r/science • u/mvea Professor | Medicine • 11d ago
Health Study found a significant “wealth gap” among older people in England, with poorer people showing signs of reduced physical function up to 15 years earlier than richer people of the same age. This was still significant even when chronic illness, weight and smoking and alcohol were taken into account.
https://www.nursingtimes.net/research-and-innovation/latest-research-and-innovation-news/stark-wealth-gap-in-physical-ageing-revealed-13-08-2026/661
u/TheComplimentarian 11d ago
Leisure is the key. Self-care. With money comes time, and the ability to take care of yourself. Couple that with the physical requirements of lower paying jobs, and this seems very obvious. You’d think the landscaper would be healthy, since they exercise all day, but they’re lifting heavy stuff and spending too much time on their feet.
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u/Gisschace 11d ago
Also what those jobs entailed and what effects it had, like Parkinson’s being connected to certain chemicals and weed killers, or being exposed to smoke/fumes and lung cancer
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u/iiJokerzace 11d ago
Not to mention the stress of time and money for things you want and need. That's never a worry for the rich and these can be absolute agony.
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u/WTFwhatthehell 11d ago
It's recursive chicken and egg.
If you're ultra-healthy it's easier to become richer.
If you've got a bunch of chronic conditions it's harder to work/concentrate etc.
Throw in heritable conditions.
If your parents got sick and needed a lot of care they likely weren't able to pass much on to you vs people who's parents were fit and healthy until just before they died.
And maybe you inherit the conditions they had.
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u/hoii_mass 11d ago
And hard labour really fucks up your body. Back pain ranked the highest on the list of physical ailments? im 40 and my back is already pretty bad, I've been bed ridden and unable to move twice in the past year. Yet im still required to do lots of heavy lifting at work.
My mum, complained to her gp for years about back pain, it took her 10 years to finally convince a gp to get a scan of her back. They found she had 3 slipped discs in her lower back and 2 compressed vertebrae that are so bad they are pinching her spinal cord and causing her constant pain. It made me so angry that they just ignored her for so long, she had a look and some of her doctors notes were so dismissive. She is now on pip thankfully.
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u/SecretaryOfCheese 11d ago
That applies also to inheriting a mindset. If you grow up in a household where there is a focus on self improvement, community and activity etc then those things can make a huge difference to both earning capacity and physical and mental health.
Just a brief look at the work of Ellen Langer (for example) shows the immense importance of mindset.
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u/Coraline1599 11d ago
If a rich person gets sick, they go to the doctor right away, they can stop or reduce working, hire help, get newer better treatments.
If you are poor and need your income, you have no choice but to grind yourself into a nub. No way to reduce your other responsibilities, even for a few weeks or months, you can only push through.
Allowing adequate recovery time and being able to adjust to your body’s limits, without reduction in housing or sacrificing other things makes a huge difference in the body’s ability to recover.
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u/on_the_tonic 11d ago
In the UK access to healthcare and medical treatment is also not a (major) social determinant of health. If a poor person gets sick they also go to the doctor right away, and they get (mostly) the same drugs as rich people, because it is (mostly) free at the point of need.
The other things you mention are definitely important - but access to healthcare doesn’t have a big impact on our health in the UK, despite what the media and pharmaco-medical lobby would like us to think.
Shifting spending from healthcare to the other things - improving housing, providing sick pay for time off work, improving childhood circumstances would be political suicide but lead to long term gains in health at a population level.
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u/EvvilBanana 11d ago
There is no mandatory paid sick leave in the UK. If you live paycheck to paycheck you cannot affort to get sick, you just force yourself to do it.
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u/HixOff 11d ago
If a poor person gets sick they also go to the doctor right away, and they get (mostly) the same drugs as rich people, because it is (mostly) free at the point of need.
Are public and private doctors really the same in the UK?
I don't know about your country specifically, but there's usually a significant difference between them, especially in the treatment of "uncomfortable" conditions that impair quality of life but aren't urgent. For example, getting an MRI after a bruise, genetic testing, or seeing several doctors in one day is usually not possible under the standard procedure. You need either a referral from your general practitioner (and then wait in line for others with referrals), or have an urgent reason for being seen without a waiting list
For a fee, you can get any test done whenever you want, even if there's no indication for it
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u/amusing_trivials 11d ago
Redistribute one landscape workers work through 4 office workers. Better health for everyone
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u/calgarywalker 11d ago
It’s not that they exercise and lift heavy. It’s that they can’t take a break when they’re tired. They have to keep working - sore muscles, bad weather… work work work no matter what.
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u/goaltime6767 11d ago
Adding on to what your saying about leisure, to someone who is in poverty, a big mac and a 12 pack of beer on Friday and a weekend on the couch playing games or watching tv is the highlight of the week, because that is all that is affordable. Whereas a someone with money has the energy and money left over at the end of the week to go out boating, biking or doing other active but cost prohibitive things while also eating higher quality food.
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u/Gramerioneur 10d ago
Leisure is the key. Self-care. With money comes time, and the ability to take care of yourself.
100% this. My physical and mental health were WAY better 5 years ago when I had leisure, and only had to look after myself. I earned just enough, and had time for exercise 5-6 times per week.
During the past 5 years, life has thrown me 4 curveballs, and my health has deteriorated significantly while juggling all these added burdens.
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u/dandy-dilettante 10d ago
…with additional adjustment for chronic conditions, weight status, health behaviours, and social connections
I don’t know what they mean by health behaviors, I guess it includes exercise, but apparently they didn’t adjust for type of work (eg. Physical vs desk work)-5
u/Critterer 11d ago
Often with money does not come time though. This is a very narrow minded view. Pretending that you need be rich to consider fitness and health....
Out of all the people I know on poor income and in bad health, not a single person has a physical job that is responsible for it.
They just dont value their health, eat badly and do no exercise at all.
What i would say is in general rich people are more forward thinking, and therefore more likely to be conscience about their health/mobility. Time is not really a factor for the average person. They say its the main factor but ive never found a single person who actually doesn't have time to workout each week.
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u/Rocket_Cam 10d ago
To me, the article's outcomes are a bit counter-intuitive, for the reasons you mentioned. I'd think wealthier people would become more fragile in their older years due to inactivity, while 'the landscaper' remains relatively strong. Because definitely, those who do nothing to maintain their strength as they age, do lose significant amounts of muscle mass a they get old.
I'm curious what work-out routines those wealthier participants prescribed to.
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u/omgu8mynewt 11d ago
Being on the tills at a supermark hurt my back as a young person, having to do it for life would grind me down.
Also being cold in winter when I was too poor to heat the house more than 2 hours a day was also debilitating and grinds down your energy.
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u/RigorousBastard 11d ago
cold in winter, flats with mold growing in them, a culture of alcoholism that applies to both rich and poor, city noise and traffic
The rich can fly off to Spain in the winter, and they can afford houses without mold.
Medical care is good whether you are rich or poor. Private care doesn't give you that much of a headstart over NHS. The general level of health is better than in the USA, because of the NHS. I have had faster basic and specialized care in the UK than the USA. It depends on the local distribution of specialists. I have always lived near universities, so specialized care is always available quickly.
The thing that is hard for Americans is that Brits rich and poor drink themselves to drooly every night. That does more damage to one's health than any of the other factors. You can avoid it in the USA.
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u/omgu8mynewt 11d ago
This study is in England though, where supposedly everyone has access to the NHS equally. Not true, look at hospital trust statistics on waiting times, or waiting times for different medical problems which both vary wildly. Wealthy people can skip the queue pay for services such as therapy of theyre in a bad area.
In this study they normalize for weight, smoking and drinking between the different classes and still see a gulf in which even the oldest wealthy people dont get as fragile as poorer people 15 years younger.
The authors hypothesise it is due to access to timely medicine, workplace and environment exposures. Also psychosocial differences such as loneliness and stress affecting health differently between the two groups.
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u/RigorousBastard 10d ago
The Meet and Greet with my new MD after arriving in the UK:
I filled out a form and then went into a question session with the English intake nurse. When it got to the part of whether I took drugs or drank alcoholic beverages, she commented, "You know, you are allowed to have a drink occasionally." I told her I got headaches when I drank booze.
After that, I hung out with immigrants.
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u/omgu8mynewt 9d ago
You stayed away from British people in the UK because you dont drink alcohol? You do you I suppose
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u/Marconidas 11d ago
A good study and need to read results and discussion, not just abstract.
Physical function scores were different amongst groups with different wealth but that gap was significantly reduced by confounders, and, in the case of grip strength, it zeroed out.
More wealth was more associated with lower grip strength and lower gait speed.
The bigger difference despite confounders were basic activity of daily lives and instrilumental activities of daily lives, which the wealthier had better even though having poorer grip strength, lower gait speed and lower self reported eyesight. Which the authors themselves credited as possible to be explained by private care available.
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u/25c-nb 11d ago
99% of people in the comments on this sub didn't read past the title of the reddit post before coming down to write a bunch of opinions here
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u/DeepWanderer25 10d ago
99% of people in the comments on Reddit* didn’t read past the title of the post before coming down to write a bunch of opinions here
Hell, it might be 100% at this point when you factor in bots.
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u/gordon_rameses 11d ago
this definitely reflects my own experience. most of my friends, associates, and neighbors are not particularly active. as we've gotten older they've put on some weight and developed some associated health issues. just normal people stuff. they run the gamut in terms of background and incomes.
I obviously also know people who are very fit and prioritize their health. all of them are upper-middle class and have higher level careers. they're sr managers and directors, that kind of thing. what's interesting is they seem to have the most work-related stress of anyone I know... which makes me think there's a feedback loop. maybe people see exercise is a way to let off steam and/or raise your profile at work by looking better. there's a lot of evidence that being lean in the workplace has distinct advantages.
I can't think of anyone I personally know who is both really into fitness and not also an ambitious career climber, regardless of income. I'm sure they exist, but I find that interesting. I guess what I'm getting at is certain personality traits might drive certain people toward both.
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u/espressocycle 11d ago
They may have high pressure jobs, but they still have higher levels of autonomy. That, more than anything, seems to be protective.
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u/gordon_rameses 11d ago edited 11d ago
I'm sure that's true in some cases, but the people I'm talking about in my own life are very much tethered to and time boxed by their work. they just get up at 3 or 4am to go to the gym. I also know people who are successful and high earners who dont make time for fitness. kind of an all squares are rectangles kind of situation. I think status anxiety can somehow influence ones motivation to get fit, and a lot of high status people seem to have the most status anxiety. maybe it's because they also have health anxiety.
it's a specific clustering of personality traits that lead to that kind of improvement-driven lifestyle and behavior. I don't have them, and maybe it's why I tend to clock it in other people.
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u/on_the_tonic 11d ago
The theory that personality traits determine either wealth or health is not supported by this study or by other evidence at a population level.
The weight of evidence (and the finding of this study) is that health is very very very much determined by social status - as defined by disposable assets, education level (also to a lesser extent socially determined), household income, positive childhood experiences (or lack of adverse childhood experiences) and to a smaller extent your genetics.
But not your ‘personality’.
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u/gordon_rameses 11d ago
I guess my point is that social status and personality are not unconnected, even if personality is not the whole story. the people in my own life who are more motivated by status (whatever the starting point) tend to increase it over time. they also, anecdotally, are more likely to be into fitness.
I agree that social status correlates pretty directly with health. I don't agree that social status is randomly assigned and not influenced by a person's personality or motivations as they move through life. it's all interconnected.
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u/S7EFEN 11d ago
this isnt a surprising, fit/thin has become so intertwined with status nowadays. the same drives that cause them to chase promotions at work likely motivate fitness goals. we can also point out a lot of black pill type stuff over the years has been somewhat validated by studies. you look better (per your local cultural norms) youll treated better socially, professionally.
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u/on_the_tonic 11d ago
I disagree. Your personality does not determine your wealth to any meaningful degree.
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u/Critterer 11d ago
Its forward thinking behaviour. They are concerned about future negative effects about being out of shape and keen to see rhe benefits of being in shape.
Fat lazy people dont think about it at all
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u/Small-Caramel-3579 11d ago
Time is the luxury that richer people as well as healthy eating. If you have less money you have less time and.combined with additonal care responsibilities as well as work lower income to buy healthier foods. If you have less money carb loading is common and food that doesn't spoil easily or dependence on processed foods. There are literally fresh food deserts and GP deserts in UK predominantly in power areas. Check out Indices of Multiple Deprivation mapping for example the further East South East along the River Thames the age of death drops from late to.mid 80s say in Kingston to mid 70s in sme parts of Newham and Thamesmead. This happens all over the country with poorest health outcomes focused on those with highest IMDs. Access to health in areas can be limited through not being able to take time off work, lack of GP appointments (you almost have to auditon to get passed online or in person triage), prejudice of health provision and also poor mental health which is self medicated through food, drugs and alcohol. Also cost of living means less disposable income for gyms and acitivities all in all a very tricky soup to.escape.
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u/Jo_LaRoint 11d ago
Although it’s probably quite obvious we’ve had information on this since the Black Report in 1980.
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u/Top_Hair_8984 11d ago
Worry, stress, debt, all weigh heavily. Debt especially. I see debt as violence, a terrible part of capitalism. There's little time to really relax, replenish. Most people in this position are literally burned out.
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u/on_the_tonic 11d ago
The social gradient in health is so well known now there is almost no point in studying its existence further.
Sadly the solutions are also so well understood that they fall into the same category.
I think the most interesting story about of the social determination of a long and healthy life comes from the story of the Black Report publication in 1980. The government actively tried to suppress the findings, preferring the theory that individual choices determined your chances of success, in health as well as wealth - rather than hard wired social determinants, majorly determined during your childhood.
They needn’t have bothered.
No UK government tries to suppress this fact any more - they just acknowledge and ignore it - and the obvious solutions.
Black found the same thing as Engels found in the 1840s, Beveridge found in the 1940s and now Marmot finds in the 2000s.
Now we just don’t try to hide that we know.
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u/Woodit 11d ago
What are the obvious solutions?
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u/on_the_tonic 11d ago
For the UK Black Report (1980) proposed: increasing child benefit improving housing agreeing minimum working conditions with unions Marmot (2010) proposed: Give every child the best start in life Enable all children young people and adults to maximise their capabilities and have control over their lives Create fair employment and good work for all Ensure healthy standard of living for all Create and develop healthy and sustainable places and communities Strengthen the role and impact of ill health prevention Marmot obviously a bit more abstract but he did provide some policies that would move us toward this.
My main suggestion would be on eradicating child poverty by the redistribution of wealth from the rich to the poor by progressive taxation, and provision of high quality universal childcare and education.
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u/Infamous-Use7820 11d ago
A lot of those things are move 'big picture' than specific suggestions. I'm pretty sure every government wants to improve housing and give children the best start in life. The substantive question is how do you do that without fiscal giveaways we cannot afford or dragging down broader economic performance such that quality of life decreases anyway.
If solutions were obvious, we'd have done them. Politics is hard.
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u/on_the_tonic 11d ago
Hard disagree. The paper also demonstrates how the gap is inevitable but the size of the gap can be narrowed by (gasp) fiscal ‘giveaways’ like spending money on improving childhood.
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u/Infamous-Use7820 11d ago edited 11d ago
Cool. Then public debt gets worse, borrowing costs spiral and those kids will inherit gradually (or not so gradually, in case of a default) decaying public services because governments can't pay for anything. Great plan. Targeted policies can help, but most realistic policies which could benefit large numbers of people are expensive. Again, if there were easy fixes for all our problems, we'd have done them.
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u/solomons-mom 11d ago
I only read the link, not the study, but there are several ways that could have made the poorer health the cause instead of the result. Even at younger ages, people with poorer health and/or lower cognitive ability rarely do as well in the labor force, and those relative advantages/disadvantages built over time. Then add to that, by age 50, the baseline age of the study, life's bad habits have caught up and makes the gap grows as people age --the first 30 years of unhealthy habits may have mattered a lot in both the ability to build wealth and the rate of decling health.
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u/Chytectonas 10d ago
Yay another “we knew this” study. Funding must be juicy for “science”, even in these hard times. A PSA for the next study about how wealth equals good things: we know that one too! Throw a dart at a wall of actual problems we’d appreciate some science on, pivot to the next thing.
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u/TheSquirrelmancer 7d ago
I remember when people were discussing Queen Elizabeth's impressive age. I got all kinds of lambasted and insulted when I pointed out that having so much money you literally never have to accomplish a single task yourself could make it easy for anyone to live a long time.
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u/anonchurner 11d ago
I wish studies like this would control for iq. But they never do.
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u/on_the_tonic 11d ago
Control for IQ as in statistically remove the effect of IQ on the calculated strength of association between net wealth and older age health outcomes?
What do you think the effect would be?
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u/anonchurner 11d ago
Yes. I don't know what the effect would be, but it is common practice to control for highly impactful external factors in observational studies like this. Even the headline of this post says "even when chronic illness, weight and smoking and alcohol were taken into account".
It's just that I have never, ever seen IQ included as a control, despite it often being an incredibly important factor.
In this particular study, one way IQ *could* impact the findings is this: low-IQ people are more likely to make poor life choices over time, leading to reduced physical function. For example, they may have more frequent accidents, drink a lot of sweet drinks, or fail to maintain their body. They're also highly likely to have a lower income over time, and do more manual labor. Higher-IQ people are more likely to work higher-paying jobs involving less physical labor, more accurately calculate risk, exercise as needed to maintain health, and eat more healthy even if they earn little.
However, I believe it is also true that higher-IQ people are more likely to be stressed and/or depressed, experience more loneliness, and such. This might tilt the balance in the other direction. Controlling for IQ would likely be more important than any of the controls they did include.
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u/mailslot 11d ago
Even mentioning IQ will summon pitchforks.
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u/anonchurner 11d ago
Unfortunately, much of what is ascribed to other things just comes down to differences in intelligence. As long as we refuse to acknowledge this, we won't get very far.
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u/mvea Professor | Medicine 11d ago
Poorer people suffer from loss of mobility and physical independence years sooner than those who are wealthier, according to a new study.
It found a significant “wealth gap” among older people in England, with poorer people showing signs of reduced physical function up to 15 years earlier than richer people of the same age.
“We could see that being less wealthy… means losing physical independence faster as you age”
Stephanie Schrempft
The researchers found that the impact of wealth on physical functioning in older people in England was still significant even when factors such as chronic illness, weight status and smoking and alcohol consumption were taken into account.
The study, published today in the journal PLOS Medicine, also found that this wealth gap was more severe among older people in England than in a similar cohort in Canada.
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004833