When I say “heart attack” what are your first thoughts in terms of causes? A good bet is that you will consider cholesterol levels, and immediately after that, diet. After a bit more thought, you might want to add stress induced by a job with too much pressure and responsibility, and finally—just maybe—you will consider the possibility of a genetic predisposition. These are all the causes we hear from the media are associated with heart disease, and indubitably there is a lot of research to back these claims up.

However, and most astoundingly, research available since the 1960s and repeated several times since, also shows that all the above factors are actually minor causes of heart disease. The best single predictor of heart problems is indeed stress, but of an entirely different and still widely ignored type: the stress that comes not from doing too much or being under self-imposed pressure, but from being ordered around with little or no control over your destiny.

A study conducted among 17,000 British civil servants (and before that on a million employees of Bell Telephones in the 1960s) clearly shows that the status of a person’s job is the most reliable predictor of heart attack, more than obesity, smoking or high blood pressure (though these count as well, so don’t rush to get that triple cheeseburger just yet). High cholesterol is also a risk factor, but only in people that are genetically predisposed to it. It seems that your heart is by and large at the mercy of the size of your pay check.

The studies linking the pecking order on the job with heart problems found that what happens is that being ordered around diminishes your sense of control over your life, which causes stress mediated by the release of the hormone cortisol. High levels of cortisol not only create problems for your coronary arteries, but depress your immune response, so that you are also more likely to fall prey to an infection—which is not helped by the fact that the rise in cortisol is accompanied by a decrease in serotonin, meaning that you don’t sleep very well and you never feel rested.

Privatization can do that to you too. A follow up study on British civil servants explored how they were coping with the new 1990s concept of no job security. Suddenly, these people could loose their jobs for reasons that had nothing to do with their performance and all to do with the capricious oscillations of the market economy. Predictably, the employees in question felt no control over their source of livelihood, which caused stress and eventually illness—all of which had little to do with diet, drinking and smoking.

Researchers have been able to explode another myth related to heart attacks: the idea that it is a disease of the rich, suffered by CEOs because of the high pressure they experience on their job for prolonged periods of time and the associated responsibilities of such a situation. Well, if you are a CEO and are planning on using that as an excuse to raise your bonus this year, forget it. While there are exceptions, the heart attack rate in this category is actually much lower than the population at large, presumably because these people are actually very much in control of what they are doing, since they are everybody else’s boss (and even when they “fail” they get to retire with a few extra million dollars in their bank accounts). This category becomes at risk—rather ironically—only after retirement, possibly because their new “relaxed” life style is actually associated with very little control. Taking it easy for someone used to issue orders and be in charge can be fatal, literally.

Human beings are primates, and evolutionary theory teaches us to expect something similar in our inter-specific cousins. Sure enough, studies on baboons have shown an increase in stress level and production of cortisol in males that join a new troop, because when they do so they find themselves at the bottom of the pecking order, with little control over availability of food and mates. The same is true for monkeys studied in zoos, where researchers found a nice inverse relationship between pecking order and the furring up of arties. Next time you see a monkey or ape, remember to empathize with their working conditions.

Amazingly, you can even demonstrate the effect experimentally on humans by dividing people into two groups, giving them the same tasks, but ordering around one group and empowering the other with self decision making. The latter group experiences lower levels of stress hormones, blood pressure and heart rate.

What are we to learn from all this? For one thing it is interesting that we are experiencing a continuous pressure in modern society to “take responsibility,” follow a healthy life style, control our diet, watch closely what sorts of habits and addictions we develop, or else. While this is all good advice in general, why don’t we ever hear that the single most important factor affecting our health is the lack of control over our lives that modern society forces upon us? I am no neo-luddite (see my August 2001 column), but shouldn’t we question the social order at the least to the extent that it makes us unhappy and possibly kills us?

I am not of course suggesting that we are experiencing a “great media conspiracy” to blame us instead of the system. The danger is a lot more subtle than that since the facts are out there for anybody to check, if they only bother to. What started me on this was reading a summary of what I have discussed in the widely available volume by Matt Ridley, Genome. Then again, no newspapers, TV news, or talk show picks up on this sort of information, disseminates it to the public, and raises awareness. The reason is probably that questioning the system and lifting the blame from the individual goes directly against an entrenched aspect of the American psyche, it challenges the basic assumption of individualism and “opportunity” for everybody that this country is all about. Well, at least once in your life it is healthy to question even the most fundamental assumptions. Go for it, it might hurt less than you think.

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