Social status is intimately linked with health-related risk factors. In the current issue of Deutsches Ärzteblatt International, Thomas Lampert, of the Robert Koch Institute (RKI) in Berlin, inquires to what extent smoking, physical inactivity, and obesity are associated with social status (Dtsch Arztebl Int 2010; 107(1-2): 1-7).

The data for his investigation of social status-specific differences stemmed from the RKI’s Telephone Health Survey. In interviews conducted with a total of 8318 individuals over a period of 18 years the RKI recorded interviewees’ responses to questions regarding current smoking status, degree of physical activity, height, and weight. The subjects’ social status was determined from their statements on education, occupation, and net household income. The analyses were also intended to reveal any age- and sex-specific variations.

Evaluation of the data showed that men of low social status are more likely to be smokers, to be physically inactive, and to be obese. The same goes for women, with an even stronger link with obesity.

Given that the risk factors smoking, physical inactivity, and obesity are connected with many chronic diseases, Lampert sees considerable potential for prevention and cost reduction.

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Numerous German and international studies indicate that the risk of illness and early death varies with social status and is highest among the lowest status groups . The diseases and causes of death that are distributed unequally according to social status include coronary heart disease, stroke, diabetes mellitus,  chronic bronchitis,  liver cirrhosis,  and certain forms of cancer, e.g., lung cancer and bowel cancer. Many of these diseases are associated with risk factors that can be viewed in connection with the patient’s individual health behavior.  Great importance is therefore attached to status-specific differences in health behavior in explaining unequal rates of illness and death. 

For instance,  the World Health Organization (WHO) assumes that more than half of the social differences in early mortality among men in industrialized countries can be attributed to the higher rates of smoking in the low status groups. Other factors thought to be responsible for the increased risk of illness and death in segments of the population with low social status are the lower rates of participation in sports and physical activity in general and the higher frequency of overweight and especially obesity.

In Germany,  it was demonstrated empirically as early as the 1980s that persons of low social status smoke more commonly, have lower levels of physical and sporting activity, and are more often overweight or obese.  Among   other   investigations,  compelling findings emerged from the German Cardio vas cular Prevention     Study     (Deutsche     Herz-Kreislauf- Präventionsstudie, DHP) and the MONICA Augsburg Study,  both of which focused on cardiovascular diseases and risk factors.  In recent years the nationwide health surveys conducted by the Robert Koch Institute (RKI) have played a leading role in providing robust basic data for analysis of the connection between social status and health and health behavior.

Alongside the National Health Survey 1998,  the RKI’s 2003 Telephone Health Survey established interview of members of the population by telephone as an instrument of epidemiological research and health reporting in Germany.

This study uses the data of the 2003 Telephone Health Survey to investigate status-specific differences in the distribution of tobacco smoking, physical inactivity, and obesity among the adult German population.

The analyses are intended to establish how pronounced these differences are and whether there are age-  and sex-specific variations.

Methods: The 2003 Telephone Health Survey carried out by the Robert Koch Institute from September 2002 to May 2003 (n = 8318) provided the data for this study. The subjects’ current smoking status, physical inactivity, and obesity were assessed. Their social status was judged on the basis of the information they gave about their education and professional training, occupational position, and net household income.

Results: Men of low social status were found to be more likely to smoke (OR = 1.89, 95% CI = 1.53–2.34), to be physically inactive (OR = 2.30, 95% CI = 1.87–2.84), and to be obese (OR = 1.34, 95% CI = 1.02–1.77) than men of high social status. For women, social status had just as large an effect on smoking and physical inactivity as it did in men (OR = 1.63, 95% CI = 1.30–2.09; and OR = 1.91, 95% CI = 1.58–2.33, respectively), while its effect on obesity was even greater than in men (OR = 3.20, 95% CI = 2.46–4.18).

Conclusion: These results imply that persons of low social status should be an important target group for preventive and health-promoting measures, both in health policy and in medical practice.

Contact: T. Lampert
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Deutsches Aerzteblatt International

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Why poor people smoke and drink, and why smokers/drinkers are poor

I’ve been reading Rich Dad Poor Dad this week, it’s a book I’ve read before, back in 2004, so I’m re-reading it this week as I’ve been in need of some inspiration.

What I’ve taken from re-reading RDPD is that idea of reducing your liabilities and living costs, and always paying yourself first. I fully understood the idea of passive income, and the various ways of achieving passive income, however, I had fallen into the trap of thinking that I needed to earn more money to be able create spare cash that could be invested.

Another thing that has caught my attention whilst reading the book again, is that concept of people being pushed around by life, with the mark of a true winner being someone who will push back. It strikes me that a lot of people who have been pushed around, find it hard to push back, through lack of confidence or self-esteem issues, and invariably turn to things like alcohol and cigarettes to help them deal with the daily struggles.

And of course, if you go to the pub on a daily basis to have a few pints it will cost you - a lot of money. For example, I went to the pub the other night, had three pints and that came to almost a tenner. If I smoked, I would probably be getting through a pack of twenty a day, which is another £5 a day. So without being an alcoholic or a heavy smoker, you can easily spend £15 a day on unwinding and dealing with stress, which is £105 a week or £472.50 a month.

If you didn’t go to the pub every night, and smoke 20 a day, you could put that money into savings/investments.

It’s this lack of self discipline that can cause financial ruin. It’s no surprise that in RDPD, Robert Kiyosaki states that as a key differentiator between the rich and the poor, the self discipline to pay yourself first and pay your bills last, only spending the income that you’ve generated from your assets.

The more I think about this, the more profound it becomes. Everyone I’ve met who has been wealthy has been a very strong willed person, and everyone who I’ve met who is poor has been almost a polar opposite, always blaming someone/something else for why they have no money.

I can say with all honesty that I’ve been like that, when I was a student, I was always skint. That’s because I didn’t earn much money (I was studying after all), and I went out to the pub or the student union almost every night. And I smoked…

My advice to anyone struggling with their finances is to go cold turkey on cigarettes and alcohol. By not spending money everyday on cigarettes and alcohol, mentally you will feel like you are more in control of your finances. Do some excercise, and do it regularly. I read somewhere that to stay healthy, both physically and mentally, you should walk your dog every day, even if you don’t have a dog.

Lastly, be prepared to push back whenever life pushes you, if you don’t, you will be weakened by each successive knock-back, until you eventually give up.