"In Weberian socio-economic terms," says Wikipedia, "the middle class is the broad group of people in contemporary society who fall socio-economically between the working class and upper class." Which is an incredibly awkward way of saying "the people between the rich and the poor." Being middle class means a bunch of things – degrees, the News Quiz, kale and so on – but it can also have a pretty big impact on your health.
Top of the list is that you're more likely to have something wrong with you. Or at least, you're more likely to have it diagnosed. A study out recently, for example, found that kids from poor families were half as likely to be diagnosed with coeliac disease than their middle class peers. Given that there's no real reason why one group should have it more than the other, the most likely explanation is that kids from poorer areas just don't get diagnosed as often.
So far so good for Radio 4 listeners. The trouble is, more diagnosis isn't always a good thing – especially if it's likely to lead to more false positives.
Cervical screening is a good example of this. It's a great way to detect the early stages of cancer and saves lives, so you'd assume that getting more women of all ages to have it done would be a good thing, yet at the moment women under 25 aren't screened – something that upsets quite a lot of people. Trouble is, women under 25 are much less likely to get cancer and much more likely to have random abnormalities in their test results – oddities that go away naturally over time. That means more false positives, which means more unnecessary treatment, which means more harm to women on average than if they weren't screened.
Things get even murkier when you delve into mental health issues. There's a long-running debate in the medical profession about increasing rates of ADHD for example, and whether too many kids are being given a false diagnosis thanks to parental pressure and a pretty subjective test. An article in the BMJ last year cited evidence that up to half a billion dollars was wasted in the US on inappropriate diagnosis, which in real terms translates as a lot of kids medicated up to their eyeballs on strong prescription drugs who shouldn't be.
That said, it may not be as simple as too many kids getting diagnosed. Better testing and more vigilance also explain some of the rise in cases of things like ADHD and Asperger's . What is clear is that middle class parents are far more likely to seek and get a diagnosis than poorer families – class has a bigger impact on rates than pretty much anything else. So where there are false positives and over-medicated children, they're likely to be middle class.
And yet if middle class kids are overmedicated for some conditions, they're under-treated for others, which brings me to the MMR vaccine and the measles clusterfuck current hitting the US. Measles just shouldn't happen in a modern nation with a functioning healthcare system, because for decades now we've had safe, effective vaccines. Unfortunately, some parents have stopped letting their children have them, and now kids are getting sick.
A big problem with anti-vaxers is they tend to live together. Not literally in the same house, but it tends to be the same types of people who fall for this anti-vaxxer crap, and they tend to live in the same sorts of areas, which means their children go to the same schools, which means a big localised pool of unvaccinated kids for outbreaks to take hold in.
Who are these people? Well, there are two basic groups. One, as you'd expect, is people in poverty. Folk from rough inner-city neighbourhoods, with poor access to services, whose main impression of government is a bunch of greasy white Tories telling them how useless they are and how they should fuck off back to wherever they came from.
The other group, a bit more surprisingly, is middle class parents with graduate educations in richer areas. In Kensington and Chelsea for example, MMR vaccination rates fell to less than 60 percent during the early 00s. You can see a similar effect in California, in the wealthier parts of places like Orange County, where rates of vaccination are a lot lower than surrounding areas.
The problem with these people is that they're just clever enough to be stupid. They know enough to be confident searching for alternative sources of information on Google, but all that new information confuses their poor, harried brains and they end up making bad choices anyway. These are the people responsible for much of the current mess in the United States right now. Working class people may skip the odd vaccine, but it takes middle class Californians to be so colossally moronic as to throw measles parties.
So can being middle class killing you? Is it bad for the health of you or your children? Unless you've done something spectacularly stupid, probably not. For all the unnecessary crap you bring down on yourself with your Googling and your hypochrondria and your stupid tiger parenting, the simple fact of your class means that you've got anything up to seven extra years of life baked in from your cosy, organically-fed womb.
It's not easy being middle class. But it's far better than being poor.
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