Ward, Colin. Healthy Autonomy

AutonomyWARD, Colin (14/8/1924 – 11/2/2010)

I have a strong bias in favour of research findings so long as they support my ideological preconceptions. [1] This is why in October 1996 I keenly reported in this column a Channel 4 Equinox feature that told me how dominant baboons and top civil servants have fewer heart problems and live longer than subordinate baboons and bottom civil servants. [2].

An epidermiologist, Richard Wilkinson, from University College London, studying health files covering a long period found that "high rank carries with it the privilege of control, freedom from censure and powers of delegation, whereas the stress that features in the live of society’s subordinates siphons off energy vital to powering the body’s natural functions".

He then learned of Calfornian long-term studies of baboons and another study of monkeys which noted that the low-status monkeys that suffered most were lonely isolates. Those who, despite their inferior position in the pecking order, engaged to the full in social activities like mutual grooming, non-mating intercourse with the other sex and playing with infants, had far better life chances. I, of course, extrapolated to the concept of workers’ control by way of the findings of industrial psychologists about satisfaction depending on the ’span of autonomy’ and the finding that the self-employed, though poor and insecure but continually making decisions for themselves, are happier and live longer. Sadly, that television programme of 15th September 1996 brought little public discussion, but I hope that the resulting book will. It is The Social Determinants of Health by Michael Marmot and Richard Wilkinson, to be published in August at £26.50. Describing its findings in The Guardian for 6th July 1999, Jane Feinmann describes how their work on the health records of 17,000 civil servants was followed by a further study which "delved further and found that you don’t have to be hugely rich and important to enjoy optimum health, although it helps. It’s the power to control all aspects of your life - work particularly - that wealth and status tend to confer that is the key determinant of health. Men who have low job control face a 50% higher risk of new illness: heart attacks, stroke, diabetes or merely ordinary infections. Women are at slightly lower risk but low job control was still a factor in whether they fell ill or not."

Firmin ROCKER, "Sweeper"

This phenomenon has already been given a label: ’the biology of social inequality’, and Professor Wilkinson adds that, "as humans we are exquisitely sensitive to our position in the hierarchy, to put-downs, being excluded, or not being valued. Simply being at the bottom of the heap causes an acute state of anxiety - which explains why the adrenal glands of paupers are larger than those of the middle classes".

In the same article Jane Feinmann also reports that the Health Education Authority (HEA) is to launch a People at Work campaign at the end of this month. I don’t know who funds the HEA, but its new leaflet People at Work identifies lack of control over work as a major stressor. It also encourages people to stand up against bullying, form alliances with colleagues, join trade unions and get involved in schemes that promote staff participation.

However, these are not the trends observable in working environments today. Trade union membership has dropped by a huge proportion in the past twenty years, and worker participation is not a phrase you hear nowadays. Alliances with colleagues are not likely to be found in the casualisation of work that is seen in every aspect of life. Jane Feinmann also cites the view of Professor Pamela Gillies, HEA director of research, that "poverty doesn’t necessarily mean bad health".

In that television interview of 1996, Professor Wilkinson made the same point slightly differently. He said: "Wealth does not determine health. What does is the gap between the rich and the poor. The larger the gap, the sicker the society". Now we know how that gap grew wider all through the 1980s and is now on the rise again. The Joseph Rowntree Foundation’s report Monitoring Poverty and Social Exclusion: Labour’s Inheritance found at the end of last year that the number of people in Britain living on low incomes relative to the average is far higher than it was twenty years ago, with the number in households with below half average income rising from four millions in 1982 to eleven million in 1992. Although the number fell in the fell in the mid - l990s, 1996-97 showed a significant increase of over 9% to 10.5 million individuals. Just one of them is me, and I expect that another is you.

[1First published in Freedom, 24th July 1999

[2’Affairs of the Heart’, Freedom, 5th October 1996