An Instincts, Social Status And Chronic Disease


Social standing is a matter of life and death. Literally. For social primates like humans, the implications of how we look in the eyes of others, and our standing in the pecking order, is correlated to how long we live and our quality of life along the way. There are significant implications for leadership of organisations.


Life and death

Professor Robert Wilkinson has solved a puzzle. Wilkinson is professor of medical research at Surrey University and the University College London. Professor Wilkinson and his colleagues were bewildered that in developed countries differences in chronic disease and life expectancy could not be explained by a country’s wealth: there is no correlation between a country’s wealth (average income) and life expectancy. Likewise, there is no correlation to the level of expenditure on medical care. Nor could an explanation be found in the incidence of smoking.
Then, Eureka! The researchers discovered a startling correlation in the data. For developed countries, the incidence of chronic disease and life expectancy are strongly correlated to income relativity: countries with narrow income differences between the rich and the poor are healthier and their citizens live longer than countries with higher income inequity.

The correlation is almost linear (r = -0.86) between life expectancy and income inequity; the greater income disparity between the rich and poor in a society, the lower the life expectancy. For example, people are healthier and live longer in Greece than the US, even though the US is significantly richer. Japan and Sweden are the healthiest countries and are the most egalitarian in terms of income. The US, despite being the richest country and spending more per person on medical care than any other country, stands at 25th in the international rankings of life expectancy.
The correlation doesn’t stop at the country level. The researchers looked at comparisons between the 50 US states and found the same result. In states where income differences are relatively narrow, people live longer and suffer less chronic disease (high blood pressure, high cholesterol, cancer, diabetes, arthritis).
They then went a level of society lower and looked at cities. Even at this level there is the same clear correlation. In 282 USA cities, cities with narrower income differences have better health outcomes. For Australian readers, Australia is in the middle of the table for both income inequality and life expectancy. Melbourne is a healthier (and more egalitarian) city than Sydney.    
Trust, violence and social affiliation

The significance of income relativity between the rich and poor of a society goes beyond chronic disease and life expectancy.
Trust is strongly correlated to income differences. In more egalitarian societies people trust each other more (r = 0.7). In the US, in the most equal states (like North Dakota and Iowa) only 10 to 15 percent of people feel they cannot trust each other, while in the more unequal states (like Louisiana and Massachusetts) the proportion rises to 35 to 40%.
The same correlation exists between income inequity and the incidence of violence and homicide.
And finally, income equity is also correlated to social affiliation. In more equal societies, people are more likely to be involved in volunteer and community clubs.
(Source: Richard Wilkinson, The Impact of Inequality – How to Make Sick Societies Healthier, The New Press, USA, 2005).

The biology

Why does income equity have such a significant effect on social outcomes? The reason has to do with stress associated with our social standing.

Looking good in the eyes of others is a key dimension for the life of a social animal. Individuals high in the hierarchy experience less stress than individuals below them, and the degree of stress increases at each descending step of the hierarchy. People at the bottom of the hierarchy suffer most stress, and in the most unequal societies the stress is greater than in egalitarian societies.
Stress levels are caused by the fight/flight response. Wilkinson explains that on the one hand the flight or flight response serves us well. It readies the body for immediate muscular activity, which is okay where the fight or flight situation is over in minutes. On the other hand, the fight or flight response puts on hold longer term systems to do with tissue repair, immunity, digestion and reproduction. Where we sustain stress over months or years there are accumulative negative effects.
From office workers to monkeys

In a study of 10,000 office workers (the Whitehall study in London), controlling for age, death rates from heart disease were four times higher among the junior (lower-status) staff than among the most senior (higher-status) staff.

Changing a monkey’s social standing has significant effects on its health. In a fascinating study of captive monkeys, social status was manipulated by moving animals between troops. High ranking individuals were taken from different groups and put together in a compound so that some would become low ranking in their new group. Likewise, low ranking individuals were taken from different groups and put into the one compound so that some of those would become high ranking and some would remain low ranking. Diet was controlled. Any physiological change in the individuals could only be attributed to change in status.
Observed changes in the physiology associated with low status in the monkeys is the same as for humans. These included a more rapid hardening of the arteries, a worse ratio of high- to low-density blood fats and a tendency toward both central obesity and insulin resistance. The animals that moved down the social scale suffered a fivefold increase in cholesterol blockage during the twenty-one months in their new social group. (Wilkinson, page 73).

Social standing -- looking good

In societies with greater income differences, there are abundant and persistent symbols of being relatively poor and being diminished in the eyes of others. A Rolex doesn’t buy the owner more time or tell any different time to a Seiko, but the point is the image or social differentiation associated with the brand. If you are a labourer or carwash attendant in a country where income differences are narrow, then you are not relatively disadvantaged. But if you fill these roles in a country with wide income differences, your status is much more apparent, much more in your face, much more real and much more stressful. Displays of affluence and superiority by some become shame and inferiority for others.

Implications for organisations

Organisations are micro-societies. If the same health correlations hold for organisations then social equity has significant implications for organisational outcomes.

In this light, trends in the acceleration of executive compensation are sobering. In the period 1971-2008, CEO pay in Australia grew by around 470 percent, a growth rate nine times higher than real average earnings in the same period that grew by 54 percent. The growth in CEO salaries was unrelated to productivity growth: in the two decades from 1978, growth in real CEO pay was approximately six times the growth in productivity.

he American experience is similar. In 1982 American CEOs were paid 42 times average production workers. But by 2001 CEOs were paid 411 times average earnings. At the extreme, the highest paid Wall Street CEO in 2007 was paid $68 million for his year’s work!
We saw in the global health data that Sweden is one of the most egalitarian countries. In 2000-01 CEOs in the USA were paid 367 per cent higher than CEOs in Sweden, while McDonald’s workers’ base pay was 8 per cent lower in the USA than in Sweden. This difference in CEO salaries was not because the companies controlled by American CEOs are larger. In 2006, the 20 highest paid US CEOs received an average of three times the remuneration of the 20 highest paid European CEOs, yet the companies controlled by the US CEOs had sales 29 per cent less than those controlled by the European CEOs. (Source: David Peetz, Professor of Employment Relations, Griffith University, Australia, Submission to Productivity Commission Inquiry into Regulation of Director and Executive Remuneration in Australia sourced from the Internet).
Egalitarian leadership

When we spoke to business audiences last year, Dr Jane Goodall shared a finding from her fifty years studying the chimpanzee community at Gombe in Tanzania. Alpha males who led with an intimidating and bullying style tended to hold their position for only two years. Those who used their position to lead through a constructive, affiliative style reigned for around ten years. Perhaps chimps have ways to screen for leaders that are best for the health of the community.

If the same social correlations hold at an organisation level as for the health data, then how leaders use the power of their position has implications for levels of trust, for staff collegiality and for staff health and wellbeing.

Leaders who lead through an affiliative style will be known for:

  • Valuing the role of all staff irrespective of their function or their level
  • Giving people a greater degree of control over their work
  • Avoiding differentiation through benefits, conditions of employment and badges of office
  • Valuing social events and opportunities to interact with staff
  • Being friendly and approachable
  • Equitably distributing resources
  • Ensuring that people are valued in the eyes of others.

A prerequisite for a healthy and productive workforce may be narrow income and status distinctions between the top and bottom of the hierarchy.

A prerequisite for a healthy and productive workforce may be narrow income and status distinctions between the top and bottom of the hierarchy.

Andrew O'Keeffe
December 2009


Andrew O'Keeffe is a Human Resources Executive. He has observed bosses for many years, has worked for bosses and has been a boss. As a result of these studies he has written one of the very best leadership books ever, called 'The Boss'and recently released 'Hardwired Humans'.

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