The influence of status on health and longevity is the important question raised by Professor Sir Michael Marmot, Professor of Epidemiology at University College London, in his book Status Syndrome: How Your Place on the Social Gradient Directly Affects Your Health (2004).

An expert in his field, Professor Marmot undertook further research on the topic as head of the UK government’s national review of health inequalities. The research team published its findings in a 242-page report entitled  which was published in 2010.

We dig deeper into Professor Marmot’s research to find out more:

• Why status matters
• What did Professor Marmot’s research find?
• More than just poverty or financial hardship?
• How reliable is the research?
• Studies supporting Professor Marmot’s findings
• Other factors effecting longevity
• What can be done?

Why status matters

In over 30 years of research, Professor Marmot found a recurring pattern of social status, from Hollywood actors to Whitehall civil servants. This pattern led him to conclude that social status influences how long we live.

His explanation for this is that the lower our status the less control we have over our working lives (resulting in greater stress) and the less opportunity for social participation (meaning less opportunity for the protection against illness that social relationships can bring) resulting, for instance, in greater risk of cardiovascular disease.

A summary of Professor Marmot’s thinking: 

What did Professor Marmot’s research find?

Here is a selection of findings from his research:

• High ranking civil servants in the UK live longer than lower ranking civil servants, who suffer more from heart disease than those at the very top (even when smoking and cholesterol are taken into account).
• A Swedish study found people who had a PhD lived longer than people who had a Master’s degree, who in turn lived longer than people with a first degree and that this pattern continued down the educational hierarchy.
• People tend to live longer in Kerala, a state in south-west India, where there are more educational opportunities and lower levels of social inequality, than in other parts of India and in other poor countries.

More than just poverty or financial hardship?

It is not only health researchers who recognise that our socioeconomic status can influence our health and how long we live. Actuaries, whose job it is to assess risk (including how long insurance companies are likely to have to pay out pensions) have reached the same conclusion. The 2012 Longevity Bulletin from the Institute and Faculty of Actuaries notes that ‘mortality rates worsen as socioeconomic status worsens, even within small populations’.  

However, the common assumption is that poverty or financial hardship increases the risk of an earlier death. Professor Marmot has a different interpretation. He believes that both psychological and social factors are at work and argues that low status and social inequality (i.e. being low status, feeling low status and being made to feel low status) has a significant effect on people’s lives and on their health.

In this sense, he distinguishes between poverty and social inequality, seeing social inequality as more damaging to health than poverty. He observes that in developed countries most people have the basic resources necessary for life. What they do not have, as his research into civil servants demonstrated, is control over their lives: the power to live as they choose.

How reliable is the research?

Some of Professor Marmot’s evidence, for instance from civil servants in the UK, is from public sector workers. It would be helpful to have evidence from workers in the private sector and in the voluntary sector to be sure his conclusions apply more generally. The evidence is also stronger for men than for women, perhaps reflecting the historic significance of work for a man’s status and identity. The factors described are also interrelated. For example, with regards poverty and psychosocial disadvantage, which is cause and which is effect?

Many of us can probably think of celebrities from fields such as popular music, film and sport who have abused their status and have died young due to drug or alcohol consumption. Some examples are Prince, Michael Jackson, Marilyn Monroe and George Best.

There is also mixed evidence when it comes to the effect of awards on longevity (the ‘Oscar effect’ suggested earlier).

For example, one study, published in 2015, looked at 4,190 scientists nominated for election to the Chinese Academies of Science or Engineering. The main benefit of being elected is enhanced status, with limited financial benefit. However, those elected lived an average of 1.2 years longer than those who weren't.

In contrast, a 2016 study of Japanese literary awards found that recipients of an award for new and emerging novelists (i.e. an increase in social status) lived 1.4 years longer than non-recipients. Those receiving an award for mainly established novelists, however, died 5.2 years younger. It is thought that the ‘new and emerging’ novelists, being less experienced, progressed upwards from a ‘lower social stratum’, while the more established novelists had already achieved a certain level of social status. 

Studies supporting Professor Marmot’s finding

Larger scale health studies published in 2016 and 2017 appear to support Professor Marmot’s finding that social status affects how long we live.

• In 2016, BMJ Open, a UK open access medical journal, published a systematic review of ten published studies into the association between subjective social status (what status we feel we have, often based on our income, occupation and education) and the chances of health risks like coronary artery disease (CAD), diabetes and obesity. The review concluded that lower subjective social status is associated with significantly increased odds of CAD, hypertension (high blood pressure), diabetes and dyslipidaemia (abnormally high levels of fats in the blood), with a trend towards an increased chance of obesity.

Taking other factors into account, the review suggested that how we perceive our own social status affects our health beyond our actual income, occupation and education.

• In 2017, The Lancet published a global study into the association between socioeconomic status and longevity.The study included data from 1.7 million people. It found that participants with low socioeconomic status died 2.1 years earlier than participants with higher social status. This was a lower reduction in life expectancy than for smoking, diabetes and physical inactivity, but higher than hypertension (high blood pressure), obesity and alcohol consumption.

Other factors effecting longevity

Professor Marmot recognised that a number of other factors also affect health, in particular:

• genetic factors
• access to healthcare
• lifestyle choices such as smoking, diet and regular exercise (a point confirmed by The Lancet study above).

This fits with Age Watch’s own review of the research into how, where and why some people live longer. We find that a complex mix of factors, including genes, gender, lifestyle and personality, all contribute in some way to affecting our expected span of life.

However, Professor Marmot’s identification of social status as an independent factor affecting health and longevity has added a new dimension to this subject. A dimension which is being increasingly confirmed by research.

What can be done?

Professor Marmot suggests that governments need to help reduce social inequality and to nurture social participation. This may seem controversial to some and might be easier said than done. If he is correct, however, these government actions could have significant public health benefits. Governments, and the people who elect them, might consider his suggestions worthwhile exploring further.

For example, do socioeconomic factors such as status, income and education have more of an impact on health outcomes than medical treatment, as some evidence suggests? If so, what are the implications for current government policies and priorities?

In a linked article, we also look at what individuals can do to reduce the potential health risks of low social status.

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Other relevant articles on our website:

• Living longer: Is status a life sentence? 
• Living longer: Centenarians 
• Mind: Stress 
• Mind: Work and health 
• Health Campaign: Healthy and wealthy 

 June 2020 Next review, May 2024