July 4, 2012
It is decades since the famous Whitehall studies in Britain documented the relationship between mortality and social class. The study used British civil servants (thus Whitehall study) and the fact that in Great Britain there is coding at the time of death that puts its citizens into categories. Civil servants in different levels of the official hierarchy were coded and it was found that independent of smoking and traditional risk factors civil servants who were at the high end of the social spectrum lived significantly longer than those at every level below. Remember this is GB and everyone has access to medical care through their National Health Service, so access was not an issue.
The studies have been replicated countless times in many countries and repeatedly demonstrates a strong relative relationship between class and mortality independent of other risk factors for disease.
The monumental amount of work on the different databases both demonstrates and suggests that it is the stressors of life, the lack of control over your daily activities plus your neighborhood and what it provides and doesn’t in terms of schools, security, food quality, parks and recreation that makes the difference. So enters public health directly into the lives and longevity of citizens.
A new concept is developing of mapping neighborhoods ie Geo + Medicine to do a forensic evaluation of a city, a town or a neighborhood to assess the risks to its citizens. It allows for a methodology to be applied to “fix” the social determinants of health. Imagine a Rand McNally of health in your neighborhood?