On the road again

Last weekend marked a welcome milestone. A bit shy of four weeks after having arthroscopic knee surgery I ran, sort of, my first post-op 5K. I was really slow but it was nice to be in motion again.

Jogging had been out of the question this summer due to persistent knee pain. Other favorite activities had to stop too, like jumping rope, kicking a bag and sparring. Karate became pretty much impossible towards the end. I tried to make do on a bike but it just wasn't the same.

One thing that made the run more special was the fact that I completed it with my 7 year old grandson, who ran every step of the way. In fact, the little bugger finished ahead of me.

I think I can still take him in karate though.

YOU PROBABLY ALREADY KNEW THIS, but the price of health insurance is going through the roof.

THE MORAL ARC THING. As far as I can tell, the moral arc of the universe swings around randomly (in fact, "moral universe" seems like an oxymoron, but here is an interesting alternative perspective.

WHAT DO YOU SEE? Human perceptions of race vary with perceptions of social status--and vice versa.

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Houses and sniffles

A Rhinovirus, courtesy of wikipedia. I think they magnified it a time or two.

There is a large and growing body of scientific research about how things like inequality, class and social status engrave themselves into our bodies. Generally speaking, people in higher social positions are less likely to develop conditions like heart disease or diabetes than those in lower positions. The same affect seems to apply to infectious diseases as well.

In a fascinating study, healthy adults first answered questions about their socio-economic status (SES) and that of their parents when they were growing up. They were then exposed to one of two forms of rhinovirus (aka common cold viruses) and kept in quarantine to monitor the symptoms.

Here's a surprising finding:

For both viruses, susceptibility to colds decreased with the number of childhood years during which their parents owned their home...This decreased risk was attributable to both lower risk of infection and lower risk of illness in infected subjects. Moreover, those whose parents did not own their home during their early life but did during adolescence were at the same increased risk as those whose parents never owned their home. These associations were independent of parent education level, adult education and home ownership, and personality characteristics.

The researchers concluded that "A marker of low income and wealth during early childhood is associated with decreased resistance to upper respiratory infections in adulthood. Higher risk is not ameliorated by higher SES during adolescence and is independent of adult SES."

In other words, poverty or relative deprivation during early childhood can have negative health affects throughout a lifetime. That's something to think about now, as the recession has driven more families on a downward economic spiral.

SIGN OF THE TIMES. Half of all US children and 90 percent of African American young people do or will receive food stamps, according to a new study.

THIS NEEDS FIXED. The House version of health care reform would phase out the Children's Health Insurance Program. Senator Rockefeller is not amused. Nor is El Cabrero. This needs to be fixed in conference.

A FAMOUS UNREADABLE (FOR ME ANYWAY) ANTHROPOLOGIST has died at the age of 100.

HOW SMART ARE DOGS anyway?

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Demand and control

Edith is stressing out the turkeys.

El Cabrero has been blogging off and on about how social status affects health and longevity. As mentioned previously, there's a really clear social gradient that seems to work all up and down the scale.

Those in the highest status positions are healthier and live longer than those with "only" high status positions, who live longer than those with moderate social status positions, and so on.

One key factor in all this, according to British epidemiologist Michael Marmot, is having a sense of autonomy and control over life and work. This tends to increase as you climb the ladder and decreases as you descend it. In The Status Syndrome, Marmot cites research that finds that high demand/low control work situations are particularly toxic.

This problem isn't limited to the workplace however. A typical low income person in the US can face control/autonomy issues all the time, i.e. by living in an unsafe neighborhood and/or in bad housing; facing economic insecurity, from juggling bills to dealing with evictions or foreclosures; and dealing with conflicts with landlords, neighbors, bill collectors, etc. These kinds of experience trigger the body's stress reaction and change body chemistry and hormone production.

And here we face an evolutionary lag. Our bodies developed the stress response (or fight or flight syndrome) to deal with short term dangers and threats. If the stress is chronic, this can trigger all kinds of problems, ranging from heart disease to mental disorders such as depression...all of which explains why diseases and early mortality are as unequally distributed as wealth and status, albeit in the other direction.

PUBLIC OPTION. Here's the latest on health care reform in the Senate.

OUCH. The US economy has lost over 5 percent of jobs since Dec. 2007. The numbers are much higher in some areas than others.

KING SOLOMON DON'T LIVE 'ROUND HERE. This analysis from the Charleston Daily Mail talks about how hard it will be to find "balance" in current coal controversies.

THE LATEST TWIST in the Megan Williams saga is here.

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That's just the stress talking

Workplace stress is probably not a major issue for this green heron.

Goat Rope has been running an off and on series lately about the links between social status health. The short version is that there is a big connection between the two and that people's health tends to be better the higher up the social ladder they are.

It's not just that people who are poor and/or have relatively low social standing get sicker and die younger, although that is true as far as it goes. Rather, it's like a social gradient that works all the way up or down. People who have very high status are healthier than people who just have high status. And so it goes.

British epidemiologist Michael Marmot, who has spent decades studying this, identifies some key components that might explain the gradient. One big one has to do with autonomy and a sense of control. This is especially true in the workplace.

While most people on the job talk about stress, research indicates that not all stresses are created equal. As Marmot puts it,

Ask more successful people if they are stressed at work and they will tell you, in slightly macho fashion, about how many e-mails they receive a day, how much in demand they are, how many different tasks await their attention, about their deadlines. If you ask about stress, they are unlikely to tell you that work is monotonous, boring, soul-destroying; that they die a little when they come to work each day because their work touches no part of them that is them. But this is the reality of many jobs; and the lower the status, the more likely that is to be so. Ask the people with all the e-mails which job they would rather be doing, the high-status job with continuous demands, and the company BMW and the firm's credit card, or the soul-destroying job with tasks that ask for little use of skills, that are completely determined by others, and, oh yes, that offer little in the way of self-fulfillment, financial rewards, or status enhancement. There are not too many high-status people who would swap their "stressed" place in the boardroom for a place on the production line.

More on that to come.

HEALTH CARE REFORM. A new poll shows strong support for a public option.

TWO CENTS MORE. Here's economist Dean Baker on the same.

CHILD WELFARE. El Cabrero's beloved state of West Virginia doesn't come out too well in this report.

MEGAN WILLIAMS CASE. There's been another strange turn of events.

URGENT GIANT SPIDER UPDATE here.

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It's relative

Would you rather be a big cat or a small dog?

Developments in behavioral economics have challenged the old idea of humans as belonging to the species "homo economicus," a fabled creature that purportedly rationally acts in accord with its material self interest. Real humans often have other priorities, including things like a need for social status and a sense of fairness (which admittedly aren't always compatible).

One experiment cited by Michael Marmot in The Status Syndrome: How Social Standing Affects our Health and Longevity is a case in point:

...people are asked to imagine two situations. First, you live in a society where the average income is $100,000 and your income is $125,000. Now consider a new situation. Average incomes are now $200,00 and your income is $175,000. In the two societies, a dollar has the same purchasing power. Which situation would you prefer?

If people were really out to go for the bottom line, they would pick scenario #2. In reality, most people pick #1. As Marmot puts it, "They would rather sacrifice material gains for better social standing."

There are several ways to interpret these results. One would be that people are obsessed not just with keeping up with the Joneses but with burying them in the dust. A more charitable interpretation--and one that makes sense in light of other research--is that a key factor in peoples' sense of well being, and even of health and mortality, is the ability to fully participate in society.

Being at a material disadvantage in comparison with others in the same society can limit our sense of being able to fully participate. For that matter, a lot of research on things from health to violence indicates that relative poverty, i.e. one's position in comparison with others, is a major factor in causing lots of problems--and not just for those who are relatively poor.

More on this to come.

PAYING MORE TO DIE SOONER. Here's another critique of the American health care system.

ONE THING NOT TO FEAR, Dean Baker argues, is the public option in health care reform.

By the way, I heard last week that the vote on the public option may take place today in the Senate. I don't know whether this has changed. Still, it wouldn't be a bad idea to make yet another call.

STATING THE OBVIOUS. The AFLCIO blog points out that millions of Americans already rely on government-provided health care. And they're not trying to get rid of it.

INCONSISTENCIES. This Gazette op-ed by a friend of mine looks at some of these on the right.

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An interesting question

This guy is very status conscious.

Off and on lately, this blog has been looking at how social status and related factors affect health and longevity. (Short version: they do in a big way.)

But this kind of musing leads to an interesting question:

*Given that there are status hierarchies in primate populations and many other animal groups as well; and

*Given that humans are primates; and

*Given that all human societies have some kind of hierarchy (even if it is mostly a guy thing)....does this not imply that this is a fact of nature and that there's nothing we can do about it?

Epidemiologist Michael Marmot examines this question in his book The Status Syndrome: How Social Standing Affects Our Health and Longevity. Here's one possible answer.

Striving for status is probably a legacy of our evolutionary heritage (again, chiefly amongst the dudes). BUT for most of human history, we were foragers or hunter-gatherers. Such groups in general don't accumulate a lot in the way of property and don't have class systems that institutionalize inequality. Also, one can gain status in such a group in lots of ways, including by showing generosity and concern for others. Also, if you know anything about hunting or fishing, you know that sometimes you're hot and sometimes you're not, which would tend to make status differences fairly fluid.

We really see the status affect in humans at it strongest in class societies quite unlike that of our ancestors. These have all kinds of built-in structural inequalities. But even within these, the affects of status vary widely, with the degree of inequality having a major effect. In other words, a lot of the status syndrome and related social determinants of health are socially constructed and vary widely from society to society.

To quote Shakespeare, "The fault, dear Brutus, is not in our stars but in ourselves, that we are underlings"--at least to a large extent.

SIGNS OF THE TIMES. Unemployment claims have nearly doubled since last year in El Cabrero's beloved state of West Virginia. Meanwhile, over 300,000 state residents got SNAP or what used to be called food stamps. That number was up over 60,000 from the previous year.

ON THE OTHER HAND, there are some signs that job losses are slowing at the national level.

AND BY THE WAY, the American Recovery and Reinvestment Act is playing a big role in making things less bad. As part of ARRA, food stamp payments went up and there were also mechanisms to extend, expand and modernize unemployment, aside from all the other effects of the boost in spending.

THE NEXT BIG HISSY FIT after health care reform will be climate change legislation.

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Untangling a knot

He did it with a sword. "Alexander cuts the Gordian Knot," by Jean-Simon Berthélemy (1743–1811)

When it comes to health and well being, there are a lot of issues to untangle. Obviously one is the lack of health care at all, which is a serious problem in the US and one that is getting worse in the wake of the recession. In yesterday's post, I linked a recent news item about a report that found that 45,000 Americans die prematurely each year because they don't have it.

Obviously, moving towards universal health care is way overdue. But there are some things about health and longevity that go beyond mere health coverage. As I've mentioned in the last several posts, status matters. People in higher social positions enjoy better health and longer lives than people in lower positions.

Typically, people try to explain this in terms of bad habits of people down the status scale, particularly among poor people, but this is missing a major point. According to Michael Marmot, author of The Status Syndrome: How Social Standing Affects our Health and Longevity, two key factors are autonomy and social participation:

...social conditions affect the degree of autonomy and control individuals have and their opportunities for full social engagement. These needs, for control and participation are more adequately met the higher your social position. As a result, health is better.

Conversely,

Lack of social participation and inadequate control over your life, in the sense of not being able to lead the life you want to lead, will lead to chronic stress, which in turn increases risk of a number of diseases, heart disease among them.

Marmot argues that this lack of control and full participation may lead to behaviors that are bad for health in the long term, but those things seem like small potatoes when one is just trying to get by in the short term.

ON THAT NOTE, here's another take on the link between health and social conditions.

RECESSION NATION. The latest Census data shows that the recession has had a major impact on Americans.

MEANWHILE, BACK ON THE PARANOID RANCH. Here's an interview between Bill Moyers and Max Blumenthal about today's rabid right and here's former religious right leader Frank Schaeffer on far right versions of politicized religion.

HOW WE GONNA KEEP HIM DOWN ON THE FARM NOW? Gazette reporter and uberblogger Ken Ward of Coal Tattoo fame was featured on NPR's Living on Earth.

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The necessities

A large and growing body of research shows that things like health and mortality are affected by social standing. Once people have the basic resources needed to stay alive, health is influenced by how one stands in relationship to other people in the same society.

This isn't an entirely new idea. Adam Smith, writing in the 1700s, understood that what we consider to be necessities vary according to social customs:

By necessaries I understand not only the commodities which are indispensably necessary for the support of life, but what ever the customs of the country renders it indecent for creditable people in the lowest order to be without. A linen shirt, for example, is, strictly speaking, not a necessity of life. The Greeks and Romans lived, I suppose, very comfortably though they had no linen. But in the present times, through the greater part of Europe, a creditable day-labourer would be ashamed to appear in public without a linen shirt, the want of which would be supposed to denote that disgraceful degree of poverty which, it is presumed, nobody can well fall into without some extreme bad conduct. Custom, in the same manner, has rendered shoes a necessary of life in England. The poorest creditable person of either sex would be ashamed to appear in public without them.

In other words, it's not just about staying alive; it's about being able to participate decently in the life of the community.

SPEAKING OF NECESSITIES, a new study found that 45,000 Americans die prematurely each year due to lack of health care.

FEELING JUNGIAN? Click here.

SPEAKING IN (OR ABOUT) TONGUES. Here's the latest edition of the Rev. Jim Lewis' Notes from under the Fig Tree.

POLITICAL PARANOIA was the theme here a few weeks back. Here's another take on it.

FINANCIAL REFORM. Krugman says do it.

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Honk if you love the class system

In his book Lies My Teacher Told Me, James Loewen relates the story of an interesting experiment on American attitudes towards social class and status.

It had to do with honking horns and cars.

Two students drove around Burlington, Vermont, first in a new luxury car and then in an old junker. In each case, they would sit at a stoplight after the light turned green to see how long it would take drivers behind them to honk.

The results were pretty striking. It took less than seven seconds for drivers to honk at the junker, but almost twice as long (13.2 seconds) for them to honk at the luxury car.

When you consider that statistically speaking most of the honkers were working class people, this shows how many Americans unconsciously ascribe respect and deference to people who seem to enjoy a higher social position.

That explains a lot.

CHANGING OF THE GUARD. From Ken Ward's uberblog Coal Tattoo, here's a post about Rich Trumka, the new president of the AFLCIO. Trumka is former president of the UMWA.

HEALTH CARE REFORM. Here's a statement from Robert Greenstein of the Center on Budget and Policy Priorities on Senator Baucus' health care reform plans and here's Paul Krugman on whether the bill is or can be made to be up to snuff.

WHY THE #*$& DO WE CUSS? Dealing with pain may be part of the answer.

URGENT T REX UPDATE here.

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I'd like to thank the Academy...

Earlier this week, there was a post about the connection between social status and health. Suffice it to say there is one and it's big.

In fact, there is what epidemiologist and author Michael Marmot calls "a social gradient" for health and mortality. It's not just that the very poor are sicker and more likely to die sooner, although that is true. It's also the case that there's a difference in health and mortality at every level, i.e. the very rich have better health outcomes than the rich, who have it better than the well off, who have it better than the middling sort and so on down the line.

Again, money is part of it but not all of it. A big part is status.

Here's a very interesting finding. Two researchers, Donald Redelmeier and Sheldon Singh looked at health and mortality data for actors nominated for Academy Awards over 72 years. They found that Oscar winners on average lived four years longer than those who were nominated but didn't win. The non-winners were highly respected actors with plenty of film credits and a healthy income, but there was some kind of magic boost in the recognition an award like that give.

The same kind of pattern shows up all over the place.

LINKS are on strike today. We're hoping they'll settle by tomorrow.

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Inequality and health

Image courtesy of wikipedia.

Topics like economic inequality and health outcomes show up frequently in this blog, but lately I've been nudged into looking at the overlap between the two. In the public health field, a growing amount of attention has been paid to what is called the "social determinants of health," which kind of is what it sounds like.

A large body of scientific research has shown that how long we live and how well we are is influenced in no small degree by our social standing. It has long been known that life can be nasty brutish and short for the very poor, but the latest research shows that this applies all across the board.

This also means that negative health outcomes increase as inequality grows.

It's not all about money or education level, although they are a major part of it. As Michael Marmot put it in The Status Syndrome: How Social Standing Affects our Health and Longevity,

...for people above a certain threshold of material well-being, another kind of well-being is central. Autonomy--how much control you have over your life--and the opportunities you have for full social engagement and participation are crucial for health, well-being, and longevity. It is inequality in these that plays a big part in producing the social gradient and health. Degrees of control and participation underlie the status syndrome.

In our society, autonomy and participation are closely correlated with income and education. And, as I've written about many times before, one of the nastiest things about poverty is that it robs you of both. The interesting thing about the latest research is that it shows the effect of status on health at all levels of education and income. In other words, it's everybody's business.

More on this to come.

HOW DID I MISS THIS? Here's a major NY Times article about water quality that highlights mining's effect on health in West Virginia. And here's way more on the subject from Ken Ward's Coal Tattoo.

HEALTH CARE. One positive feature of proposed health care reform is an expansion of eligibility for Medicaid benefits, but the politics are complicated. And here is an op-ed by a friend about the public option.

UNEMPLOYMENT is up in El Cabrero's beloved state of West Virginia, but is still below the national average.

HEALTH ADVICE. Your mama got it right sometimes. Other times, not so much.

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