WaPo book review on THE STATUS SYNDROME by Marmot

[many a good man]

THE STATUS SYNDROME: How Social Standing Affects Our Health and Longevity by Michael Marmot. Review by Eric Klinenberg.


<<<Michael Marmot, professor of epidemiology and public health at University College, London, calls this phenomenon the status syndrome. His bold, important and masterful new book not only explains the social sources of this global pandemic, it sets an agenda for a radically different approach to health policy. Drawing from his work as a participant in the British government's Independent Inquiry into Inequalities in Health (published as the Acheson Report), Marmot argues that investing in child care and better education for the disadvantaged, cleaning hazardous urban environments, and providing social support for the elderly are the best antidotes to the status syndrome. In the United States, where medical spending is double that of comparably healthy nations, Marmot's message is not just timely, it's urgent. >>>

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<<<Above a certain threshold it's deprivation relative to others in one's society that matters, even for those (like the Oscar nominees) near the top of the ladder. The reason, Marmot argues, is that social participation -- rewarding relationships, access to a community, and the respect of others -- and individual autonomy are crucial determinants of health and happiness. High status usually affords more opportunities for social involvement and control of one's conditions. Low status means that external forces -- a mean-spirited boss, a company that dumps toxic waste near your neighborhood -- are more likely to determine one's fate, social support is less reliable, and insecurity is a feature of daily life. Although the meaning of full participation varies from places to place, Marmot claims that the beneficial effects of being connected are constant. >>>

<<<Lack of agency produces dangerous forms of stress. People who labor in dull, dead-end yet demanding jobs suffer from an imbalance between their efforts and rewards. As recent studies of coronary disease in Britain and seven Eastern European countries show, work that deprives men and women of control destroys the heart as well as the soul. Moreover, a daily onslaught of difficulties makes people less likely to focus on their long-term health. Marmot believes that the vulnerable understand their grim condition, and that they engage in dangerous but pleasurable behaviors such as smoking or overindulging in fast food because they prefer enjoying the moment to holding out for a future they might not reach. >>>


<<<There's good evidence that skimping on these fundamental and wide-ranging social protections while spending lavishly on medical care is foolish public policy. Cross-nationally, the longevity gap tends to decrease during eras of social equalization and increase during periods of polarization. Americans have learned this the hard way. Outspending all competitor nations on health care has not helped to raise U.S. life expectancy above the level of Spain, Cyprus or Singapore, where the social gradients are more even. We've all heard officials say that the United States has the best medical system in the world. Whether or not that's true, longevity is greater in France, the United Kingdom and Canada. >>>