Poverty makes you sick. There’s nothing surprising about that idea. If you can’t afford good food and good housing, if your teeth rot because you can’t afford a dentist, and if you work in a polluting factory, why wouldn’t you be sick?
But two recently reported studies take this much farther. One was carried out by Michael Marmot, head of the International Centre for Health and Society at University College in London; the other by Leonard Syme, Professor of Epidemiology at the University of California at Berkeley. Independently researching the effects of both poverty and inequality, they came to the same conclusion: that class is the major determinant of health. When they were interviewed on ABC Radio, I was compelled to listen.
The biggest health risk: exploitation. Over a period of 25 years, Marmot tracked the connection between job status and health in a group of British civil servants. He looked at the impact of the following factors on their health:
- Their position in the job hierarchy
- How much control they had over the work environment
- The degree of security in their jobs
- How much social support they enjoyed.
None of these people was poor. All had incomes which could comfortably provide the necessities of life. Nor was any of them rich. Yet Marmot found a direct correlation between their position in the hierarchy and their level of disease. The lower their status, the sicker they were.
Between a quarter and a third of the difference could be explained by the kinds of behaviours caused by unsatisfying lives. Like all the studies before it, Marmot’s showed that smoking, too much alcohol, poor eating and lack of exercise bring on disease.
But that left between 66% and 75% of the difference unexplained. Marmot found evidence that employees’ lack of control over the running of the workplace directly affects the brain via various hormones. The physiological and biochemical changes that happen over time increase the risk of disease. In other words, you can be a non-smoking, non-drinking vegetarian health fiend, and you will still be less healthy than your boss.
How much less healthy? In the British Civil Service, the difference in the health of the top versus the bottom is four-fold! The stark inequality of status and power, in fact, was the primary cause of preventable death. Professor Marmot estimates that each year 17,000 fewer people in Britain would die prematurely if everyone enjoyed the health of the people in his top two categories.
Professor Syme studied a group of workers who were already showing signs of ill health. These were the bus drivers of San Francisco, and Syme studied all 2,000 of them.
He found that poor health – such as hypertension and back problems – increased in direct ratio to how long they had been in the job. Literally, the job was making them very sick. These drivers were under intense pressure to meet impossible timetables and faced punishment when, inevitably, they failed to do so.
Professor Syme’s conclusion? The worse the exploitation, the greater the likelihood of a life-threatening disease.
To control our lives, we must control our own livelihood. As a working woman, I’m suspicious of media-promoted research. It’s either a vehicle for sexist, racist, homophobic and anti-worker disinformation or it’s so limited in focus that it can’t possibly rock any boats. We’re told we’re sick or that our family, friends and co-workers die because we’re irresponsible or reckless with our lifestyles. The more exploited and oppressed we are – for being women, people of colour, queers, young or older people – the message, backed by “research,” is always that we are the ones digging our graves.
Rather than pointing the finger at the victim, Marmot and Syme place responsibility squarely at the feet of the system. A capitalist society, by its nature, deprives working people of the power to make decisions, both in our work and in our lives. This must be so where production is done for profit. How can such a society permit industrial or political democracy? Capitalist society is not our society. It is also a system in terminal crisis. The speed at which a spooked and desperate ruling class has moved to strip workers of everything won through struggle has had an effect it did not foresee. Plunged into “third world” conditions, working people are everywhere recognising a common cause. We are all damaged and even killed by the exploitation of capitalism – all, that is, except those at the top.
The remedy: workers’ control. During the ABC interview, a woman called in. She said that the health of sex workers has improved over the last two decades. They’ve won some control over their working conditions, such as the mandatory use of condoms. That is, this picture of bad health is reversible, if we organise!
Marmot and Syme come right out and say it: the best remedial health strategy is workers having control in their workplaces. That means overturning management decisions to sack permanent full-time staff and replace them with super-exploited contract or casual labour. It means abolishing work practices which raise productivity levels to churn out more profit and which discriminate according to sex, race, age, sexuality and disability.
Once we control workplace practices, we’ll be in control of much more. To me, Marmot and Syme are really talking about the majority running society – its economy, workplaces, politics and cultural life. The best thing for our health is socialism.