An assessment of yourself as rich and powerful may keep you healthy, according to UCSF study

By Maureen McInaney

Scientists have known for decades that poverty leads to higher rates of illness
and mortality.  More recent research led by UCSF faculty has shown that these
effects don’t end at the poverty line. In fact, health improves at each step of
the social ladder.

“It is not simply the effects of income or education that are linked to better
health, but also the perception that one is higher on the social hierarchy,”
said Nancy Adler, PhD,  UCSF professor of psychiatry and lead author of the
study which appears in the November issue of Health Psychology, a journal
published by the American Psychological Association (APA).

The researchers found that women who placed themselves higher on the social
ladder reported better physical health, took less time to fall asleep at night
and had lower resting heart rates and less abdominal fat (a key indicator that
these women adapt to stress better), said Adler. Perceptions of lower social
standing were also associated with negative psychological factors, including
greater chronic stress, pessimism and lower perceived control of life.

The researchers studied a sample of 157 healthy white women age 30-46. In
addition to reporting on their income and education, the women completed a new
survey that asked them to rate their own socioeconomic status (SES). They were
shown a drawing of a ladder with ten rungs and told to think of the ladder as
representing where people stand in society. At the top of the ladder are people
who are best off - those who have the most money, education, and best jobs. At
the bottom are people who are the worst off - who have the least money, least
education and worst jobs.  Participants were then asked to place an “X” on the
rung which best represented where they think they stood on the ladder.

The women, who had varying socio-economic backgrounds, were evaluated for
psychological indicators, including negative affectivity (how much they
generally tend to feel negative emotions), pessimism, perceived control over
life, coping style, self-defined stress levels, and chronic stress levels.
Participants were also evaluated for sleep patterns, resting physiological
response, and fat distribution. A sub-sample of 59 women took part in a
laboratory stress study that examined their cortisol response to stress over a
three day period.

Cortisol is a stress hormone that may play a role in the accumulation of
abdominal fat, explained Adler.  Abdominal fat deposit, in turn, is linked to
metabolic and cardiovascular disease. “With repeated experiences of the stress,
the body has greater exposure to cortisol. Abdominal fat has a relatively
greater sensitivity to cortisol than peripheral fat, so individuals with higher
cortisol reactivity, high resting levels of cortisol and /or great exposure to
events that evoke a stress response accumulate greater abdominal fat,” she
said. Researchers analyzed the accumulation of body fat by measuring body mass
index (BMI) and waist-to-hip ratios. They found that women who consistently
secreted cortisol when exposed to repeated stress had the lowest ladder

“Our findings suggest that perceived low SES is linked to greater stress. Low
subjective SES may either increase stress directly or make women more
vulnerable to the effects of stress,” said Adler. She explained that lower
ladder rankings are linked to increased stress even when researchers controlled
for a woman’s actual socioeconomic placement (determined by education,
occupation, income) and how much these women report experiencing negative

The research serves as a human analog to studies of social ordering and health
among animals, explained Adler.  Subordinate primates have higher cortisol,
higher blood pressure, and worse health than dominant animals in stable social
environments, according to previous research. “The ladder rankings may reflect
direct social comparisons of social rank that are more similar to dominance
hierarchies than are traditional measures of SES that include education,
occupation, income,” she said.

The fact that all participants were healthy, white women who had at least a
high school degree presents a limitation to the study, according to the
researchers. In a second and related paper, published in the same issue of
Health Psychology, researchers determined that subjective status may be a more
important determinant of self-rated health for women who have higher income
levels - in this case whites and Chinese Americans. For Latina and African
Americans, who had lower average incomes and education levels, household income
was the most important determinant of how these women rated their health.

Co-investigators on the first study included Elissa Epel, PhD, post-doctoral
fellow in the UCSF department of psychiatry; Grace Castellazzo, BSN, research
nurse at Yale University; and Jeannette Ickovics, PhD, associate professor of
epidemiology and public health at Yale University. The lead author on the
second study was Joan Ostrove, PhD, assistant professor of psychology at
Macalester College.  Co-investigators included Adler, Miriam Kuppermann, PhD,
MPH, UCSF assistant professor of obstetrics and gynecology; and A. Eugene
Washington, MD, UCSF professor and chair of obstetrics, gynecology and
reproductive sciences.

Both studies were funded in part by the John D. and Catherine T. MacArthur
Foundation Research Network on SES and Health. Other funding came from the
National Institute of Mental Health, the National Institute of Child Health and
Human Development, the Agency for Health Care Policy and Research, the National
Center for Human Genome Research, and the American Psychological Association
Division of Health Psychology.