Reaching for a Healthier Life:  Synopsis

There are substantial disparities in health and longevity among different sectors of the US population.  Who suffers from poorer health and greater premature mortality?  How do these differences come about?  What can be done to eliminate these disparities?

Reaching for a Healthier Life answers these questions.

Reaching for a Healthier Life is the result of a decade of work by the MacArthur Foundation Research Network on SES & Health. This multidisciplinary group of scientists has examined the pathways by which socioeconomic status “gets into the body” to affect health and longevity.  There is no single pathway by which this occurs.  Rather, resources associated with where people stand on the social ladder shape multiple aspects of their lives in ways that affect their health and well-being.  Key findings are:

 (1) The effects of socioeconomic status are substantial. They are not limited to the effects of poverty but occur at all levels. Premature death is more than twice as likely for middle income Americans as for those who are the best off, and more than three times as likely for those who live near or in poverty compared to the most privileged.

(2) Throughout life, from birth onward, our access to socioeconomic resources affects our chances for living a healthy life. The conditions we live in during childhood affect our health throughout our lives.

(3) Health care is important when we are ill but accounts for only a small portion of health disparities. More important are factors that determine if we fall ill in the first place.

(4) Each step up the social ladder provides greater access to social and physical environments that enable individuals to engage in health protective behaviors, (e.g., safe places to walk and access to healthier foods).

(5) Conditions at work can contribute to health and health disparities. Jobs held by those lower on the ladder are more likely to involve shift work and physical hazards, low control over how and when tasks are done, job insecurity, and conflicts between family obligations and work requirements.

(6) Exposure to extreme and prolonged stress,( “toxic stress”), is more common lower on the social ladder. Stressors that last a long time, like financial insecurity, interpersonal disputes, work-induced exhaustion, or chronic conflict are recorded in the body.

(7) The biological consequences of exposure to stress are not transitory; they are cumulative. The normal functioning of the cardiovascular, immune, metabolic and nervous systems is disrupted. This disruption is made worse by poor health habits molded by social and physical environments lacking health-promoting alternatives.

What can be done? 

Two kinds of policies are required to reduce premature death and eliminate health disparities:
1. Policies that impact income and wealth distribution, educational attainment and occupational mobility, and 2. Policies that buffer individuals from the damaging conditions of living below the top rungs. Supporting educational attainment, assuring a living wage, reducing crime, increasing opportunities for control at work, banning sale of soft drinks and junk food in schools are just a few policies with health consequences.  Economic, education, labor and zoning policies are all health policies.

The facts contained in this document support the case that policies to support healthy living conditions for all citizens are needed. The cost of implementing such policies would be offset by subsequent savings through increased productivity and lower health case costs. The initial investment would be money well spent. The one thing we cannot afford to do is nothing.

Reaching for a Healthier Life is available electronically, or write the network office to request a hardcopy at michael.daluz@ucsf.edu.

Psychosocial Notebook: Subjective Social Status (revised March 2007)

Social Environment Notebook: Measuring sources of stress in the environment (November, 2005)

Social Environment Notebook: Measuring aspects of the environment related to physical activity (December, 2005)

Social Environment Notebook: Measuring aspects of the environment related to availability and accessibility of healthy foods (December, 2005)

Publications List: Chronological Publications  (May, 2007)

Developmental Chapter: SES and health across the lifecourse (July, 2005)

Conference Archives

Racial, Ethnic and Socioeconomic Disparities in Health: Implications for Action Conference
April 29, 2004
National Press Club
Washington, DC

The Network partnered with the Center for the Advancement of Health to convene a meeting to  increase the understanding of the intersection of socioeconomic status, race/ethnicity and health and to explore how to use what we know in policy and action. The meeting moved from a summary of the basic facts to an examination of practical interventions, to the implications of policies and actions targeting race/ethnicity or SES and then to actions for using what we know. It was structured to promote knowledge-sharing and realistic discussion of changes in policy and practice.

We were excited about the overwhelming and enthusiastic response to this meeting. Participants in the meeting included health policy researchers, decision makers and other stakeholders, including those from think tanks, foundations, community organizations, government funding agencies and the media.

Details of the meeting including a more detailed overview, final agenda, speaker biosketches and materials from a selection of the presentations are available.

INEQUALITY MATTERS June 3-5, 2004 New York City The aim of the conference, organized by Jim Lardner and colleagues, was to shed light on the long-neglected problem of increasing income inequality in the United States. Income inequality has been shown to have insidious implications for health, education, justice, community, and democracy. A central goal was to supply the knowledge and tools for a campaign of popular education and political action. Details and updates from this conference are available.

Heart Risk 'of working when ill'
Research from the Whitehall II Study, under the direction of Michael Marmot, showed that some workers who don't take time off when ill had twice the rate of heart disease. The researchers concluded it was the stress from working when ill which caused the risk of heart disease. Read the BBC News overview.

Status Syndrome: How Your Social Standing Directly Affects Your Health and Life Expectancy
On June 7th Bloomsbury Publishing published the British edition of Michael Marmot's new book which puts forth the argument that health inequalities between rich and poor are caused by relative rather than absolute differences in wealth  and success. The book is based on thirty plus years of research which Sir Michael presents in a highly accessible form. Reviews for the book are available on a number of Web sites including the New Scientist, Guardian Unlimited, and EurekAlert.

The End of Stress As We Know It
Listen to Bruce McEwen discuss stress, allostatic load, and suggestions for how to keep the body's stress response in the healthy zone, in his December 4, 2002 NPR Fresh Air interview.   The paperback version of his book by the same title, written with Elizabeth Norton Lashley, is expected out in Fall, 2004.

Redefining Public Health: Epidemiology and Social Stratification
Read a Conversations with History interview with Michael Marmot in the archives of the Institute of International Studies at the University of California at Berkeley. Sir Michael talks about his background, his ground-breaking Whitehall studies and their applicability to policy and social change.

 BI-MONTHLY PUBLICATION LIST FOR JANUARY - FEBRUARY 2008

Evans, G. and Kim, P. (2007). Childhood poverty and health: Cumulative risk exposure and stress dysregulation. Psychological Science, 18(11):953-957.

Evans, G., Wethington, E., Coleman, M., Worms,M. and Frongillo, E. (2008). Income health inequalities among older persons: The mediating roll of multiple risk exposures. Journal of Aging and Health, 20(1):107-127.

Gianaros, P., Horenstein, J., Hariri, A., Sheu, Lei, Manuck, S., Matthews, K. and Cohen. S. (2008). Potential neural embedding of parental social standing. Social Cognitive and Affective Neuroscience, advance access published online 2/8/2008. 

Alkire, S. and Foster, J. (2007). Counting and multidimensional poverty measurement. Oxford Poverty and Human Development Initiative, OPHI, OPHI working paper series No. 7.

Kindig, D., Day, P., Fox, D., Gibson, M., Knickman, J., Lomas, J. and Stoddart, G. (2003). What new knowledge would help policymakers better balance investments for optimal health outcomes? HSR: Health Services Research, 38(6):1923-1937.
                                     
Kjellstrom, T., Hakansta, C. and Hogstedt, C. (2007). Globalisation and public health - overview and a Swedish perspective. Scandinavian Journal of Public Health, Supplement 70.

Naess, O., Claussen, B. and Smith, G. (2007). Housing conditions in childhood and cause-specific adult mortality: The effect of sanitary conditions and economic deprivation on 55,761 men in Oslo. Scandinavian Journal of Public Health, 35:570-576.

Nexoe, J.,  Halvorsen, P. and Kristiansen, I. (2007). Critiques of the risk concept - valid or not? Scandinavian Journal of Public Health, 35:648-654.

Nolte, E. and McKee, M. (2008). Measuring the health of nations: Updating an earlier analysis. Health Affairs, 27(1):58-71.

Quinn, M., Sembajwe, G., Stoddard, A., Kriebel, D., Krieger, N., Sorensen, G., Hartman,C., Naishadham, D. and Barbeau, E. (2007). Social disparities in the burden of occupational exposures: Results of a cross-sectional study. American Journal of Industrial Medicine, 50:861-875.

Rosengren, A., Hawken, S., Ounpuu, S., Sliwa, K., Zubaid, M., Almahmeed, W. A, Blackett, K. N., Sitthi-amorn, C., Sato, H. and Yusuf, S. (2004). Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet, 364:953-962.

Starfield, B. (2007). Pathways of influence on equity in health. Social Science and Medicine, 64:1355-1362.

Westin, M. and Westerling, R. (2007). Social capital and inequality in health between single and couple parents in Sweden. Scandinavian Journal of Public Health, 35:609-6017.

Yusuf, S., Hawken, S., Ounpuu, S., Dans, T., Avezum, A. , Lanas, F., McQueen, M., Budaj, A., Pais, P., Varigos, J. and Lisheng, L. (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet, 364(9438):937-952.