Status Syndrome by Michael Marmot

Stress thrills the rich, but kills the poor

In his political credo, pronounced at the beginning of the year, the Conservative leader Michael Howard declared his disbelief that one person's poverty is caused by another's wealth, or that one person's sickness is made worse by another's health. It seems safe to assume that his disbelief is shared by his opposite number, and by most people with any influence over how such matters are nowadays arranged. To think otherwise seems to hark back to a bygone age in which one person's wealth was another's poverty because there was not enough to go around. Greed is a virtue - though it is now gauche to put it so bluntly - but envy remains a vice.

In his political credo, pronounced at the beginning of the year, the Conservative leader Michael Howard declared his disbelief that one person's poverty is caused by another's wealth, or that one person's sickness is made worse by another's health. It seems safe to assume that his disbelief is shared by his opposite number, and by most people with any influence over how such matters are nowadays arranged. To think otherwise seems to hark back to a bygone age in which one person's wealth was another's poverty because there was not enough to go around. Greed is a virtue - though it is now gauche to put it so bluntly - but envy remains a vice.

It's hard to imagine things any other way, dazzled as we are by the spectacle and onrush of unleashed wealth-generation that has surrounded us for the past quarter-century. But, during this period, research- ers such as Michael Marmot (now Sir Michael, and professor of epidemiology and public health at University College London) have been gathering evidence that offers the possibility of transforming our understanding of health, happiness and how to make a good society. Michael Howard's disbeliefs are beside the point. What we need to grasp is that one person's health may be made worse by another person's wealth.

For this to make sense, we have to stop thinking of wealth simply in material terms. Once there is enough to assure the basics of life for all, one person's wealth is not harmful because it reduces the amount left for another, but because it raises the wealthy person to a higher rank. As social status rises, so do health prospects and life expectancy.

Marmot pioneered this understanding with his studies of Whitehall civil servants, in which he discovered a steady gradient in the risk of heart disease from the lowest grades to the topmost. Men at the bottom were four times more likely to die than men in charge - and less than a third of the gradient disappeared when the usual suspects, such as smoking and cholesterol, were factored out. ( Status Syndrome is generally surer of itself about men than women.)

Elsewhere, similar effects were observed in baboons, leading to predictable amusement and a theory of how status is related to health. Low status leads to stress, forcing the individual into permanent crisis mode, inducing physiological changes that can lead to heart disease. For Marmot and his colleagues, control is at the heart of the matter. The more control you feel able to exert over your situation, the more likely stress is to be stimulating rather than corrosive.

Other studies display the other side of the coin: having a sense that one is supported by relationships with others, rather than oppressed by them, is very good for health. One researcher exposed volunteers to cold viruses, having quizzed them about their friends, family and colleagues. The more numerous and varied the relationships, the less likely the volunteers were to catch colds.

By contrast, Marmot conveys the effects of solitude not with data but with a quote of exquisite aptness from Joseph Conrad's Nostromo, in which a marooned man is overcome, to the point of suicide, by "a state of soul in which the affectations of irony and scepticism have no place".

Adorned with epigraphs, bubbling with findings, discreetly illuminated by the light of social justice, written considerately for ordinary readers, Status Syndrome is packed with ideas that should have been coursing through public debate for years now. Marmot's understated voice makes him more comfortable as raconteur than as crusader.

He is not the thinking person's Michael Moore, nor this year's Naomi Klein, though he is presenting more radical ideas than they are. Despite its conversational tone, and contrary to some media coverage, Status Syndrome is not a conversation piece about social climbing. It is about how to save lives, and how to live good lives.