To stay healthy, we can eat our vegetables, keep fit and firm, avoid smoking, drink in moderation, and inherit the right genes — but is that all we can do? No, says professor Nancy Adler, PhD, a medical psychologist at the University of California at San Francisco Medical School. Her research shows that changing the way we see ourselves can help us live longer, healthier lives.
Instinctively, we believe that richer, better-educated people enjoy better health. And in general, that’s true; well-off people tend to eat well, see the doctor more often, and live in cleaner, safer places. But according to Adler, the relationship between health and social status is far more subtle: It’s not just a question of where you sit on the socioeconomic ladder; it’s also your perception of how many rungs you must climb to reach the top. Here, Adler, chair of the John D. and Catherine T. MacArthur Research Network on Socioeconomic Status and Health, explains.
Q: So it’s not cash or class, but status that predicts a longer life?
A: The common assumption is that the higher you are on the Social Economic Standing [SES] scale, the happier and healthier you will be. Our research at UCSF suggests that it’s not that simple. The factors we use to measure SES — education, income, and occupation — are not as related to one another as you might expect; there isn’t a straight line where every extra point of income or level of education guarantees a more elevated status. However, it turns out that your own perception of your social and economic standing compared with other people’s is an excellent predictor of your physical health and longevity.
Q: So how do you measure this perception of social status?
A: By asking just one question: "Compared with other Americans, in terms of income, education, and occupation, where would you place yourself on this ladder?" We literally show them a ladder, the MacArthur Subjective Status Ladder. People are very savvy about social status and have a very accurate sense of just where they fit. Recently, we also started to have people rank themselves on where they stand within their community.
Q: How does your perception of where you are on the ladder affect your health?
A: Your position predicts stress, and stress has a lot to do with premature mortality. People who place themselves on the lower rungs of the ladder report more stress and stress-related illnesses. Stressed-out people are more likely to develop heart disease, more susceptible to inflammation and infection, and more likely to release too much cortisol, a hormone that causes fat to accumulate at the waist. We know from public health data that people at lower SES levels tend to gain weight earlier in life than those who are higher, and being overweight puts them at risk for many poor health outcomes. The ladder helps to explain why this happens. By the way, cortisol is one of the things that causes us to crave the wrong foods when we’re under stress. When laboratory animals are subjected to conditions of high stress and given a choice of chow, they prefer the high-fat, high-fructose chow because it dampens the cortisol release. While it’s hard to generalize from animal studies to humans, that behavior seems a lot like someone who eats an ice cream cone when things get bad.
Q: How static is my status? How do I change it?
A: We see a huge benefit to getting more active locally: joining groups, being on committees. When people consider all the positive things in their day-to-day lives — friendships, community activities, family — they give themselves a higher total status than if they just look at traditional SES indicators like education and income. And I think that in general changing status is easier for women since we’re used to playing so many roles. We can choose to focus on the aspect of our status where we feel most confident. For example, when my daughter was in a playgroup, every mother had to take a turn bringing the snack. One day, another mother had made these adorable teddy bear cookies, frosted and decorated with eyes and everything. I felt just terrible, because every time it was my turn to bring the snack, I bought Fig Newtons. But I said to myself, "You’re never going to be the best baker mom, but on the other hand, you do have a pretty good job, and at least you remembered to bring a snack. So maybe you’re not so bad." Instead of feeling crummy that I had bought cookies instead of baking them, I let myself focus on a part of my life where I felt successful.
Or you could focus on your spiritual life, thinking, "I am very moral and a good person," and that can improve your own view of where you sit in the social hierarchy. Taking pride in the successes in your personal life as well as in your community seems to be a very powerful indicator for health.
Q: Are you saying that by thinking good thoughts about myself or by counting my blessings, I can improve my health?
A: It’s not enough just to trick yourself into thinking you’re better off than you are. What our research acknowledges is that social status is complex and made up of many components — some of which can be changed by positive decisions that you make about your life, like going back to school or getting involved in your community. You can alter your perception of how well you are doing in the world, and if you feel that things are going well for you, it makes a big difference.
Originally published in MORE magazine, May 2006.