Why Social Position is a Cause of Disease and What to Do to Improve Your Health Regardless of Position on the Ladder

Social position is a cause of disease as shown by the Whitehall I and II studies

Social position is a cause of disease as shown by the Whitehall I and II studies

One of the theoretical benefits of living in a small community is the relative absence of social boundaries that force people into disparate groups based around material evidence of wealth. When these boundaries are removed, social capital increases resulting in improved quality of life for everyone. Since it’s never a good idea to take something as valuable as social capital for granted, I’ve selected the 1967 Whitehall study as a reminder of what happens when it’s missing.

The study was initially of 18,000 male British civil servants who all worked at Whitehall, the engine room of government in the UK. As you can imagine, the wheels of administration in Whitehall are tuned and turned at different levels of a hierarchy – not dissimilar to any large organization. The interesting finding from this study was that men in the lowest “grades” of Whitehall were significantly more likely to die prematurely than those in the highest grades.

The Whitehall study was subsequently extended to include both men and women aged 35 to 55 years in 20 government departments in Central London. Initiated in 1985, this second study has been following the health of civil servants for almost 30 years.

Social gradient predicts disease and mortality

The Whitehall II study not only confirmed the initial findings that there exists a social gradient for mortality, but extended this gradient to include a range of illnesses: heart disease, cancer, chronic lung disease, gastrointestinal disease, depression, suicide, back pain, and general absence of wellbeing.

Subjects of Whitehall II in the lowest employment grades were more likely to have many of the established risk factors of coronary heart disease, such as propensity to smoke, lower height-to-weight ratio, less leisure time, and higher blood pressure. However, even after normalizing for these factors, the lower employment grades were still at greater risk for a heart attack. Another factor was needed to explain the social gradient for health outcomes.

Unable to explain their findings based on traditional risk factors, the investigators continued to look for mechanisms through which social position influences health.

The major influence on our health is not genes or lifestyle choices, but rather psychosocial factors

It turns out the major influence on our health is not genes or lifestyle choices, but rather psychosocial factors that contribute to a person’s own concept of his or her social standing. In particular, decision autonomy (the amount of control or influence in one’s life), workplace predictability (stability of work and absence of unexpected changes), and the link between professional achievement and self-esteem have all been offered as potential explanations.

Summing up the findings of the Whitehall studies, the researchers concluded that “more attention should be paid to the social environments, job design, and the consequences of income inequality.” All well and good, but what if you’re in a job with little decision autonomy, workplace predictability or opportunity for professional development? How do you overcome the unfairness of your situation and achieve the health outcomes of someone with these things?

That’s where volunteering comes in, but that’s the subject of another article

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One response to “Why Social Position is a Cause of Disease and What to Do to Improve Your Health Regardless of Position on the Ladder

  1. Pingback: Why Mind and Body are One, and What This Means for Consciousness and Your Health | the mindbody doc·

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