Ed,
I'm kicking myself for not mentioning a classic
piece of longitudinal research that strongly
answers to your question. This is the Whitehall
study led by Prof Marmot. The Abstract (unusually
perhaps!) reads well and I'll copy it below:
Health inequalities among British civil servants: the Whitehall II study
* Prof M.G. Marmot, FFPHM, S. Stansfeld,
MRCPsych, C. Patel, MD, F. North, MB, J. Head,
MSc, I. White, MSc, E. Brunner, MSc, A. Feeney,
BSc, M.G. Marmot, G.Davey Smith, MA
Abstract
The Whitehall study of British civil servants
begun in 1967, showed a steep inverse association
between social class, as assessed by grade of
employment, and mortality from a wide range of
diseases. Between 1985 and 1988 we investigated
the degree and causes of the social gradient in
morbidity in a new cohort of 10 314 civil
servants (6900 men, 3414 women) aged 35-55 (the
Whitehall II study). Participants were asked to
answer a self-administered questionnaire and
attend a screening examination. In the 20 years
separating the two studies there has been no
diminution in social class difference in
morbidity: we found an inverse association
between employment grade and prevalence of
angina, electrocardiogram evidence of ischaemia,
and symptoms of chronic bronchitis.
Self-perceived health status and symptoms were
worse in subjects in lower status jobs. There
were clear employment grade differences in
health-risk behaviours including smoking, diet,
and exercise, in economic circumstances, in
possible effects of early-life environment as
reflected by height, in social circumstances at
work (eg, monotonous work characterised by low
control and low satisfaction), and in social
supports. Healthy behaviours should be encouraged
across the whole of society; more attention
should be paid to the social environments, job
design, and the consequences of income inequality.
Keith
At 15:04 29/09/2012, Ed wrote:
From today's AlterNet Newsletter. I find the
last paragraph interesting -- the idea that ill
health and diminishing life expectancy are at
least partly the result of the poor feeling
they are sinking into an increasingly hopeless
situation. Might life expectancy be related to how good and useful you feel?
Ed
Shocker Stat: Life Expectancy Decreases by 4 Years Among Poor Whites in U.S.
Yesterday, the New York Times
<http://www.nytimes.com/2012/09/21/us/life-expectancy-for-less-educated-whites-in-us-is-shrinking.html?pagewanted=all>reported
on an alarming new study: researchers have
documented that the least educated white
Americans are experiencing sharp declines in
life expectancy. Between 1990 and 2008, white
women without a high school diploma lost a full
five years of their lives, while their male
counterparts lost three years. Experts say that
declines in life expectancy in developed
countries are
<http://articles.latimes.com/2011/jun/15/nation/la-na-womens-health-20110615>exceedingly
rare, and that in the U.S., decreases on this
scale "have not been seen in the U.S. since the
Spanish influenza epidemic of 1918." Even during
the Great Depression, which wrought economic
devastation and severe psychic trauma for
millions of Americans, average life expectancy
<http://www.sciencedaily.com/releases/2009/09/090928172530.htm>was
on the increase.
What are the reasons for the disturbing drop in
life expectancy among poor white folks, and in
particular for the unusually large magnitude of
the decline? According to the Times, researchers
are baffled: one expert said, Theres this
enormous issue of why . . . Its very puzzling
and we dont have a great explanation."
Undoubtedly, the increasing numbers of
low-income Americans without health insurance is
a major contributor factor. Researchers also say
that lifestyle factors such as smoking, which
has increased among low-income white women, play
a role; poor folks tend to engage in more risky
health behaviors than their more affluent counterparts.
I will offer an alternative hypothesis, one
which is not explicitly identified in the Times
article: inequality. In the U.S., the period
between 1990 and 2008, which is a period that
saw such steep declines in life expectancy for
the least well-off white people, is also a
period during which economic inequality
<http://inequality.org/income-inequality/>soared.
Moreover, there is a compelling body of
research that suggests that inequality itself --
quite apart from low incomes, or lack of health
insurance -- is associated with more negative
health outcomes for those at the bottom of the
heap. One of the most famous series of studies
of the social determinants of health, Britain's
<http://en.wikipedia.org/wiki/Whitehall_Study>Whitehall
Studies, had as their subjects British civil
servants, all of whom health insurance and
(presumably) decent enough jobs. Intriguingly, these studies
found a strong association between grade levels
of civil servant employment and mortality rates
from a range of causes. Men in the lowest grade
(messengers, doorkeepers, etc.) had a mortality
rate three times higher than that of men in the highest grade (administrators).
The Whitehall studies found that while workers
in the lower grades were more likely to be at
risk for coronary heart disease due to factors
such as higher rates of smoking, higher blood
pressure, etc., even after controlling for those
confounding factors, these workers still
experienced significantly higher mortality
rates. So what was behind such disparate health
incomes among high-status and low-status
workers? Researchers pointed the finger at
inequality, hypothesizing that various
psychosocial factors associated with inequality
such as the higher levels of stress at work
and at home experienced by the lower tier
workers, as well as their lower levels of
self-esteem were behind the dramatic differences in mortality rates.
I believe that inequality-related stressors are
likely to be the determining factors in
declining American life expectancies, as well.
Im surprised, in fact, that the Times article
did not specifically identify inequality as a
causal factor, because the health risks
associated with economic inequality are
well-established in the scientific literature.
For decades, the United States has been making a
series of political choices that has distributed
wealth and power upwards and left working
Americans not only poorer and sicker, but also
feeling far more burdened and distressed, and
experiencing far less security and control over
their lives. The consequences of these choices
have been devastating, and absent a dramatic
reversal in our political course, they are
likely to get even worse. Where inequality is
concerned, Republicans have their foot on the
accelerator, while the best the Democrats seem
to be able to do is to (temporarily) put their foot on the brake.
We are on a trajectory all right, and its not a good one.
The Washington Monthly / By
<http://www.alternet.org/authors/kathleen-geier>Kathleen Geier | Sourced from
<http://www.washingtonmonthly.com/political-animal-a/2012_09/shocker_stat_of_the_day_life_e040058.php?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A%20washingtonmonthly/rss%20%28Political%20Animal%20at%20Washington%20Monthly%29>Washington
Monthly
Posted at September 22, 2012, 8:27am
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Keith Hudson, Saltford, England http://allisstatus.wordpress.com
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