But if access to care and lifestyle habits can't account for all the early deaths, what's going on? Researchers suspect constant stress is a culprit. Studies of some of our closer animal relatives, baboons, show that both low-ranking animals and those that are socially isolated have higher levels of stress hormones like cortisol. While humans are not baboons, Marmot suspects the same biological mechanisms are at work in the civil servants he studies; constant stress both on and off the job may be contributing to ill health.
Health disparities aren't likely to go away, but the gaps can be narrowed. At a policy level, that suggests a need for broad changes, Burgard says. It would involve getting the unemployed—who are most at risk of health declines—back in the workplace quickly, and, yes, making sure everyone has access to health insurance. That's particularly important for older workers, she says. Social programs can help, says Eunice Rodriguez, an associate professor at the Stanford School of Medicine who studies the impact of such programs on health. "The bottom line is to provide strong unemployment insurance in a way that people can have a feeling of security when looking for a job," she says. Welfare doesn't seem to provide the same protection, perhaps in part because of the stigma involved, Rodriguez adds.
What to do. Individuals can protect themselves by trying to find a job with a positive work environment and being smart about health insurance, says Amick, though he acknowledges that it's tough to do that in the current economy. But when and if you have some leeway in employment or a choice of managers, take your work conditions seriously—don't write them off as "just a job." If you're unemployed or not happy at work, try to stay on a good track with a healthy lifestyle—exercise is particularly helpful for relieving stress and maintaining general physical and mental health, says Burgard. And stress relief can help, too. (Here's some advice on how to manage your stress and even make it work for you.) On the flip side, don't think that because you do have a good job you're free to abuse your body; a study published this week found that affluence provides no protection from the ill effects of tobacco.
Beyond individual behavior, society needs to take as hard a look at helping people pursue nurturing, gainful employment as it has at new drugs and the latest diet trend, says Hadler. "It's important to be comfortable in your own skin," he says. "People need to feel valuable."
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