Physical and mental health run parallel to social rank. In England, commoners die sooner than aristocrats. In the military, sergeants have more heart attacks than generals. Blue-collar workers -- and not only those working in mines, construction sites and chemical plants -- have more respiratory infections and hacking coughs than white-collar workers. Office clerks are more anxious and depressed than office managers. Lower-middle-class Americans are more mortal, morbid, symptomatic and disabled than upper-middle-class Americans.
With each little step down on the educational, occupational and income ladders comes an increased risk of headaches, varicose veins, hypertension, sleepless nights, emotional distress, heart disease, schizophrenia and an early visit to the grave.
The funny thing is, no one knows why.
Of course, people who are socially well-placed have not always been spared the ravages of disease T. MacArthur Foundation established a research network on socioeconomic status and health, under the direction of Nancy Adler, a psychologist at the University of California, San Francisco.
Much of the excitement dates to the 1980 publication of the "Black Report," when Sir Douglas Black (a former president of the Royal College of Physicians) and his medical, social science and public policy associates showed the statistical association between illness and social class in England and Wales.
The Conservative government detested the Black Report, viewing it as a trespass of social medicine into politics, an ideological tract produced by welfare-state advocates longing to redistribute wealth and level the social class system. Liberal egalitarians, just as predictably, took the study as proof that social hierarchy is a public health problem.
Politics aside, no one knows precisely why people with high status are more healthy and less crazy.
It is not primarily because they havLondon.
The Whitehall study showed that with each tiny descent in civil service rank, from senior executive officer down to executive officer, comes more angina, more diabetes and more rough cough with phlegm. In this securely employed population, the mortality gap between senior administrators and clerical workers is even greater than the health divide in the general population.
Moreover, as comparisons between richer and poorer countries in Europe have shown time and again, greater national wealth does not readily translate into greater national health. A 45-year-old Greek male can expect to live longer than his English counterpart.
The health gap cannot be blamed primarily on life style differences, either. It's true that clean living (no smoking, alcohol or fatty foods, and lots of exercise) is a high-status religious activity (though professional women probably drink more liquor than working-class women).
Nevertheless, it turns out that most of the social inequality in of the reasons above. Perhaps it is a statistical artifact.
Perhaps the safest thing one can say is that the socioeconomic health gradient is a "multiple complex synergistic non-linear incremental cumulative threshold-bound lag effect." Social scientists like to talk like that when they think they are looking at something important but don't really know what is going on.