Murderous inequality
Damned branded
British researchers have identified a direct link between life expectancy and social inequality
Alla Astakhova, "Results" No. 5-2012
Social inequality is killing us. And in the literal sense of the word. This idea does not leave the pages of American and European newspapers today. No one hides: the wave of discussion has risen in connection with the protest movement on Wall Street. However, the discussion is based on strict facts. The number of scientific publications on this topic is growing like a snowball. It has long been known that long-livers and the healthiest people do not live in rich countries, but where there is more trust in human relations. Scientists have finally found an explanation for this phenomenon.
People from the streetIn the beginning there was also a street.
Only London, Whitehall – its name has become a household name for the British government. It was among the civil servants of Great Britain that 18 thousand participants of the first experiment were selected in 1967. For a decade, scientists have scrupulously recorded morbidity and mortality in this group, hoping to find confirmation of the hypothesis that chronic stress causes diseases. In principle, it turned out that way, but the researchers were in for a surprise. "At first we assumed that the higher the social status of an employee, the more stress and higher mortality," says Sir Michael Marmot, director of the International Institute of Society and Health, Professor of Epidemiology and Public Health at University College London (UCL), to whom the Whitehall study brought not only scientific fame, but also the title of knight. "However, to everyone's amazement, we saw data that at first was considered simply incredible." Everything turned out to be exactly the opposite. Subordinates died more often than bosses! The lower the employee's status, the higher the risk of heart disease and many other diseases was for him. The difference in the death rate between officials who occupied the upper and lower rungs of the career ladder turned out to be threefold. And it wasn't just the difference between the top and the bottom, as many might think. It turned out that the point is not that good medicine is available to the rich, but not to the poor. It was about government employees who have access to the same insurance. Another thing is important: the existence of a so–called social gradient - a gradual, step-by-step change in health indicators and life expectancy depending on a person's status.
The discovery was so amazing that the work in this area decided to continue. Today, a whole series of Whitehall studies has been done not only in the UK, but also abroad – in Finland and Japan. There is talk of holding a "Whitehall" in Washington. "By studying people's health, we can learn something about the structure of society, and by studying the structure of society, we can learn something about health," says Sir Marmot. So far, the main conclusions of the researchers are as follows: the higher the social contrasts in a certain country, the greater the difference in the mortality rate between the top and the bottom. For example, in Glasgow, Scotland, the life expectancy of those at the bottom of the social ladder is now 54 years, while representatives of the elite have every chance to live to 82 years. But in Finland, where the differences in the position of high–ranking and ordinary employees are not so large, the difference in mortality between the top and bottom is less - not three times as in the UK, but only twice.
But the most amazing thing is something else. Scientists have found that in those countries where the overall level of socio-economic inequality is the lowest, everyone lives longer – both the bottom and the top. And the general health of the population there is much better. This is clearly noticeable if we compare countries that are approximately equal in per capita income. So, in the countries of Scandinavia and Japan, where the population is mostly homogeneous, the overall incidence of cardiovascular and mental diseases, the number of cases of obesity, the prevalence of bad habits is much less than in the United States and Great Britain, where per capita incomes are not less, but social contrasts are more striking. That is, inequality has a bad effect not only on the "lower", but also on the "higher". Why? Scientists were able to guess the reason when they took a closer look at the nature of social dominance.
Three minutes of screamingThis time, amazing news from the animal world came in handy.
Whitehall research was already in full swing when Robert Sapolsky, a professor of biological sciences, neurology and neurological sciences at Stanford University, began studying the behavior of close human relatives – African baboons. These animals have a very rigid social structure of the pack. Males occupying the lowest levels of the hierarchy experience chronic stress due to the constant aggression of tribesmen belonging to the top of the pack. It is not surprising that there are much more stress hormones in the blood of males who did not get into the elite: the constant rise in their level increases the risk of diseases. Sapolsky associates stress with a violation of homeostatic balance – the coordination of physiological processes that maintain a stable state of the body. However, in most animals, this condition is short-term.
"For 99 percent of the animals on the planet, stress is three minutes of screaming, after which either you're done with someone, or they're done with you," explains Robert Sapolsky. However, other possibilities arise in the baboon pack. Being in it, you can spend only three hours a day searching for food and not be particularly afraid of predators. What does it mean? "You have nine free hours a day to create psychological stress for other animals from the pack," Sapolski explains. – In this, baboons are similar to humans. They're just like us. They are not threatened by hunger and predators. They threaten each other."
For 30 years, Robert Sapolsky and his colleagues collected blood and tissue samples, electrocardiograms of baboons. It turned out that exposure to chronic stress causes them diseases that are not usually found in other mammals. About the same thing happens in humans, only with us everything is much more serious. "When humans invented inequality and socio-economic status, they came to a hierarchy of dominance and subordination never seen before in primates," says Robert Sapolsky.
However, those who have reached the very top of power are also not without stress. The study showed that the alpha males at the very top of the hierarchy have no less stress hormones in their blood than those at the lowest level. Does it affect life expectancy? The question is whether they have the ability to control the situation. American psychologist Martin Seligman conducted many experiments on different animals – they were divided into pairs and subjected to electric shock. Only one of the animals knew about it in advance and could prepare, and for the other, the action of the current was always unexpected. As a result, the latter became ill with various diseases, including cancer.
A recent study published in the Journal of the American Medical Association shows that even chronic stress is not so destructive to health if you feel like the master of the situation. Scientists have tracked the average life expectancy of American presidents and Oscar winners. It turned out that almost all presidents who died of natural causes were decades ahead of the average life expectancy in the United States, and Oscar-winning actors live on average four years longer than just those who were among the nominees. At the same time, life is nervous for both laureates and presidents. But they feel that they own the situation. What about the rest of the people?
The researchers found that where society is more homogeneous socially, all its members, as a rule, have more opportunities to control and predict their own lives. In the same place, where, as in a pack of baboons with a particularly aggressive top of the hierarchy, peace reigned only after the alpha male ate too much stale meat and died, no one can be calm.
"The rules of social interaction should be clear to everyone and be perceived as fair," comments Sergey Enikolopov, Head of the Department of Clinical Psychology at the Scientific Center for Mental Health of the Russian Academy of Medical Sciences. – There must be certain rules of the game: even in traditional societies with a fairly strong property stratification, there is an idea of the amount of effort expended and the behavior that is rewarded. Let's remember Cinderella: it's very harmful not to go to the ball if you deserve it. However, let's imagine a society in which absolutely everyone – both the bottom and the top – perceive the current order of things as unfair, dishonest. Or they don't understand whether the rules of the game exist at all." In this situation, health-damaging stress is guaranteed to almost all levels of the hierarchy, both middle, lower, and higher. And the swelling national mortality rates are only a reflection of this state of affairs.
Play by the rulesDoes this have to do with the picture of the highest mortality rate among the able-bodied population that we are seeing in Russia?
We have never conducted large-scale studies like the British Whitehall. Meanwhile, they could lift the existing veil of uncertainty. After all, no one knows the reasons for the mysterious "Russian cross" by and large. It is usually accepted to refer to the existing property inequality in our country. However, if we compare the situation in our country with others using the traditional Gini coefficient, which shows the level of stratification of society, then Russia will be among the strong middle peasants. The value of the coefficient 1 indicates absolute inequality, 0 corresponds to full social justice. In Russia, this indicator is slightly higher than 0.4. There are countries in which it is slightly lower, such as in Israel, or higher, as in China or the United States. But rarely in any other country do men of working age die so early and in such numbers as we do.
What's the matter? Experts only guess: in the notorious violation of the rules of the game established in society. This creates a source of stress. "The problem is that our social ties have been disrupted," Sergey Enikolopov believes, "and the attitudes that determine the rules of interaction are blurred. Freedom of movement has been proclaimed, but registration exists. It seems that everyone is equal before the law, but you can't do anything without a bribe. Society encourages people to work a lot and with a soul, but on TV those same workers watch mostly TV shows from the lives of rich idlers, and they learn about the environment in which they themselves exist only from the news when a pipe with steam heating breaks somewhere. At the same time, we often simply do not have a culture of working relationships – no one builds a system of incentives. So it turns out that a person constantly "stumbles" when trying to plan his activities – he does not understand what rules to act by. It is not surprising that people gradually accumulate cumulative stress." Even those who are at the very top of the social pyramid are not spared from it. In this sense, "the rich cry too." They, like everyone else, are hostages of a situation that can get out of control at any moment.
What is the result? Increased mortality? Not only. "In such cases, people subconsciously start looking for different ways to cope with stress and take control of their own lives," says Sergey Enikolopov. "Someone plunges headlong into household chores, someone remembers the past with nostalgia, someone comes up with innovations, someone goes to Goa, and someone is preparing for a revolution." The latter may eventually become noticeably more, if at least some order is not brought to the public rules of the game. However, so far, apparently, there is no idea how to do this.
"In any case, the current logic of the development of such a sensitive social area as healthcare indicates a lack of understanding of the problem," says Vasily Vlasov, president of the Russian Society of Evidence–Based Medicine, Professor of the I. M. Sechenov First Moscow State Medical University and the Higher School of Economics. – Inequality in this system is only increasing. It is known, for example, that wealthy people are the record holders in our country in terms of the consumption of free medicine resources. Of course, this creates stress for ordinary patients. However, the top is also unlikely to be happy in such a situation – she simply does not trust doctors."
And the president of the League of Patient Defenders, Alexander Saversky, is outraged that, in accordance with the recently adopted Law "On the Protection of Citizens' Health," the provision of services to patients for money by state medical institutions has now been legalized in Russia. The human rights activist believes that by blurring the boundaries between paid and free medicine, the state makes unclear the rules of the game on this, the last battlefield for health and life. What will the patient get by applying to such an institution and not knowing what he should pay for and what not? We already know – stress, which will either be disastrous for him, or make him dream that those who came up with it would eat stale meat. But is it worth bringing it up to this?
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30.01.2012