Status Syndrome PSR（地位综合症PSR）.pdf

COMMENTARY Status Syndrome A Challenge to Medicine Michael G. Marmot, MBBS, MPH, PhD, FRCP, FFPHM man needs for autonomy and to be integrated into society will be met. Failure to meet these needs leads to metabolic HE POOR HAVE POOR HEALTH. AT FIRST BLUSH THAT and endocrine changes that in turn lead to increased risk of disease. is neither new nor surprising. Perhaps it should be Tmore surprising than it is. In rich countries, such The Social Gradient in Health Is Widespread as the United States, the nature of poverty has changed—people do not die from lack of clean water and Perhaps because of the British obsession with class, data by sanitary facilities or from famine—and yet, persistently, those socioeconomic position have been more readily available in at the bottom of the socioeconomic scale have worse health Britain than elsewhere. However, the social gradient in mor- than those above them in the hierarchy. Even more chal- tality is found across Europe.4 In the United States, in- lenging is that socioeconomic differences in health are not come, education, and occupation have all been shown to confined to poor health for those at the bottom and good predict mortality.5 Data on morbidity are less available, but health for everyone else. Rather, there is a social gradient a comparison of morbidity rates according to both income in health in individuals who are not poor: the higher the and education show the social gradient in health to be steeper social position, the better the health. I have labeled this “the in the United States than in England (James Banks, PhD, status syndrome.”1