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Social Class Plays a Big Role in Disease Occurrence and Deaths

(February 2001)

The evidence is overwhelming that the lower you are on the scale of income, occupation, or educational achievement, the greater the chances of becoming ill and the greater the chances of dying. The initial landmark study published in 1984 involved 17,000 British civil servants and has been confirmed in many studies in Great Britain, the United States, and Scandinavia. The findings are not related to poverty. In the British civil servant study, everybody was employed, the occupational categories being: administrative (the top category);professional/executive; clerical; and other support staff (the lowest category).

The lower the category, the greater the frequency of absenteeism due to illness. The death rate in different studies in the lowest occupational and income category has been found to be 50 percent higher to double the death rate in the top two employment categories. The excess deaths were found to be due to all sorts of causes - heart disease, some cancers (lung, stomach, esophagus), chronic bronchitis, accidents, violence, suicide. The increased risk with lower income or occupational position was not found with bowel, prostate, or breast cancers.

Those in the lower income or occupational groups had greater well-established risk factors for many diseases. They were more likely to smoke, have high blood pressure and high cholesterol levels, exercise less, and eat less fruits and vegetables. But even if all these, and other variables, were taken into account, only about one-third to one-half of the increased death rates could be explained.

Less medical care and less frequent use of preventive tests (such as mammograms and PAP smears) accounted for only a small part of the findings.

If you compare the frequency of known risk factors for sickness and death down the social class scale (as measured by income or occupational position), you will discover an unexplainable 50% increase in illness and death in the lowest sectors.

And, the disparities in illness and death between the higher socioeconomic status people and the lower have been growing for the past thirty years. What has happened is that the upper socioeconomic groups have made greater strides in health; the lower socioeconomic groups have also gained, but not nearly so much, so the gap has widened.

What is the explanation for these important findings? While there are no absolutely clear answers, some impressive data suggest that, among those lower down the scale in income and occupation, there is more hostility, more depression and feelings of hopelessness, in considerable part related to feelings that they have inadequate control over their own lives. They also live in less attractive housing and express less job satisfaction.

Some investigators have suggested the explanations for less healthy status may even go back to childhood. They point out that in the first three years of life, children of poor parents are calculated to receive fewer than 100,000 positive communications from their parents; among children of blue collar parents, the positive communication number was calculated at 200,000, and for the young children of professional parents 500,000. Presumably, this can result in lesser self esteem for those with fewer positive communications.

Whether it is possible to link early childhood experiences to later health is uncertain, but this much is clear - being lower down the income scale and the occupational ladder (as well as having less education) carries a real risk of worse health. That risk is very modest for those reasonably close to the top of the scale and increases progressively as one moves down the scale. And the medical profession cannot explain most of that health risk by measuring the blood pressure or cholesterol level, or by smoking, or by the amount of exercise or by the diet - or by any of the usual variables.

It looks more and more likely that the explanation lies with variables such as job satisfaction and feelings of not having at least a reasonable amount of control over your own life. Anger or depression or other negative emotions resulting from lack of job satisfaction or feelings of inadequate control over one’s life may well translate into a whole variety of physical illnesses, as well as susceptibility to accidents and suicide.

These are very important studies. It seems very likely that creating a happier job environment, and thereby increasing job satisfaction, will reduce absenteeism (both for short duration illness and longer duration illness) and will make employees a lot healthier. Having greater social supports (from friends, relatives, church groups, neighborhood groups, etc) appears to be able to counter some of the bad effects from lower income and lower job categories.

The bottom line is that good health is a very broad concept, that mind-body relationships, feelings of job satisfaction, feelings of reasonable control over your own life, having less depression, more self esteem, and less hostility can result in a lowered risk for heart attacks, cancer, and a host of other diseases.

The distressing fact is that the situation does not seem to be getting better and it won't until we, as a society, begin to pay more attention to the meaning of all these studies.