The rankism that pervades society is a serious threat to public health in much the same way that smoking is. This analogy can even be extended to "secondhand rankism"--namely, that resulting from passing a rankist insult along to someone of lower rank, sometimes referred to as the "kick-the-dog" phenomenon. The depredations to which the working poor are exposed take an unremarked toll that, over a lifetime, shows up as significantly enhanced morbidity and reduced life expectancy. A cover story in the New York Times Magazine makes the case that the ongoing stress experienced by those of low socioeconomic status in inner cities is a silent, unperceived killer.
In an email communication, Dr. Jeffrey Ritterman, who is chief cardiologist at the Kaiser Permanente HMO in Richmond, California, acknowledged this. Noting that his hospital serves a population of low socioeconomic status and great ethnic diversity, he observed: "Many of our patients suffer from nobody status, which deeply affects their health outcomes." That rankism is also a factor in determining who is afforded health care becomes especially clear in the aftermath of crises like Hurricane Katrina, which exhausted resources in New Orleans and along the Gulf Coast in 2005.
In ancient times, an excruciating form of execution was known as "death by a thousand cuts." Its modern counterpart is "death by a thousand indignities."As evidence of the adverse effects of rankism on public health mounts, health care professionals are going to feel honor bound to educate the public about the social costs of malrecognition.
To deal with this public health menace we are going to have to purge rankism from all our social institutions in the same way that, led by a series of Surgeons General, we are curtailing public smoking.
Given the cumulative damage wrought by indignity, we should expect to see benefits to those who manage to shield themselves from it. A study by Dr. Donald Redelmeier of the University of Toronto suggests exactly that. He reports that Oscar winners live on average almost four years longer than other actors. For multiple Oscar winners, it's six years. Dr. Redelmeier argues that such success has a powerful influence on a person's health and longevity. He says, "Once you've got that statuette on your mantel, it's an uncontested sign of peer approval that nobody can take away from you. [Winning an Oscar] leaves you more resilient. Harsh reviews don't quite get under your skin. The normal stresses and strains of everyday life don't drag you down."
Dr. Nancy Adler, director of the Center for Health and Community and professor of medical psychology at the University of California at San Francisco, says:
Status is made up of many things--it's a matter of education, money, ethnicity, and gender. What we're learning is that in each of those areas, health is better the higher up you are.
The issue for stress is not how many demands you have, but your sense that they are manageable. A demand that you have the resources to deal with--that you have some control over--can actually be invigorating. It's the difference between a challenge and a threat. Control goes up at each step up the social ladder and that usually works to diminish stress.
Dr. Adler quotes Leonard Syme of the University of California's School of Public Health: "If you could only ask one question of a person, and you wanted to be able to predict what their state of health would be, it would be their social class." Syme showed that it wasn't just that those of the highest status had a longer life span and better overall health than those at the bottom, but that health improved with each rung up the social hierarchy. It is important to recognize that higher social class doesn't just mean better health care. It also often means less exposure to rankism, which in turn means less need for health care.
In this vein, Michael Marmot, a professor of epidemiology and public health at University College London and author of The Status Syndrome: How Social Standing Affects Our Health and Longevity, writes:
The higher your status in the social hierarchy the better your health and the longer you live....A way to understand the link between status and health is to think of three fundamental human needs: health, autonomy, and opportunity for full social participation....The lower the social status, the less autonomy and the less social participation.
Participation includes the positive feedback one receives from social recognition and being a valued member of society.
Dignity: A Centerpiece of Health Care
This brief survey of the effects of rankism on health and the health care system suggests that any system-wide fix will need to make dignity its centerpiece. To be successful today, a health care model must proffer respect for patients, who are rebelling against their traditional infantilization; it must preserve the dignity of doctors and nurses, most of whom have chosen the profession out of a desire to serve; and finally, it must respect the indispensable role of administrators, who have the thankless task of managing a scarce but desperately needed resource.
Quite obviously, no society can regard itself as dignitarian if access to quality health care is limited to those with enough money to afford it.
Equally obvious is that health care, like any resource, is limited in supply and must be rationed some way or other. Controlling access to it by the ability to pay might be justified when a resource is optional, but not when it is indispensable to life, liberty, and the pursuit of happiness.
(Note: You can view every article as one long page if you sign up as an Advocate Member, or higher).