A study of English civil servants has shown that those who earn the least are almost twice as likely to get type two diabetes than those who earn the most.
The ones who earn the least are also over one and a half times more likely to be obese and also one and a half times more likely to pursue an unhealthy lifestyle. This lifestyle includes a group of factors including smoking, drinking excessively, having a poor diet and being physically inactive.
The group comprised of over 7000 adults and equal numbers of men and women and measurements were repeated over an average of 14 years. The authors of the Whitehall II study, do not discuss what the reasons may be for the associations but I can think of a few possibilities.
Healthy food such as meat, fish, eggs, cheese, butter, olive oil, fruit and vegetables cost a lot more than unhealthy food such as sausages, sausage rolls, bread, pasta, pizza, chips, burgers, vegetable oil and margarine. As you will know from our book, the cornerstone to preventing weight gain and controlling diabetes is a low carbohydrate diet that is plentiful in protein, vegetables, some fruit and naturally saturated and mono-unsaturated fats.
I’m not sure if the studied civil servants all worked in central London or not. If they did, it would be logical for those who earned more to be able to afford housing nearer their place of work, thereby having to spend less time commuting.
Spending more time travelling to work each day certainly can eat into time that could otherwise be spend on planning meals, shopping and undertaking planned exercise. Being able to have flexible working hours can also help people spend less time commuting and undergo less stress while they do so.
As employees rise higher in the civil service the annual leave time allowed tends to rise as well as the pay. This could also affect the time that could be spent on exercise as well as enjoyable pursuits. As we know, many exercise options are free, but some are not, and with poor weather outside, exercise plans can slide. Being able to go to a gym, tennis club or golf course can provide a social outlet as well as an opportunity to exercise. Exercise helps improve mood and relief stress as well as being an opportunity to gain muscle and being able to eat more calories a day and get away with it.
What about smoking and drinking then? Why are these behaviours more common in those who are paid less?
It has been known for a long while that those with less money tend to smoke more. As for drink, the more affluent can certainly put away plenty of drink too, particularly the more affluent, executive middle class woman, compared to her shop assistant or factory working sister. Greater workplace stress and difficulty with the elusive work/life balance are thought to be factors for the higher earning woman.
What about mental health factors? It has been found that the lower choice someone has about their job role the higher their stress and the greater their chances are of becoming depressed. Perhaps the lower the job status the less autonomy civil servants have at work? From my work in the police force and the NHS I have seen the opposite scenario as well. I have seen very able people refuse promotion because of the necessity to do a lot of unscheduled extra work and take on responsibility that seems relatively poorly rewarded financially as people rise up the hierarchy.
Television watching also tends to increase the amount of sugary food and drink consumed across all age groups according to a study. Do the more affluent watch less telly? Perhaps having a dining table and using it for family meals can be a factor in reducing our waistlines?
The reasons for the socio-economic differences in the causation of type two diabetes are up for discussion. But also up for discussion is what can we do to lessen the chances of being affected?
Being aware that your job could be putting you are more risk of type two diabetes is a first step. How can you get more control over how you do your job? Can you get flexi-time so as to make home arrangements and commuting less stressful? Can you eat in a more healthful way? Can you make more time for exercise or incorporate physical activity into your working day? Are those self- soothing habits such as smoking, drinking and watching the telly stealing years from your life?
Sadly it looks like the workplace subsidised canteen and gym perks are becoming less likely rather than more likely. I would not be surprised to see these socio-economic differences between civil servants greatly amplified between people who are unemployed and those workers who are just scraping a living wage compared to more affluent workers. And where type two diabetes goes so does the increased rates of complications, cardiovascular disease and cancer.
Based on Contribution of modifiable risk factors to social inequalities in type 2 diabetes: prospective Whitehall II cohort study. Silvia Stringhini et all. BMJ Sept 12 and BMJ learning module: The effect of television watching on dietary intake.