Health can be very much affected by the social situation we experience and the environment around us, as well as by our personalities. In particular, home and work circumstances have a strong influence on whether people are able to maintain healthy lives.
We are all individuals, and it is through our direct associations with one another – whether friends, relatives, neighbours, work colleagues or health professionals – that we can do the most to help everyone maintain the best possible health. But looking at society as a whole can help to reveal sources of health problems and how they can be dealt with by social means. This can contribute, for example, to how new homes are built, how offices and other workplaces· are run, and to identify which groups in society need extra support.
There seems to be no doubt that relative ·wealth and status in society have a direct effect on health. In general, people of lower socioeconomic status tend to have higher rates of heart disease, and there is much evidence that poverty is stressful. Research on baboon groups carried out by Robert Sapolsky in the USA supports this. Sapolsky found that baboons with a lower rank in the social group had higher levels of the stress hormone cortisol – probably because the higher-rank animals were bossing them around. They also had low er levels of HDL (high-density lipoprotein) cholesterol – a state that is linked to heart disease because ‘good ‘ HDL cholesterol helps to remove ‘ bad ‘ (LDL) cholesterol from the blood.
A Tale Of Two Cities
There is a large and widening gap in life expectancy and rates of heart disease between the countries of Western and Eastern Europe. A recent Swedish study has assessed the contribution of psychosocial factors in the east-west divide by comparing men in two cities – Linkoping in southern Sweden and Vilnius, the capital of Lithuania.
In the study, the Lithuanian men all reported more social isolation, job strain and depression than the men from Sweden – signs that stress was getting to them. Then, all the men did a laboratory stress test. The Swedish men all had low levels of the stress hormone cortisol before the test. During the test, the Swedes showed a normal rise in cortisol. Which then fell back to normal. Men from Vilnius with a high income had a low baseline cortisol level, too, but after the test, their cortisol levels took longer to return to normal. However, Lithuanian men with a low income had a high baseline. Cortisol level, which did not even respond to the stress test. These men were already stressed, it seemed, by their circumstances in life and were probably more likely to suffer ill health as a result.
Conditions in society
The relation between health and social status is not always straight for ward, however. For example, a recent UK study showed that middle-ranking civil servants in Britain with little control over their workload run a higher risk of heart disease than their superiors – so far, so predictable. But the study also showed that those ranked below them were less stressed: it seems there may be a position of maximum stress’ in the work hierarchy. Similarly, several recent studies have shown a higher frequency of eating disorders (such as anorexia nervosa and bulimia) in better-off sections of society. The desire to be thin, it seems, is more common among teenage girls from a wealthy background. Income level is just one part of a complex picture here: the family, ethnic background and media images are all major influences on how people see themselves. The most ‘ desirable ‘ body shape depends on fashion and culture, and a well-rounded figure has been thought to be the epitome of beauty in ages and societies other than our own.
The conditions that society imposes on its members can sometimes be positively beneficial. For example, over the last decade, there has been a widespread drive to reduce smoking in public places and to make most offices smoke-free environments. Some employers have introduced programs to help staff to quit or at least cut down their cigarette consumption during working hours. Any initial resentment from smokers usually disappears as people come to appreciate the health advantages both for themselves and others.
