The poor have poor health. At first blush that is neither new nor surprising. Perhaps it should be more surprising than it is. In rich countries, such as the United States, the nature of poverty has changed—people do not die from lack of clean water and sanitary facilities or from famine—and yet, persistently, those at the bottom of the socioeconomic scale have worse health than those above them in the hierarchy. Even more challenging is that socioeconomic differences in health are not confined to poor health for those at the bottom and good health for everyone else. Rather, there is a social gradient in health in individuals who are not poor: the higher the social position, the better the health. I have labeled this “the status syndrome.”1
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