Why are middle class older people so much more healthier than their poorer counterparts?

[Gorzf]

Sorry, if this is obvious to people but I can't help but notice all the well off people I meet in their 50s/ 60s / 70s, they're just healthy, their skin is glowing, they're fit and mobile.

I am a child of immigrants who came with nothing. We were quite poor growing up, the only kid in my friendship group on free school meals. Even as an adult I'm not particularly well off, just getting by. Growing up, most older people in my poor area / community just declined. It was almost a thing I thought was just normal, that's what happens.

It wasn't as I grew older and started meeting people from different socioeconomic status that I realised that wasn't the case.

It can't just be about having more money, surely. What is it that they're doing that the poor folk around me didn't do.

Better diet. Junk food is cheaper than good quality bread, variety of fresh fruit, veg and decent quality meat.
Better lifestyle. Less likely to smoke. Less stress as most household stress is money related, less domestic violence on average (yes, individual households may differ but I’m talking averages), more balance with exercise, less likely to do manual labour jobs that cause early aging on body.
Better health. Mainly in the preventative sense, but also more likely for things to be addressed early before compounding into bigger health problems as less dependant on waiting lists, referrals and so forth. Good dental care from early which also has a positive impact on the whole body.

Only on MN would you find the suggestion that the middle classes are all paying for personal trainers, therapists, private healthcare, and regular holidays. Most middle class people are struggling with the cost of living and can barely afford a basic gym membership let alone a personal trainer.

I’m Indian and I get you - back when I was a child even the poorest Indian family used to eat better than rich white people. We had no ultra processed food. Everything was ‘fresh’ and homemade. They also take their health extremely seriously and get all the proactive checks they can. But I do think what let my parents down was regular exercise above and beyond their physically demanding jobs - they never went out for walks. They never stretched. And so when their problems started they didn’t have the solid muscle tone required to recover.

There’s also this fad of eating dal, bhat, roti every evening and in massive portions. People in India traditionally never did that. They ate much, much smaller portions for lunch, no breakfast (unless a child), and lunch / dinner was a little meal while on the move. Rice and roti were traditionally never eaten together - my gran called the combination ‘wedding food’ and felt it too much for her. You’d eat one or the other.

In India itself those people who live longest (and healthiest) exercise above and beyond their daily lives & eat one main meal . It’s the one thing all the long lived have in common & something we probably need to go back to.

That's really interesting, thanks

A friend of mine, when I told her I was pregnant at 39, was horrified: "But you're going to be an OLD mum! OLD! I mean, look at me! You'll be trying to deal with a teenager while your health packs up!"

She is older than me and was in her early 50s at the time. She comes from a very poor background and from what she has said about her family members, it sounds like they were all in a bad state by her age, and she herself has a bunch of health problems. It's partly weight (she's not so badly off but tends to buy very cheap food and go for quantity over quality - I think it's a habit you acquire when you grow up poor, as a sort of survival mechanism). And it's partly the fact that she's often shied away from healthcare services, and the various health issues that she has had have not been dealt with and have been left to grow worse. Again, I think she probably had experience of very poor and patchy healthcare provision where she grew up, which was not in the UK. It's hard to shake these habits off.

That said, she has succeeded in losing some weight in the last couple of years and I finally managed to persuade her to start going for scheduled cancer screenings etc. So nothing is completely written in stone. Growing up poor does seem to make things harder though.

Early psychological stress may also have longterm negative effects on things like blood pressure.

Access to healthy food and when I say that I mean financially and that they don’t live in areas where it’s takeaway city and they struggle to find shops with fresh fruit and vegetables.

I think it's a bit naive to deny the fact that people in low income groups seem to be a lot more likely to choose unhealthy foods and drinks. I don't think this is about accusing people of being feckless etc. I just think that when your life is a bit shit, it's easy to use sweet and greasy food as a way of getting through the day. George Orwell said the same thing back in the 1930s or whenever it was.

Who on Earth decided that the middle classes are less likely to smoke and drink?! Most middle/ upper class women smoked in the 60s and 70s, as it was believed to keep them thin.
Access to easier work, exercise and better food and better healthcare are the more likely reasons.

You may be right about the smoking but you're not about drugs, the middle classes consume more drugs and alcohol than the working classes.

Who on Earth decided that the middle classes are less likely to smoke and drink?

All the evidence at a population level in this country finds an association between deprivation and smoking. I don’t doubt that there are some areas or professions where that isn’t necessarily the case (eg the trend for city workers to take coke or models smoking to be thin) but by and large the data suggests the trend holds true.

I'll go up a level. I usedto work in finance. From time to time at annual shindigs, senior partners would bring along their teens and kids in their 20s. I was also in my 20s. These people had absolutely incredible skin, girls and boys. They walked around looking like they has used all the filters. I continued to notice this trend as i got older. Rich people's children have gorgeous skin because they can afford better everything, and also they neverhave to stress about school or doing well in life because they have trust funds. The short answer is MONEY.

It mainly comes down to food and activity.
More nutritious food vs ultraprocessed food makes a massive difference.
Middle class people are more likely to go out for walks, take up yoga go for a swim and generally move more.

So the long and short of it really is money.

Just a bit sad really.

It’s talked about a lot in healthcare and public health. It’s really well documented that the health and social outcomes for people who are richer / from ‘better’ areas far exceed those from more deprived areas.

I’m not being snotty when I say this and sorry if it comes across that way. I’m trying to say you’re absolutely right and people do know and care, that there are pieces of work / policy trying to address it but it’s a drop in the ocean sadly.

Having more money often buys you more time. Time allows you to look after yourself.

Also, greater self-esteem. Being at the lower end of society's unjust structures is bound to affect self-worth. If you don't value yourself you tend not to take care of yourself.

Better quality food, more able to afford health care, dentist, pharmacy products
Vitamins, holidays,
Company insurances and health benefits or regular health checks to monitor the workforce, hence well looked after people.
Higher incomes to me means a better quality life, healthier homes, quality over quantity if you choose too.
A more structured organised life, so you need to care for yourself.
Image is also a big industry nowadays, so botox, fillers, face lifts for those who have hung ups about aging naturally.

Orwell on food, around 90 years ago: https://www.george-orwell.org/The_Road_to_Wigan_Pier/5.html

When the dispute over the Means Test was in progress there was a disgusting public wrangle about the minimum weekly sum on which a human being could keep alive. So far as I remember, one school of dietitians worked it out at five and ninepence, while another school, more generous, put it at five and ninepence halfpenny. After this there were letters to the papers from a number of people who claimed to be feeding themselves on four shillings a week. Here is a weekly budget (it was printed in the New Statesman and also in the News of the World) which I picked out from among a number of others:

3 wholemeal loaves 1 0 1/2 lb. margarine 0 2 1/2 1/2 lb. dripping 0 3 1 lb. cheese 0 7 1 lb. onions 0 1 1/2 1 lb. carrots 0 1 1/2 1 lb. broken biscuits 0 4 2 lb. dates 0 6 1 tin evaporated milk 0 5 10 oranges 0 5

Total 3 11 1/2 [three shillings elevenpence and a halfpenny]

Please notice that this budget contains nothing for fuel. In fact, the
writer explicitly stated that he could not afford to buy fuel and ate all
his food raw. Whether the letter was genuine or a hoax does not matter at
the moment. What I think will be admitted is that this list represents
about as wise an expenditure as could be contrived; if you had to live on
three and elevenpence halfpenny a week, you could hardly extract more food-
value from it than that. So perhaps it is possible to feed yourself
adequately on the P.A.C. allowance if you concentrate on essential
foodstuffs; but not otherwise.

Now compare this list with the unemployed miner's budget that I gave
earlier. The miner's family spend only tenpence a week on green vegetables
and tenpence half-penny on milk (remember that one of them is a child less
than three years old), and nothing on fruit; but they spend one and nine on
sugar (about eight pounds of sugar, that is) and a shilling on tea. The
half-crown spent on meat might represent a small joint and the materials
for a stew; probably as often as not it would represent four or five tins
of bully beef. The basis of their diet, therefore, is white bread and
margarine, corned beef, sugared tea, and potatoes--an appalling diet.
Would it not be better if they spent more money on wholesome things like
oranges and wholemeal bread or if they even, like the writer of the letter
to the New Statesman, saved on fuel and ate their carrots raw? Yes, it
would, but the point is that no ordinary human being is ever going to do
such a thing. The ordinary human being would sooner starve than live on
brown bread and raw carrots. And the peculiar evil is this, that the less
money you have, the less inclined you feel to spend it on wholesome food. A
millionaire may enjoy breakfasting off orange juice and Ryvita biscuits; an
unemployed man doesn't. Here the tendency of which I spoke at the end of
the last chapter comes into play. When you are unemployed, which is to say
when you are underfed, harassed, bored, and miserable, you don't want to
eat dull wholesome food. You want something a little bit 'tasty'. There is
always some cheaply pleasant thing to tempt you. Let's have three pennorth
of chips! Run out and buy us a twopenny ice-cream! Put the kettle on and
we'll all have a nice cup of tea! That is how your mind works when you are
at the P.A.C. level. White bread-and-marg and sugared tea don't nourish you
to any extent, but they are nicer (at least most people think so) than
brown bread-and-dripping and cold water. Unemployment is an endless misery
that has got to be constantly palliated, and especially with tea, the
English-man's opium. A cup of tea or even an aspirin is much better as a
temporary stimulant than a crust of brown bread.

There’s a lot to be said for being able to advocate for yourself better too

From personal experience: my Dad had a big heart attack 15 years ago. A few days after his incredible, life-saving operation on the equivalent of the NHS (not UK), the hospital were ready to discharge him home - a bit early, but they needed to make space for another patient. My Mum pushed hard for him to stay a bit longer (for very valid reasons related to the suitability of their home for a recovering patient). They moved him to a recovery ward. A day later he had a massive post-operative bleed. The nurse realised what was happening, and he was rushed to emergency theatre.

At home, he would have died, but since we had advocated for him he lived.

Now 15 years later, my Dad is really healthy and well (he took post-recovery exercise instructions seriously!). However, my Mum has advanced Alzheimer's. My Dad cares for her at home, and is absolutely amazing at meeting her needs, with a fair bit of outside help since he's not so physically strong now: partly paid for by the state, but organised by him. If he wasn't caring for her, she would have moved into a residential home about 4 years ago when she was no longer safe by herself at home (we all work in a different oountry). Statistically, life expectancy is lower in a residential home: especially over covid, which spread so fast through care homes.

So quite apart from money, if my parents hadn't had the confidence and ability to advocate for themselves, I would have lost them both by now. They're only one example, but this is how population-level differences build up.

Everything that's been said already bit social contagion plays a part too. I remember realising "there are no fat people in this town". I dont still live there btw.

When it comes to buying food and diet, if you have plenty of money you can afford to buy something new and if it turns out you don't like it, it's not a problem, you can eat something else. If you have hardly any money, buying something that nobody eats is a disaster, because there isn't anything in the cupboard or fridge or freezer to replace it, without leaving you short for another meal. Also, it may well be cheaper to make certain things from scratch rather than buy them ready-made, but that takes time, knowledge, equipment, fuel costs, access to a shop where you can get the ingredients, and confidence that (a) you can do it and (b) the rest of your household are going to eat it. It must often seem easier to get the familiar value brand family size lasagne instead, and frankly it will often be cheaper.

Does that theory remain of the parent move into better quality living and incomes over the first 5-10years?

It’s well documented - Google the inverse care law and the Tudor Hart study. There is very much a proven inequality for health and well-being compared with income and poverty. What’s tragic is this was known about 40-50 years ago and there are still children growing up in poverty now.

The biggest indicator of whether you’ll be fat is whether your friends are overweight. The secretaries at my office get deep fried food from the chippy for lunch, the senior staff get soup or a salad. The meals will cost the same
I agree with this.
Also far too simple to say ‘money’ as if the middle classes just shook a magic money tree and gained it effortlessly. The attributes that make person more likely to take on a more responsible and better paying job - eg self-discipline/resilience/deferred gratification are those that also make them more likely to take responsibility for their own health rather than reliant on ‘them’ for ‘social prescribing’.
I come from a provincial town where it is definitely the norm to be overweight and people expect to have health problems but do nothing to try to prevent it whereas I now live in an area where most people have migrated from other places.They have an energy and dynamism that is lacking in those who remain rooted where they grew up /now living next door to their mum who told them that ‘middle aged spread’ and dentures at 40 was inevitable and acceptable.

So true about confidence to advocate. A mental health professional smirked when I said that although my son was on the ASD spectrum yes, the specific disorder was xxxx. She stopped writing. She asked how I knew and when I said I'd matched the many specs online to his behaviours, she didn't disguise her amusement.

I suppose I challenged her amusement (politely) I asked her who compiled the specs on NHS, HSE Australian health websites? "Just Mums like me?" or "professionals?" I said there were many many specs on line, many ways to corroborate, available from different countries, different organisations, charities, government funded, semi funded, I asked her did she think I would not notice patterns of behaviour over the years, would I be unable to match a pattern of behavior to specs online?

She dragged her pen back to write xxxxx as I originally told her.

I wanted to say the information is all there. You do not need 7 years study to be able to identify the specific spectrum disorder that your own child that you raised has.

I bet if id had a overweight body smelling of smoke and a working class accent she would have dismissed me with even less subtly.

Less likely to have suffered an industrial accident or disease. Less likely to smoke. Less likely to live in an area with poor air quality. Better diet.