It is a myth that good, honest, ordinary, hard-working men and women win in life. From the classic It's a beautiful life to Jimmy Barnes’ Working class man the rhetoric is, honest, ordinary workers have lives that are “richer”. The rich may have the material wealth but it is the ordinary man or woman who has nuggety character, respect, love, family and the best of life. Stressed out executives have heart attacks at 40, mobile phones fry yuppies' brains and the bosses are too busy to see their kids and enjoy anything of life. If you believe these myths you may have to revise your thinking. If you equate good with honest, hard-working average men and women, then it seems the good die young.
People who have the largest amounts of money and power live better and longer than anybody else. They have a higher quality of life and they enjoy the power and privilege they have. So you say we already knew that, the rich obviously live longer than the poorest of the poor. Yes that's true, but did you know that your immediate boss is likely to live longer and have less disease than you do, that you are likely to live longer than the colleagues who are on a lower salary level than you are, and that you will likely live longer and have less likelihood of a heart attack than your secretary or your cleaner?
In the Autumn 2005 edition of Australian Prospect we explore the social gradient of ill health discovered by Sir Michael Marmot in over 20 years of comprehensive epidemiological research and importantly we start to ask what can be done about it?
Marmot defines the social hierarchy of health as follows: You are not poor. You are employed. Your children are well fed. You live in a decent house or apartment. You turn on the tap and drink the water in the secure knowledge that it is clean. The food you buy is not contaminated. Most people you come across in your daily round also meet this description. But among these people, none of whom are destitute or even poor, you acknowledge that some are higher than you in the social hierarchy - they have more money, bigger houses, a more prestigious job, more status in the eyes of others or simply a higher-class way of speaking. You also note that there are other people lower than you on these criteria, not just the very poor or the homeless but people whose standing is merely lower than yours to a varying extent. The remarkable finding is that among all of these people, the higher the status in the pecking order the healthier they are likely to be. In other words health follows a social gradient.
But is this social gradient of health everywhere? Marmot's view is that it is, and not one country or organisation in the world is immune to its effects. So there are many questions to ask about why this social gradient of health occurs. Our focus is pathological organisation - at every tier those above live longer and better than those below. It is difficult to replicate Marmot's empirical research to obtain qualitative findings about whether one workplace is more pathological than another, or whether one form of social organisation is more harmful than another. But certainly we must revise our thinking that there are bad companies, who for example neglect blatant health and safety laws, who should be the sole focus of the effort to improve the health in our community.
The truth is that based on Marmot's findings even the most benign organisation determines our pathology: the sum of diseases or morbid conditions that will affect our lives. Work and the organisation of life give a sense of psychosocial well being to some and not to others. Some work and occupations are challenging, involve a sense of achievement, well being and good health while others do not. Some communities seem to give a sense of achievement to everybody and others do not.
It is interesting to think about how the political and research world will respond to Marmot's important work. Some will investigate a biological determinism associated with evolution and the pecking order of nature and perhaps their conclusion will be that the social gradient of health is natural and inevitable. However the point is to change history not to follow it. Men and women can make their own destinies and certainly knowing that the shape and form of our corporate and social organisations will affect our health and longevity is a spur to a new kind of thinking about organisational reform and change. Can workplaces be improved to ensure greater productivity and better health for workers?
It is remarkable that the social gradient of health was anticipated by a great Australian, Fred Emery, who is probably better know outside his own country than inside it. It is Emery, a founder of socio-technical systems thinking, and the fields of participative workplace design and change that now seem so pertinent. Genius is often recognised some years after the main corpus of work has been completed and some years after the death of the author. So it is with Emery. It is remarkable that at the time he was writing his most interesting material and anticipating the social gradient of health, the first Whitehall studies, on which Marmot would base his ideas, were just starting.
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