SOCIOECONOMIC STATUS: Power + Wealth = Health
Rather than ask patients about risk factors, doctors "might be better off asking how much money those patients make, how many years they spent in school and where they stand relative to others in their offices and communities," the New York Times reports. An "explosion of research" now indicates that the higher one's class -- measured by income and power alike -- the lower the health risk. In the past five years, 193 papers have appeared in scientific journals addressing the impact of social factors on health. Last year, NIH "declared research on disparities in health related to social class or minority status one of its highest priorities," according to associate director Dr. Norman Anderson.
The Whitehall Study
The Times notes that the current body of research was spurred by Dr. Michael Marmot's Whitehall study, "a now- classic study, begun in the late 1960s, of men in the British Civil Service." Marmot found that mortality rates over 10 years "varied continuously and precisely with the men's civil service grade: the higher the classification, the lower the rates of death." In follow-ups, they found that the class gradient persisted into old age, even when controlling for smoking and coronary disease. Dr. Sheldon Cohen of Carnegie Mellon University discovered a link between health and stress that may illuminate the Whitehall findings. Studying macaque monkeys, he found that males at the lower end of the social dominance scale were more susceptible to colds. In another study, researchers found that humans who had been unemployed were 3.8 times more likely to contract a virus. In 1985, Marmot launched Whitehall II, which studied stress on civil servants. He found that the degree of control one has at one's place of employment "accounted for about half the gradient deaths from pay grade to pay grade."
SES Trumps Race
Moreover, in the United States, socioeconomic status can blur racial lines in health care. For example, black men in the highest overall income brackets "have a life expectancy 7.4 years longer than black men in the lowest brackets." Dr. Nancy Adler, professor of medical psychology at the University of California-San Francisco, said, "I think there has been a resistance to thinking about stratification in our society. ... There isn't going to be a single explanation or an easy solution, but we've started mapping out some of the places where we can intervene" (Goode, 6/1).