The Consequences of Status Differences

A person's perception of his or her status has profound consequences for health.

Posted Oct 01, 2013

Humans are addicted to comparing their physical and psychological features with those of others and using this information to arrive at a judgment of their potency. Children pay attention to differences in strength, size, language fluency, and motor skills. Adolescents add physical attractiveness, grades, popularity, and their family’s material possessions. Adults extend this list to include education, vocation, fame, accomplishments, and family pedigree.

The comparisons between self and others create conceptions that generate either confidence in one’s ability to dominate others or the uncertainty that trails an anticipation of being intimidated. Relative rank, not any absolute value, is all that matters. If a mysterious virus reduced the verbal fluency and reasoning ability of every human by 10 percent little would change. The same youth would be admitted to the best colleges and the same adults would accumulate great wealth because, in modern economies, each individual’s rank within their age cohort on the properties relevant to adaptation is the critical evidence. The absolute income level that defines poverty has changed over the past 50 years. But the proportion of the population in each American state that lives below the official poverty line tracks almost perfectly with the proportion of teenage pregnancies, cases of type 2 diabetes, and non-users of the Internet.

A child’s class of rearing represents a combination of distinctive family experiences, the social position of one’s family, and identifications with family members varying in accomplishment or failure. The interpretations of these experiences affect cognitive abilities, beliefs, worries, academic skills, careers, social behaviors, moral values, and health. A serious error in contemporary research on development is the habit of picking a single feature of childhood that is correlated with class (say hyperactivity, retarded language, or a mother who fails to praise her preschool child), finding a predictive relation between the trait and a later outcome, and concluding that the early trait or parental practice predicts the later trait, independent of the class of rearing. A marble placed in a groove moves in a straight line because the groove allows no other direction, not because the marble possesses an inherent bias to move in a straight line.

When social scientists discovered in the 1970s that the magnitude of income inequality in a country, state, or region had important correlates that were denied to average income, economists invented an index of income inequality, called the Gini coefficient. A Gini coefficient of zero means that everyone in the society has the same income; a coefficient of 1.0 means that one family earns all the income. Most contemporary societies have coefficients that range from 0.3 to 0.6. Canada and Sweden have the lowest coefficients (less than 0.3); whereas South Africa, Brazil, Nigeria, and China have the highest (from 0.4 to 0.6). The Gini coefficient for the United States in 2012 was a moderately high 0.38, which translates into 10 percent of Americans owning more than two-thirds of the country’s wealth. Although contemporary populations enjoy better health and more material comforts than they did in 1800 there has not been a significant reduction in the magnitude of income inequality, which is correlated with a host of undesirable outcomes that include disease burden, longevity, suicides, homicides, dishonesty, loss of trust in others, and bullying. During the depth of the recent recession in the United States from 2008 to 2010 there were more suicides than deaths due to automobile accidents, mainly by middle- age men who lost their job or a great deal of money.

The magnitude of inequality has to pass a tipping point before civil unrest or an ideological movement is triggered. Most citizens are willing to tolerate some inequality in wealth and other privileges, but become resentful when the magnitude exceeds a value that violates their understanding of fairness. Even though the United States has a relatively high Gini coefficient, Americans have been spared serious rebellions for close to 100 years because the less advantaged born after 1920 were persuaded that most privileged families earned their wealth and status fairly. Most disadvantaged Americans tell interviewers that the affluent are more intelligent and more receptive to new ideas. A Pew poll conducted in 2011 found that close to 90 percent of Americans believe that wealthy individuals either earned their money through hard work or had the good fortune of being born into a wealthy family. Americans are far more likely than Europeans to endorse the idea that hard work usually brings success. This belief was stronger in 2011 than it had been in 1983, even though this premise fit the facts better in 1983 than in 2011. But the correctness of the public’s judgments is irrelevant. A perception of fairness, combined with the traditional American belief that anyone who exerts persistent effort can become rich, is all that matters. Alexander Hamilton, Andrew Jackson, Abraham Lincoln, U.S Grant, Andrew Carnegie, Sonia Sotomayor, and Oprah Winfrey are often cited as proof of this premise.

It is relevant that the working poor in the United States, but not in all nations, are less stigmatized than they had been a century earlier when many writers suggested that a majority of the poor European immigrants possessed inherited biological defects. An essay in The New York Times of July 27, 2013 reflects the empathic attitude held by many middle-class citizens toward the poor. The author notes that those who grew up in poverty are vulnerable to many serious illnesses that could have been avoided if their families had been affluent. Compare this sympathetic perspective with the harsher European attitude present 300 years earlier when leading commentators, including Bernard de Mandeville, wrote that the economic health of a society depended upon large numbers of impoverished workers who would accept low wages.

Many Americans born after 1960 extended their sympathies toward the poor to anyone who suffered because of factors beyond their control. The celebratory reviews of Andrew Solomon’s Far From the Tree, which describes the suffering of very different kinds of victims, supports this claim. The media cooperated through dramatic portrayals of the cruel treatment of American Indians, slaves in the ante-bellum South, Jews in Nazi Germany, and the children of indigenous families in Australia. The hero in the 2003 film The Station Agent is a self-sufficient dwarf who evokes genuine affection from a lonely food vendor and an equally lonely woman. The several women in the 2012 film The Sessions who care for a man paralyzed from the neck down because of polio, including his sex therapist, fall in love with him because his optimistic mood renders him heroic and attractive.

I suspect that the growing sympathy for the disadvantaged and marginalized members of our society, which is supported by the results of national polls, persuaded many more affluent Americans that the plight of the disadvantaged was not solely their fault. A recent Pew poll revealed that 48 percent of Americans, compared with 25 percent in 1993, said that the government should do more to help the poor. The perception of increased concern should have muted some of the resentment the disadvantaged feel, but it does not mean that the status gradient in the United States is free of malevolent consequences.

An empathy for the less advantaged is an essential element in the egalitarian ethic that began in the eighteenth century in Europe and permeates many of the world’s societies. This ethic rests on the premise that every individual is entitled to the same degree of dignity, justice, and access to the resources required for a feeling of well-being, independent of their gender, ethnicity, religion, family pedigree, or accomplishments. This idealistic premise has the unintended cost of promoting a hostility toward those in elite positions.

The open expression of this attitude leads some doctors, lawyers, judges, politicians, clergy, scientists, professors, bankers, and corporation executives to recognize that they do not enjoy the unquestioned halo of respect they hoped to command when they chose their careers. Writers cooperated by portraying elites in dark colors. Scientists are painted as entrepreneurs who are as hungry for fame and wealth as any rock star. James Watson’s description of the investigators involved in the discovery of the structure of DNA affirmed this message.

A comparison of the celebratory essays on George Washington written prior to 1900 with recent biographies reflects a new eagerness to reduce the size of the shadow elites cast. Washington would surely have been upset by the books and essays of the past 20 years which question his brilliance as a general while portraying an ambitious, vain, unimaginative man who loved elegant clothes and worried constantly about his reputation.

The attacks on elite can reduce their motivation to honor the ethics of their professional position. Some physicians turn in fraudulent claims to Medicare; some scientists publish fraudulent findings; some priests abuse children, some principals of schools encourage teachers to falsify pupils’ test scores; some accountant executives approve dishonest annual reports to stockholders; and some employees of investment firms lie to their clients. The criticisms leveled at elites made these betrayals easier. Sadly, one of humanity’s frailties is the habit of believing what others say and altering one’s behavior so that it is in accord with the other’s judgments. If the community continues to say that a majority of adults in elite roles have flawed characters, some will cooperate by confirming the community’s belief.

When those at the top of the status pyramid sense that the contract they thought they had with members of their society has been broken, the pride that accompanies a perfect performance, as well as loyalty to the behavioral code associated with their role, can become muted and the strength of commitment a little weaker. The American Medical Association is troubled by the increasing number of American doctors who are abandoning a long standing ethical requirement to avoid criticizing the competence of another physician either to a colleague or a patient. Doctors who saw themselves as highly paid laborers in the health care system rather than members of a sacred profession might be expected to behave this way.

The current lack of leaders with moral authority is troubling because there are so many seemingly intractable problems that such individuals might help to resolve. This lacuna, along with the current misbehaviors of some elites, could represent one of the costs of an egalitarian, anti-elitist philosophy that brought America civic harmony and the understanding that every youth, no matter how compromised their childhood, has the possibility of fulfilling their fondest dream.

On the other hand, the current reluctance to award elites any special respect might have a benevolent face if it persuaded youth from non-elite families to realize that they, too, can achieve a higher status. Martin Luther’s rebellion against the elites in the Vatican permitted sixteenth century Europeans to entertain the idea that no person or institution was inherently sacred and protected from scrutiny indefinitely. Everyone can be challenged and anyone can, through effort and character, attain a higher status. This bold idea helped Europe, which was a backwater region in 1400, to become a world leader in science, education, democratic governments, commerce, and military power only 250 years after Luther mounted his criticism of a Pope who had abrogated his responsibilities to ordinary Christians. It is too early to tell which scenario will develop from the currently hostile posture toward elites, allowing us to hope that the second path might be the one history will follow.