Inequality in social rank and adult nutritional status: Evidence from a small-scale society in the Bolivian Amazon

Research on the social determinants of health has highlighted (a) the adverse effects of social inequality on individual health and (b) the association between individual social rank and health. In this paper, we contribute to the growing literature on the health consequences of social inequalities by assessing the association between village level inequality in social rank, a form of non-material inequality, and indicators of nutritional status. We use quantitative survey information from 289 men (18+ years of age) from a society of forager-farmers in the Bolivian Amazon (Tsimane'). We construct village level measures of non-material inequality by using individual measures of men's positions in the village hierarchy according to prestige (or freely conferred deference) and dominance (or social rank obtained through power). We find that village inequality in dominance, but not village inequality in prestige, is associated with short-term indices of individual nutritional status. Doubling the coefficient of variation of dominance in a village would be associated to a 6.7% lower BMI, a 7.9% smaller mid-arm circumference, and a 27.1% smaller sum of four skin folds of men in the village. We also find that once we decouple individual social rank based on dominance from individual social rank based on prestige, only prestige-based social rank is associated with nutritional status. Potential explanations for our findings relate to the differential forms of resource access derived from the two forms of social hierarchies and to the social and psychological benefits associated with prestige versus the social costs and psychological stress generated by dominance.