Hierarchy is a health hazard

This, in a nutshell, is the key finding of the Whitehall II Study. The higher a person’s position in workplace and other organisational and social hierarchies, the better their health is likely to be and the longer their life expectancy.

In an interview with the BBC, epidemologist and Whitehall II study director Professor Michael Marmot explains the findings of the study. Amongst other things he states that a key factor in the link between social status and good health is the degree to which one is in control of one’s work and life rather than being subject to the control of others.

If these findings are correct, there are important political consequences.

The most obvious such consequence is that the study lends empirical support and an additional line of argument for the radical democratic critique of hierarchical and inegalitarian social structures of all kinds – whether corporate capitalist, Stalinist state socialist, state bureaucratic, patriarchal, clerical or military – and in favour of social democratic policies of redistribution of wealth and opportunity, and radical democratic projects of extending deliberative democratic and egalitarian modes of organisation to all spheres of social life.

At the risk of sounding triumphalist, this is yet further evidence that the most serious problems currently besetting humanity and the planet it inhabits are ones which the Left seems more likely than the right to have solutions for. The global financial crisis and the resultant discrediting of neo-liberal capitalism has concentrated our minds wonderfully on this point. And as I reported in September 2007, Thomas Homer-Dixon’s ideas on solutions to the multiple crises facing us in this century are also more broadly (though not exclusively) consonant with themes of the Left than those of the Right:

Homer-Dixon believes that civilisation will need to change in the direction of greater decentralisation and self-sufficiency of individual components within overall global networks to minimise the harm wrought by knock-on effects within interconnected systems. This has potential for radically increasing democracy. He regards market economies as a good example of decentralised, self-organising systems, and favours the use of global emissions trading within an overall global cap on emissions as a policy response to global warming. At the same time he recognises that the growth imperative of post-Depression and post-WWII capitalism, geared towards assuaging the discontent of the less well-off in industrialised societies by expanding rather than redistributing the pie, is ultimately unsustainable in a finite planet. He spoke explicitly of the probable need to shift to a “steady-state” economy sometime this century, and of the tension between such a shift and the need for further economic growth in developing countries to alleviate poverty. This tension can only be resolved through the wealthier citizens and nations of the world being prepared to make do with less in purely material terms. He repudiates the “lifeboat” ethics – i.e. being prepared to abandon the world’s poor to continuing poverty in the name of global sustainability – espoused by some more conservative and authoritarian environmental thinkers in the late 1960s and early 1970s.

P.S. For more on radical democracy, see here, here, and here.


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52 responses to “Hierarchy is a health hazard”

  1. Jarrah (formerly fatfingers)

    “in favour of social democratic policies of redistribution of wealth and opportunity, and radical democratic projects of extending deliberative democratic and egalitarian modes of organisation to all spheres of social life.”

    I fail to see how they will do away with a fundamental part of human nature, the status game. It might go some way to give greater control to people over their own lives, in certain respects, especially democratic reforms. But redistribution of wealth is very much the control of people’s lives by others, so there’s a contradiction in your thinking here.

    “the resultant discrediting of neo-liberal capitalism”

    What discrediting? I must have missed that one.

    “He spoke explicitly of the probable need to shift to a “steady-state” economy sometime this century,”

    I’m very interested in alternative economics, including steady-state economics, and have repeatedly tried over the years to find some good material on its theoretical underpinnings and/or practical mechanisms, without much luck. If anyone can point me to anything good (online or in hard copy), I’d be grateful.

  2. Jacques Chester

    What discrediting? I must have missed that one.

    Didn’t you get the memo? Markets are out of fashion with “the Left”. It’s quite a surprise.

  3. Fine

    Jacques, be careful of all that teeth grinding or you won’t have any left.

  4. Paul Norton

    The market is a good servant but a bad master.

  5. amortiser

    How do you get around the problem of the status of those in charge of the “redistribution”? The only way you can redistribute wealth is by the use of force, so those with that power will have a status above the rest.

  6. Paul Norton

    One word, amortiser: democracy.

  7. David Irving (no relation)

    Jarrah, in case you hadn’t noticed, the world’s financial systems are in a world of hurt, largely because of the pernicious influence of neo-liberalism. (I realise that your ideological position may make it hard for you to accept the connection.)

    On another topic, it’s interesting that (from the quote) Homer-Dixon appears to be talking about the increased stability of loosely-coupled systems, which is an idea I’d never though to apply to economics and politics.

  8. Talk Back Radio Gun Owner

    What a good idea to advocate equity in health. We can all equally enjoy the health of Wadeye.

  9. Jarrah (formerly fatfingers)

    “the world’s financial systems are in a world of hurt, largely because of the pernicious influence of neo-liberalism.”

    Why do you believe that?

  10. Armagny

    Neoliberalism is excellent. Markets are excellent. I can’t imagine for a moment that they would work in an irrational way, for example punishing 3rd parties for idiocies they had no control over.

  11. roger

    Why is it that a very interesting study that shows that ones control over ones life is a significant factor in your health and longevity immediately descends into an argument about neo-liberalism and whether or not it is, or is not the big evil. The point surely is that the system as it currently stands priveledges the lives of some over the many (this is how heirarchies have to work). Heirarchies are one common way that power is formally strcutured into systems, particularly bureaucratic ones, however it doesn’t need to be the only way. Those that argue that it needs to stay that way are doing so because they are priveledged by it and for no other reason. And these are the kinds of people who are more interested in arguments about why neo-liberalism has not been dicredited by what has gone on and the maintenance of things as they were (as if they weren’t designed by people to achieve certain ends). Do Jaques, TBRGO and jarrah think that modifying systems to distribute more control over decision making to those who currently don’t have it (which impacts peoples health) is a bad thing? If so why?

  12. Adrien

    If these findings are correct, there are important political consequences.
    .
    Um, like, there’s a class system?
    .
    The idea that social democracy is somehow non-hierarchical is spurious. (Hey let’s ask that airline stewardess who caught Kevvie’s wrath). I can understand that aspects of it might be so. For example the relative choices viz lifestyle options given to low paid workers in a comprehensive welfare state especially one that grants a disability pension to a dishwasher who’s ‘addicted’ to heavy metal concerts.
    .
    But hierarchies subsist in social democracies as in others. All that changes is who is subject to the dictates of others and on what basis.
    .
    I don’t think the problem of hierarchies is really about markets but about something more fundamental in human beings. We are primates, primates are hierarchical beasts and like a lot of other of nature’s nasty vicissitudes we’ve struggled with it for thousands of years. Against the will to command and, more importantly, the will to obey.
    .
    One interesting text that traces not so much the elimination of hierarchies but the flattening and opening of them is Ricardo Semler’s Maverick. Semler has been called everything from a neo-capitalist to a new kind of socialist. Whatever you wish to call him two things are apparent: #1 Markets helped not hindered and #2 It worked:

    To survive in modern times, a company must have an organizational structure that accepts change as its basic premise, lets tribal customs thrive, and fosters a power that is derived from respect, not rules. In other words, the successful companies will be the ones that put quality of life first. Do this and the rest – quality of product, productivity of workers, profits for all – will follow. At Semco we did away with strictures that dictate the “hows” and created fertile soil for differences. We gave people an opportunity to test, question, and disagree. We let them determine their own futures. We let them come and go as they wanted, work at home if they wished, set their own salaries, choose their own bosses. We let them change their minds and ours, prove us wrong when we are wrong, make us humbler. Such a system relishes change, which is the only antidote to the corporate brainwashing that has consigned giant businesses with brilliant pasts to uncertain futures.

    Semler recognizes what a lot of the people in the capitalist/socialist argument don’t that the modern corporation bears more resemblance to a Stalinist state than differences.
    .
    Trouble is it’s hard to deploy. I’ve tried to set up industrial democracies on a small scale three times. They failed. Why? Because most people just wanna be told what to do and get their paycheque. They did not want to share the risk or the responsibility and never argued or made decisions. Sad but true.

  13. Armagny

    However just to be contrarian, isn’t wealth just one of the hierarchies that we get bound up in? If it is removed, could that just (especially in our post-everything atomised society) mean that other hierarchies such as looks or physical prowess become even more dominant? One thing you could say for some kind of incentive-based system, if perhaps a little less extravagent than the present one, is that at least a range of people get a range of ways to differentiate themselves within the hierarchy, some of which draw on qualities like creativity and intelligence.

  14. Paul Norton

    tbrgo,

    your most recent comment has gone into moderation until such time as you can reformulate it so that it doesn’t make a rather offensive generalisation about “the Aborigines”.

  15. roger

    I dont know what the point that TBRGH made but this post is tailor made to show why this study needs to be taken seriously in regards to Indigenous health status. Without control serious change in relation to health status is not possible. Indigenous policy has long been made with the social Darwiniam view that Aboriginal people cannot make good decisions for themselves and therefore need to have poor ones made for them. Surely this study points out the folly of that way of thinking. What we need to do as a nation is find ways that Aboriginal people, amongst others, can gain more control and therefore improve their health status. More control would mean being able to make more decisions about education and health systems amongst others (not to mention being able to address elements of the intervention that they find objectionable). We’ll see if the Rudd rhetoric of evidence based policy is put in place now…. not likely

  16. joe2

    Well spotted Paul. A very ugly comment TBRGO. You seem to be living up to your name.

  17. Armagny

    I’m going to promulgate that link Adrien, I have mates who will whoop with joy (before going back to their air guitar) at that!

  18. FDB

    Don’t bother Paul – it’s Greenslime.

  19. Phillip

    “… corporate capitalist, Stalinist state socialist, state bureaucratic, patriarchal, clerical or military …”
    *
    I thought Stalinist was socialist.

  20. Down and Out of Sài Gòn

    Let’s not forget that “Hierarchy” can also be a health hazard to the rich (if not as much as to the poor). Mexico, Columbia and Brazil are countries with a history of inequality. Is it any coincidence that kidnappings are a growth industry in these places?

  21. adrian

    @14, as noted on another thread, I think you’ve suffered an attack of greenslime.

  22. David Irving (no relation)

    Why do I believe it Jarrah? Because it’s true. As I said before, your ideological biases may prevent you from seeing it, but it’s still true.

  23. Jarrah (formerly fatfingers)

    “Do Jaques, TBRGO and jarrah think that modifying systems to distribute more control over decision making to those who currently don’t have it (which impacts peoples health) is a bad thing?”

    I addressed the substantive topic in my first comment. I noted the hyperbole re “neoliberalism” (whatever that may be), but that was a minor point.

    I think our economic and governance systems need vast improvements, among them a transfer of “control over decision making” from those who have too much to those who have too little. There are numerous democratic reforms that would do a lot in that area. However, I don’t think radical democracy is very feasible (with its bias against consensus), and things like “redistribution of wealth” (which I don’t oppose entirely) run counter to the stated aims of this post.

    Also, Adrien has expanded on my brief point about human nature, and it bears repeating – fashioning a New Man (egalitarian, non-egoic, what-have-you) has been a popular notion for a very long time, and we haven’t had much success yet. Relative status and its social manifestations pre-date humanity itself. Just look at apes!

    “Because it’s true.”

    Sorry, I must not have made myself clear. I was asking, not for yet another assertion, but for your reasoning behind it. But if you don’t feel you’re up to explaining, don’t worry, you’re not alone – generally people can’t explain to me why “neoliberalism” or “unfettered markets” (LOL) are to blame for the GFC.

  24. Armagny

    Explain why they aren’t, we need enlightenment.

    My ignorance equated the lack of regulation of derivatives as an outcome of a structure in which prima facie any cleverdick (such as the intellectual teaming up of Allen and Overy and Guy Hands) can come up with an esoteric instrument and utilise it without first comprehensively proving it adds value to, and does not endanger, the global economy.

    Not our instruments, not our bankers, not our system defended so rigorously, so given it looks, smells and barks like a dog, explain why it isn’t?

    With respect (and I am genuinely open to being convinced on this).

  25. Adrien

    Let’s not forget that “Hierarchy” can also be a health hazard to the rich
    .
    Indeed the democratization of Semco Corp did not begin with some idealistic mission. Semler inherited the creaky old dopg in his 20s and, the course of trying to modernize it over two years of 8 day weeks, he got so sick he thought he was dying.
    .
    It was stress.
    .
    he then began to delegate authority and, well, it was one of the few firms that prospered in the hellish Brazillian economy of the 1980s.

  26. Adrien

    David – your ideological biases may prevent you from seeing it, but it’s still true.
    .
    Surely one of the truisms we can all take to heart 109 years after Nietzsche dropped dead is that in these matters there is no truth. Your ideology is just as biased as Jarrah’s and the actual truth looks something like this.
    .
    Only much much messier.
    .
    The political rhetoric of advocates of social democracy these days goes something like: These blind ideologues of neo-liberalism have destroyed the economy and that proves that social democracy is Correct.
    .
    Whatever you do don’t mention the ’70s (I did once but I think I got away with it).
    .
    It’s a bit like the Jehovah’s Witnesses that come to your door and read you their catalogue of other brands of Christianity, they say: this Church and that Church and the other Church are all bad. Therefore we’re good.
    .
    Well I can use that kind of logic to prove that Kevin Rudd is actually a wombat.

  27. Quoll

    For a more global view of disparate health concerns, within and between people because of heirarchies… from August last year.
    Lots of support for the same conclusions, the more agency (decision making and basic life needs covered) and knowledge the population has, the healthier everyone is.
    Great disparity of wealth is as Down and Out suggests often not so safe for the wealthy either, as it has historically found them losing everything to the masses one way or another. Why do they/we need all that security?
    Flawed argument re ‘apes’, but not enough space to address here, maybe later.
    ————————-
    WHO Commission on the Social Determinants of Health Report
    Full report and summaries
    August 2008
    .
    “The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries.”
    .
    “Responding to increasing concern about these persisting and widening inequities, WHO established the Commission on Social Determinants of Health (CSDH) in 2005 to provide advice on how to reduce them.
    The Commission’s final report was launched in August 2008, and contained three overarching recommendations:
    1. Improve daily living conditions
    2. Tackle the inequitable distribution of power, money, and resources
    3. Measure and understand the problem and assess the impact of action”
    .
    “Inequities are killing people on grand scale, reports WHO’s Commission
    .
    28 August 2008 | GENEVA — A child born in a Glasgow, Scotland suburb can expect a life 28 years shorter than another living only 13 kilometres away. A girl in Lesotho is likely to live 42 years less than another in Japan. In Sweden, the risk of a woman dying during pregnancy and childbirth is 1 in 17 400; in Afghanistan, the odds are 1 in 8. Biology does not explain any of this. Instead, the differences between – and within – countries result from the social environment where people are born, live, grow, work and age.”

  28. skepticlawyer

    You could just as easily parlay this kind of research into support for subsidiarity, the idea that decisions ought to be made by those whom they most directly affect. In Switzerland, for example, this means a commune of two hundred people has to do all its local government stuff itself (the classic ‘roads, rates and rubbish’ trifecta). This doesn’t necessarily twin with social democracy (which still looks very statist to me, at least as people describe it on this blog).

    Someone is still having to make decisions about wealth distribution, someone is going to have to make decisions about allocation. Lots of people don’t like markets much, and that’s fine and dandy, but the alternatives — and it’s fair to say this — have always and everywhere been worse.

    Now there’s a mountain of research showing that people who have very considerable democratic control over their local community — via subsidiarity, citizen initiated referenda and democratic mechanisms to recall politicians or force legislation to the polls — are happier and live longer, healthier lives. They also do things like ban gay marriage, or abolish multiculturalism, or legalise drugs. Only one of these things, I suspect, would garner broad support from people on this blog.

    I’m all for subsidiarity, and I like how it works in Switzerland and California, but it does mean living with what the people want in a very direct way. And what the people want is not likely to be always and everywhere particularly progressive (although it will be rather canny; Hayek was right when he pointed out that average citizens know more as a collectivity than their ‘betters’ on all sides of politics give them credit for).

  29. Born Under Punches

    The correlation between social status and health is interesting (if unsurprising). However, as a correlation it in no way provides empirical support for a radical democratic model. It would be interesting if improving people’s social standing improved their health, but all we can do with these data is speculate.

    Correlation, causation, et cetera. Come on, people.

  30. James Rice

    It’s this kind of important research that puts paid to notions that “the concept of class is completely meaningless in modern Australia” (as discussed here). In modern Australia, class shapes who dies and who lives.

    I wrote a little about this topic (and listed a few short references) in a comment on Club Troppo in January.

  31. Angharad

    What’s interesting about this study is that the Whitehall Study is explicitly about health in the civil service. As the authors say themselves, this selects out the very disadvantaged and the very wealthy, presumably becuase they don’t work in the civil service. The headline results aren’t that surprising.

    What is a bit surprising is where this comments thread seems to have ended up, with this study being used as evidence of the failure of markets, problems with neo-liberalism and calls for a new democracy.

    Quite funny to see it is about the good old English civil service!

  32. Jacques Chester

    I apologise for derailing the thread with a smartarse remark.

  33. Paulus

    The most obvious such consequence is that the study lends empirical support and an additional line of argument for the radical democratic critique of hierarchical and inegalitarian social structures of all kinds …

    But the basic problem is: the more ‘inegalitarian’ you want to make society, the more power you will have to concentrate to do so. The two objectives run at cross-purposes.

    Think about how the USSR got to be the way it was. It wasn’t just an accident of history.

    The Czarist elites weren’t about to give up wealth and power just because they were asked nicely. To defeat the ‘Whites’ on the battlefield, the ‘Reds’ had to turn to effective military and political leaders like Trotsky and Stalin. But these were not the sort of guys to readily relinquish power when the war was over.

    OK, Australia will never see conflict in that form (I sincerely hope). But if, say, you wanted a sharp increase in the tax take to fund social equality, how would you go about getting that money in the face of increased tax avoidance and evasion?

    Answer: you’d beef up the ATO and other agencies, give them stronger powers of surveillance and coercion, encourage people to ‘dob in’ tax cheats, etc etc. So the heirarchical, bureaucratic state would be expanded, not weakened.

  34. Paulus

    Sorry, my first para should read:

    “But the basic problem is: the more ‘egalitarian’ you want to make society, the more power you will have to concentrate to do so. The two objectives run at cross-purposes.”

  35. Down and Out of Sài Gòn

    But the basic problem is: the more ‘egalitarian’ you want to make society, the more power you will have to concentrate to do so. The two objectives run at cross-purposes.

    Paulus – bit of a tangent, but the USSR was never an egalitarian society, all propaganda to the contrary. I don’t even they saw equality as an objective, but as a nice side effect of all economic power falling into the hands of the nomenklaturaworkers. This is definitely not at cross-purposes with “the more power you will have to concentrate to do so”. :-)

  36. Down and Out of Sài Gòn

    I also don’t see “equality” as a objective, but for different reasons from the Soviet Union. I think poverty alleviation is more important, as so many social problems are linked to poverty. However, alleviating poverty may result in less inequality, which I appreciate.

  37. Paulus

    It’s this kind of important research that puts paid to notions that “the concept of class is completely meaningless in modern Australia” …

    James Rice, I was the author of that quote, and nothing in this research makes me change my mind about it.

    This study was carried out within the UK civil service. I don’t know how much impact class has on that these days, but here in Australia, the public service is hierarchical, but ‘classless’. Which suburb your parents live in, or which school you went to, or what accent you have — all have no effect on promotion and power within government.

    I’m not claiming the APS is a perfect meritocracy; cliques and internal politics are very powerful. But the APS is an institution in which traditional class signifiers — whatever they might be — have little to no effect.

    In other words, class is not the same as hierarchy. And the existence of one is not proof of the existence of the other.

  38. Paulus

    DOSG (is that an acceptable acronym?) :)

    I fully agree with you about poverty alleviation. That’s one of the fundamental ideological divides within the left, as I see it: between those who just want to lift up the poor as much as possible, and those who have a much more radical agenda about imposing equality throughout society.

    I’ve got no issue at all with fighting poverty, but I do have an issue with those who, say, propose executive pay caps, just because they don’t like the idea of some people earning more than others.

    BTW and OT: are you actually living in or from Saigon/HCMC? I simply ask because I will be travelling there in a couple of months and could use some tips!

  39. hannah's dad

    “….but here in Australia, the public service is hierarchical, but ‘classless’. Which suburb your parents live in, or which school you went to, or what accent you have — all have no effect on promotion and power within government”
    Really?
    The day before a friend of mine was officially promoted to a senior management position of a government dept. a prominent public figure invited said friend to a dinner the following evening with some of the ‘right people’ [quote] from the Adelaide Club with whom she ‘should’[quote] be “associating’ [quote] in the future.
    We had a quiet chuckle.

  40. Liam

    Really?

    Really. In my experience (as an outsider to them) Australia’s public services are remarkably internally meritocratic. The possible exception being the very highest ranks of senior bureaucrats on contracts who’re more or less outside the public service rankings anyway.
    The real class selection happens before one’s taken onto the APS payroll; class in Australia is much more marked by how eagerly one’s high school encouraged you to a) apply for university entrance, b) achieve high marks in the final exams, and c) continue on to Year 12 at all.
    Talk to any middle-class parent of children in the final years of primary school about where their kids will go in year 7, and you’ll have a chance to hear about the gradations of Australian class in detail that’d make a nineteenth-century social observer reach for the port.

  41. Down and Out of Sài Gòn

    I’m fine with DOSG or DaOoSN.

    BTW and OT: are you actually living in or from Saigon/HCMC? I simply ask because I will be travelling there in a couple of months and could use some tips!

    I lived in Sài Gòn from 2003 to the first few days of 2007. I’m now back in Brisbane. However, I am up for delivering tips over coffee or a beer. I can give you one now: watch out for motorcycle thieves. One of my ex-bosses lost his bag and passport due to the bastards. My wife had a mobile stolen out of her hand.

    Note: the country’s having a bad patch – costs in foodstuff have risen due to the price of petrol, and exports have dropped off due to the GFC. But it’s still fairly safe. For most of my American co-workers, it was safer than home.

  42. Armagny

    “….but here in Australia, the public service is hierarchical, but ‘classless’. Which suburb your parents live in, or which school you went to, or what accent you have — all have no effect on promotion and power within government”

    “In my experience (as an outsider to them) Australia’s public services are remarkably internally meritocratic. ”

    With respect, being INTERNAL to them across several contracts spanning state and feds, this is not the case.

    ‘Old school’ bias is there, especially regarding universities or Collins Street firms. However I think the worst problems breed internally and indeed this may cast some doubt on the idea that capitalism is the only source of painful hierarchies.

    First off, the most crushing hierarchy is in internal structuring, not the way people are employed based on an external hierarchy. That is, public service is generally extremely hierarchical in character. More so in my experience than many private companies. Sure you might be sacked quicker there if you don’t deliver, but I have spoken to people such as marketing managers in a robust and assertive manner that simply wouldn’t be allowed in the Pubes. Basically, most of the time, if someone is one step removed from your line of responsibility or immediate consultation, you cannot deal with them direct, full stop.

    Secondly, there seems to usually be a culture or circle that affects promotion, remarkably so, within most agencies. For example in a major branch of a Victorian Department a few years back, almost everyone in a senior position was (a) a woman who (b) knew the Executive Director in a personal way outside the office. In my previous role on the other hand, with a Federal agency, almost everyone senior had ties to a ‘top tier’ law firm, something that was born out in their ‘issues’ with government ethics and finer principles of ultra vires.

    I would not say it was more meritocratic than a typical law firm for example, once you are into and embedded in the hierarchy. There is no public service equivalent to being able to front the partners behind close doors, point to your billings, and state precisely what you are worth and expect something close to this in return.

  43. Armagny

    Geez I killed it, sorry! Liam I do like this apt capturing:

    “Talk to any middle-class parent of children in the final years of primary school about where their kids will go in year 7, and you’ll have a chance to hear about the gradations of Australian class in detail that’d make a nineteenth-century social observer reach for the port.”

  44. Ambigulous

    Yes, Liam and Armagny

    Parents at that stage proclaim their most fundamental views on social class, the value of education, the value of (their kids) mixing with the right folk, etc.

    It’s assumed by the middle class parent that if the child works reasonably hard, a professional career via Uni is open. If the child doesn’t work hard, the parents may still buy private tutoring.

    If professional jobs are well-paid and secure, the private school fees seen as a step towards securing same for one’s kid, may be a sound investment.

    How are class stereotypes and belief systems maintained from one generation to the next? Many decades ago, I recall the shock when a very bright kid (of a plumber) was pulled out of high school to follow his Dad’s trade. Happy he may have been, but the trades/professions decision was made by his parents. Mid-60s this was.

  45. roger

    But Ambigulous (and others) this is not about class it is about control. As a blue collar worker you can still have control if you do it as a small business person. Obviously the study doesn’t look into the stress of small businesses but if its main point holds- the control that someone has over decisions that affect their lives- then whether they are a professional/ tradie doesn’t matter. And in the abocve example the person may have been happy and healthy and not cared two hoots for sitting in an office. Many tradies earn good money and employ others, so we can see that the heirarchy repeats regardless of the sector.

    The issue around class and professionalism (and not control per se) and the desire to become part of them is that these are the sectors that traditionally call the shots- the system benefits these people the most (usually). This is why they are attractive for those concerned with being upwardly mobile- which is not about control (or health) but status (a different issue from that raised in the study).

  46. James Rice

    This study was carried out within the UK civil service. I don’t know how much impact class has on that these days, but here in Australia, the public service is hierarchical, but ‘classless’. Which suburb your parents live in, or which school you went to, or what accent you have – all have no effect on promotion and power within government.

    I’m not claiming the APS is a perfect meritocracy; cliques and internal politics are very powerful. But the APS is an institution in which traditional class signifiers – whatever they might be – have little to no effect.

    In other words, class is not the same as hierarchy. And the existence of one is not proof of the existence of the other.

    True, class is not the same as hierarchy. Nevertheless, the Australian public service is rife with class differences. There is a serious class difference between a worker with little skill and authority in the public service (for example, a receptionist) and a worker with a great deal of skill and authority (for example, a senior manager).

    There is also a distinction between one’s own class (as in one’s class location within the economic organisation of society) and the extent to which one’s own class is influenced by one’s parents’ class (in other words, the extent of intergenerational class mobility). I suppose I’m focusing on class as a location within the organisation of society, while Paulus tends to focus on intergenerational class mobility. In my defence, the Whitehall II Study mentioned in the original post also focuses on people’s own class, rather than on how they got into that class.

    Maybe this isn’t the done thing, but I’m just going to copy the comment I made on Club Troppo in January, which I mentioned earlier. Sorry if it doesn’t fit neatly with the discussion here, but it does at least present some findings on these issues from outside the British civil service, as well as alluding to some alternative explanations for the social gradient in health. I’m still unsure how anyone can believe that the concept of class is completely meaningless in a country where plant and machine operators die from ischaemic heart disease at about twice the rate that professionals do.

    It’s certainly true that sitting at a desk for long periods isn’t great for your health, although it’s also true that many physically demanding jobs involve little of the aerobic, cardiovascular exercise which is most beneficial to health. Actually, there is a well-known social gradient in health, disease, and death. For example, here are some standardised mortality ratios for ischaemic heart disease derived from a study of men aged 25-64 years in New South Wales between 1984 and 1988 (average rate = 100).

    Professionals: 66
    Managers and administrators: 79
    Para-professionals: 92
    Clerks: 94
    Salespersons and personal service workers: 97
    Tradespersons: 113
    Labourers and related workers: 118
    Plant and machine operators: 125

    In other words, this study suggests that plant and machine operators die from ischaemic heart disease at about twice the rate that professionals do.

    Some of these differences are explained by differences in lifestyle (for example, diet and smoking). Nevertheless, the social gradient in health seems to persist even after a variety of lifestyle-related factors have been controlled for. Here are some relative risks of death from coronary heart disease – derived from a study of British civil servants – after a range of lifestyle-related factors such as smoking, systolic blood pressure, plasma cholesterol concentration, and blood sugar, as well as age and height, have been controlled for (administrators = 1.0).

    Administrators: 1.0
    Professional/Executive: 1.5
    Clerical: 1.7
    Other (mainly unskilled manual workers): 2.1

    In other words, the social gradient in death from coronary heart disease persists even after various lifestyle-related factors have been controlled for.

    A range of other explanations have been offered for this social gradient in health, in addition to the lifestyle explanation. These include explanations that focus on levels of control and levels of stress at work, access to supportive social relationships (which are protective of health), and exposure to adverse conditions during childhood.

    Another speculative explanation links the social gradient in health, disease, and death to factors like social status and prestige, which sociologists have been studying for a very long time. According to this explanation, human beings are extremely sensitive to their social environments and to their places within these environments. In particular, the experience of living as a person with a relatively low social status leads to comparatively high levels of prolonged stress. Conversely, the experience of living as a person with a relatively high social status leads to relatively low levels of prolonged stress. In short, it’s stressful to have a low social status. (Experiments have been conducted on non-human primates in which high and low status animals receive the same diet and live in the same compounds. Apparently these experiments have uncovered clear stress effects of social position.) Higher levels of prolonged stress, in turn, lead to higher rates of disease and death.

    (I know this is uncalled for, but here are some short pieces on these topics, just in case anyone’s interested.

    Gavin Turrell (1995) “Social Class And Health: A Summary Of The Overseas And Australian Evidence” pages 113-142 in Gillian M Lupton and Jake M Najman (eds) Sociology Of Health And Illness: Australian Readings, 2nd edn, Melbourne: Macmillan Publishers Australia.

    Richard G Wilkinson (2006) “Ourselves And Others – For Better Or Worse: Social Vulnerability And Inequality” pages 341-357 in Michael Marmot and Richard G Wilkinson (eds) Social Determinants Of Health, 2nd edn, Oxford: Oxford University Press.

    Richard Wilkinson and Michael Marmot (eds) (2003) Social Determinants Of Health: The Solid Facts, 2nd edn, Copenhagen: World Health Organization Regional Office For Europe.)

  47. Paulus

    James, we may well be talking about different things. (Which is a big problem with ‘class’: the concept is fuzzy and there are so many different definitions.)

    Sure, a manager is in a different occupational class from a receptionist. The word class used to be incorporated in the APS pay structure itself: you were called an Administrative Service Officer Class 1 or 5 or whatever.

    But my usage of class is something rather more than that: it’s something you’re born into, defines your position within society (not just at work), and which is difficult or impossible to change. And comes with widely-understood markers, like U and non-U.

    In the APS, people could and did move from the lowest ASO class to the top of the organisation over the course of a career. Michael Costello, the former head of DFAT, was one; there were many more.

    And this is just me being pedantic, but the Whitehall II Study mentioned in the original post does not focus on class, per se. It uses the less loaded term ‘employment grade’. I did a search for ‘class’ in the PDF referred to above; the word did not come up even once.

    Anyway, I’ll stop quibbling. If people in a lower ‘employment grade’ or ‘class’ or whatever you want to call it, do suffer health consequences as a result of lower social status, what can actually be done about it?

    Sure, you can encourage industrial democracy and participative decision-making etc etc, but when the crunch comes to it, someone’s still gonna be the organ-grinder and someone else the monkey. Can that be changed?

  48. Paulus

    Down and Out of Sài Gòn, thanks for that tip! I won’t go OT any more here, but I’ve been having an interesting time browsing through the archives on your blog, and some of the Vi?t Nam blogs you link to.

  49. Jarrah (formerly fatfingers)
  50. Adrien

    Skepticlawyer made an excellent observation at #28. No-one took it up.

    Someone is still having to make decisions about wealth distribution, someone is going to have to make decisions about allocation.

    But it happens privately and directly.

    Lots of people don’t like markets much, and that’s fine and dandy, but the alternatives — and it’s fair to say this — have always and everywhere been worse.

    The direct allocation of resources for the maintenance of public wealth is not primarily a market activity. There’s no dollar to be made in adequate public facilities (there’s no dollar to be made without ‘em either hence their existence). But I’d wager that direct management of these things not only makes people happier, it’s done a whole better and cheaper. Contrast with the states’ management of the ‘education revolution’ where control of the funds is not obtained by schools but by state departments who, according at least to Ross Fitzgerald recently, skim off the top and make a righteous schmozzle of the enterprise.

    Now there’s a mountain of research showing that people who have very considerable democratic control over their local community — via subsidiarity, citizen initiated referenda and democratic mechanisms to recall politicians or force legislation to the polls — are happier and live longer, healthier lives.

    And so it is with Semco. They haven’t purged the market from Semco btw, au contraire, it’s omniscient, it exists intra-corporate as well as extra-corporate. Result: a huge cut-down on mind-games and petty tyranny in the workplace.
    .
    Capitalism doesn’t suck because of markets, it suck because the markets biggest players often resemble the Soviet Union internally.

    They also do things like ban gay marriage, or abolish multiculturalism, or legalise drugs. Only one of these things, I suspect, would garner broad support from people on this blog.

    And that’s the rub innit? The Left wants to have its liberalism and eat it too. The diversity of culture in capitalist democracies is obviously apparent. And, contrary to the assertions of the Religious Right, it is the market which facilitates the blossoming of individuality and the indulgence of the romantic persona. A communitarian ethos will probably reflect the temper of the community and that will more often than not tend to social conservatism.
    .
    Hence the Statism.

  51. James Rice

    The newspaper article linked to by Jarrah at 49 is, I believe, based on a discussion paper by Christopher J Boyce and Andrew J Oswald. I haven’t really read this paper, so I probably shouldn’t comment. Nevertheless…

    From the newspaper article:

    Promotion produces 10 per cent more mental strain and leaves up to 20 per cent less time to visit the doctor in the event of illness.

    In the discussion paper (on page 12), the latter claim is phrased as follows:

    The only stark result on changes in health, in Table 5, is for Doctor Visits. This is the -0.33^ number on the change between T-1 and T+1. Hence, recently promoted managers go on to visit their doctor less often. The effect is large. As the mean of Visits is 1.7, this estimate implies approximately a 20% fall in visits to the doctor after promotion to manager. Moreover, there is some consistency in this evidence for an improvement from time T. For the other time periods, the drop can be seen, in the right hand corner of the middle panel of Table 5, to be smaller at around -0.2, which when compared to pre-promotion period T-1 corresponds to an approximately 10% decline in visits to the GP. This appears to be more encouraging for the claim that taking a promotion improves health (although a critic might potentially raise an alternative explanation, namely, that managers simply become short of time).

    In other words, the discussion paper suggests that a 20% fall in visits to the doctor after promotion appears to support the claim that gaining a promotion improves health. Why doesn’t this explanation appear in the newspaper article?

    From the newspaper article:

    Using data on about 1000 individual promotions from 1991 to 2005, they found no evidence of improved physical health after promotion.

    One thing to note is that Boyce and Oswald only attempt to measure the effects of promotion on health (as indicated by subjective ill-health, number of visits to the doctor, and mental strain) during the 3 or 4 years following the promotion. That seems like a very short time frame to me, especially when you consider that social status is hypothesised to affect health through ailments such as cardiovascular disease that can take decades to develop. Is it surprising that they find no convincing evidence of improved health after promotion, given the short time frame they consider? Boyce and Oswald themselves write (on pages 19-20) that:

    we can follow people for only a small number of years after they gain extra seniority…Perhaps status works its effects over decades rather than years.

  52. Nabakov

    The obvious problem with hierarchies is that the more rigid they are – therefore leading to more place-holding gatekeepers – the more the quality and quantity of decision-making information degrades as it moves upwards.

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