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Win Some, Lose Some

The Complex Link Between Social Status and Health

By Abdul El-Sayed

Published May 7, 2013

In the late 1970s, The Whitehall study, an analysis of the mortality of British government employees, lead to an interesting observation: those with higher-ranking jobs lived longer.

Of course, it had long been known that there were important inequalities in morbidity and mortality between the extremes of poverty and wealth in a society. But Whitehall was unique in demonstrating that those inequalities persisted along fine gradations of social status.

Everyone in the study was employed—they even shared the same employer. And not even the employees with the lowest occupational grades could be considered poor, per se, only less well to do than their more highly-ranked counterparts. That these less obvious differences in social status could predict differential mortality rates was astonishing.

Since then, a number of studies have confirmed inequalities in death and disease along marginal differences in social status. What remains unclear however, is how social status confers that advantage. The problem is that social status is a loaded taxonomy—status confers advantages in wealth, income, social networks, lifestyle opportunities, and prestige. With so many potential mechanisms through which social status might confer a mortality advantage, it’s not quite clear which are most important.

A recent study by Professor Bruce Link and his colleagues at Columbia University’s Mailman School of Public Health may shed light on that question. They compared mortality among groups of “winners” and “losers” in high prestige occupations, like acting, professional baseball, and presidential politics. By studying individuals at the extremes of social status, where income, wealth and social networks are similar, they wanted to tease out the influences of lifestyle and prestige that were associated with winning each competition on mortality.

The findings were fascinating. Emmy award-winners outlived their competition by nearly three years, on average. However, Presidents and Vice-Presidents actually lived, on average, five fewer years than their counterparts. There were no significant differences between Hall-of-Famers and those who didn’t make it.

The health effects of social status, particularly at the extremes, is more complicated than we thought.

Some have argued that relative differences in prestige are the most important drivers in health differences by social status. However, if that were true, one would expect that winners would have outlived losers across the board. The heterogeneous findings of Link’s study then, suggest that prestige may not yield health advantages in all circumstances.

Others have argued that the observed relationship between social status and health is the result of selection. That is, the personal characteristics that predict achievement are the same as those that predict good health. For the same reasons, Link’s findings cast doubt on these arguments, as well.

Rather, the authors argue that their findings suggest that life circumstances occurring after achievement are the most important predictors of the social advantage-health relationship. The mortality disadvantage suffered by Presidents and Vice-Presidents is a perfect example—the work of governing the country is tremendously stressful, with important health consequences thereafter. Moreover, Presidents and Vice-Presidents are targets for assassination, which is an important contributor to mortality among them. In that respect, while election entails an increase in social status, the added benefit is more than abrogated by the risks of the job. By contrast, Emmy award-winners’ life circumstances don’t become substantially more difficult after they win, suggesting that the bump in social status after winning, when not opposed by arduous life circumstances, produces a net health advantage. So while social advantage generally translates to health advantage, prestige is only one small part of the equation.

And if you want a long life, don’t run for President—you’re better off winning an Emmy.

Edited by Dana March.

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The views and opinions expressed on this website are solely those of the authors and do not represent those of the Department of Epidemiology, the Mailman School of Public Health, or Columbia University.