The fact that the lower the person perceives their social status, the greater the risk of developing various diseases and the higher the risk of death from various causes, is well documented in research conducted for many years in the West. It has been shown that this is a cause-and-effect relationship, not a simple correlation. However, so far there have been no similar studies carried out on data from Poland.

Dr. Ewa Jarosz from the Faculty of Economic Sciences of the University of Warsaw and with Professor Alexim Gugushvili from the University of Oslo analysed data from nearly 2,000 people who participated in the Polish Panel Study POLPAN. The scientists published their results in the journal Social Science & Medicine.

'Research on this issue is already well developed; in the West it has been conducted for over 20 years,’ Dr. Jarosz tells PAP - Science in Poland. 'The fact that social position affects health - both the incidence of various diseases and mortality from various causes - is very well documented in scientific literature. Unfortunately, in Poland there is still too little research at the intersection of sociology and public health. Our study therefore fits into a trend that has existed for decades, but we add a small element to this extensive pool of knowledge.’

He added: ’We wanted to see in more detail how the impact of social position on health relates to specific aspects of health measured with the Nottingham Health Profile.’ These aspects have not been analysed in this way before.

Nottingham Health Profile (NHP) is a questionnaire that has been used for over 30 years, designed to subjectively measure health problems and assess their impact on everyday functioning and quality of life. It includes physical, emotional and social components, specifically: emotional reactions, physical functions, sleep, social isolation, energy levels and pain.

Importantly, Dr. Jarosz says, the study participants were followed over a long period: for a minimum of 10 years, which is an advantage of using panel data such as POLPAN. NHP and subjective social position were measured several times during this period. 'Respondents indicated where they saw themselves on the social ladder: at the bottom, at the top, or maybe in the middle. The control variables were objective indicators of an individual's social position, such as education and household income,’ she says. The researchers also took into account variables such as professional status, age and gender.

The aim of the study was to determine the relationship between a change in perceived social position and subsequent health-related quality of life.

It turns out that such a relationship exists and is statistically significant. It is especially visible in emotional reactions, physical functions, sleep quality and the experience of social isolation. 'This means that Poles are no different from other societies in this respect. Virtually in all places where such research has been conducted, it has indicated that low social status has a negative impact on health. This is very universal. Those who are low on the social ladder have a higher risk of illness and premature death for various reasons,’ says Dr. Jarosz. 

The Polish study shows that changes in subjective social position precede changes in various aspects of health, but this is particularly visible in the case of a drop to the lowest rungs of the social ladder. If a person believes that their position in the social hierarchy has decreased, after some time they also declare a deterioration in the health-related quality of life. However, the reverse change does not have a similar effect; the fact that we feel our social position has improved does not improve our scores on the NHP scales.

'In this study, we saw it clearly: if in one wave of the study someone's social position deteriorated, in the next wave, i.e. five years later, we observed a deterioration of certain health indicators for this respondent,' says Dr. Jarosz.

According to the authors of the publication, the reasons for this phenomenon are complex. Material, behavioural, cultural and psychosocial factors matter. Some scientists suggest that the prolonged feeling of being dominated or subordinated experienced by people at lower levels of the social hierarchy increases stress and results in increased adrenaline release and higher resting heart rate and blood pressure, which consequently adversely affects the cardiovascular system and contributes to many health problems. Long-term stress, as has been repeatedly proven, is also associated with the risk of degenerative diseases, some cancers and other chronic diseases.

'It seems likely that the perceived social status decline is associated with a sense of loss of control over one's life, which may, in turn, negatively impact health,’ says Jarosz. 

In her opinion, the research is particularly significant in the context of post-communist societies, which have experienced serious political, economic and social upheavals. The data suggest that people living in those countries rate themselves lower on the scale of perceived social standing than those living in traditionally capitalist countries. The results of research based on POLPAN data indicate that the post-communist transformation in Poland was associated with a general decline in subjective social position: from an average of 5.4 in 1988 to 4.7 in 1998 (on a scale of 1 to 10).

PAP - Science in Poland, Katarzyna Czechowicz

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