time. The variation depends on the balance between hierarchies and cooperation, features of every society.

Marmot presents a fascinating and thorough account of the evidence for this social gradient throughout the world, showing that societies that are socially inclusive whether they are rich like Japan, poor like Kerala or in between like Costa Rica have good health. The chapter on the missing men of Russia relates the history of central and eastern Europe to increasing mortality rates for adult men in 1980s and 1990s, and like the rest of the book is worth careful study.

Reference
Marmot, M. (2004). Status syndrome – how your social standing directly affects your health. Bloomsbury Publishing: London.