Social status can have a long-lasting influence on people’s health and longevity. This column explores the lifespan of royals – whose status is determined by hereditary rules – between 1669 and 2022. While royals still live longer than their average subject, the gap has shrunk significantly since the 19th century. Even today, monarchs consistently outlive their siblings and consorts, which may reflect the health benefits of positive stress (or eustress) associated with a strong sense of purpose and control. Reducing health inequality may require tackling social hierarchies that influence wellbeing.
Social status not only influences people’s beliefs and political views (Kreiner et al. 2020) but can also make a difference to individuals’ wellbeing and impact the health and longevity of populations. The influence of social status on individual health can emerge through multiple pathways, including access to networks and connections (Link and Phelan 1995), as well as disparities in cognitive development and economic resources during childhood and adolescence (Danesh et al. 2024, Marmot 2013). However, identifying the effects of social status is complex, as it depends on access to health information, effort, and other variables that can confound the effects.
To better isolate the health effects of ‘positions of privilege’, one can examine evidence from inherited forms of status such as royalty, where position is not earned but conferred by birth. Furthermore, within royal families, one can examine the effects on monarchs versus other royals who enjoy royal status but do not have the purpose and higher duties associated with being a monarch. Stress – both positive and negative – associated with individuals’ positions can exert an influence on their longevity.
Evidence from different settings
Research on the relationship between social status and health reveals complex and sometimes counterintuitive effects across diverse contexts, from caste and race to academia, civil service, corporate hierarchies, politics, and sports. In India, caste-based disparities show that Adivasis live more than four years less than higher-caste Hindus, while Muslims live about one year less, patterns comparable to Black–White mortality gaps in the US, which reflect enduring inequalities beyond wealth alone.
In academia, higher education and prestigious awards such as Nobel or literary prizes are linked to longer life expectancy, though effects differ depending on when recognition occurs and whether individuals already enjoy high status: newly recognised individuals often gain in longevity, while established figures may experience costs from the stress of sustaining distinction. Occupational hierarchies, as shown in the Whitehall studies of British civil servants and analyses of US military personnel, similarly demonstrate that higher rank is generally associated with better health outcomes, though the benefits can be offset by stress and responsibility (Marmot 2013).
Evidence from corporate and political settings further complicates the picture: while CEOs and managers often face reduced lifespans due to chronic stress and crises, elected officials who narrowly win office sometimes live longer, suggesting the presence of positive or ‘eustress’. Even in sports, silver medalists have outlived gold medalists, hinting at the pressures of maintaining peak status.
Evidence from royals
Hereditary monarchies provide a valuable source of evidence, as status is largely exogenously assigned at birth, offering clearer insight into the causal effects of privilege on longevity without being confounded by individual effort or career-driven selection. Ottinger and Voigtländer (2025) show that state performance was influenced by the quality and abilities of monarchs. For centuries, Europe’s royals enjoyed standards of living that most of their subjects could only dream of.
In a new study (Batinti et al. 2005), we track monarchs and their families from 1669 to 2022 and show that royalty consistently outlived the general population – sometimes by decades (Batinti et al. 2025). Figure 1 plots the ‘royal advantage’ over time: the difference between how long royals lived and how long the average citizen of their country could expect to live. It suggests that in the 18th century, royals lived 20–30 years longer than ordinary citizens. Better food, cleaner water, and protection from war and labour made the crown not just a symbol of power, but of survival. This advantage widened through the 19th century but began to shrink as public health improvements – such as vaccines, sanitation, and modern medicine – lifted the life expectancy of common people. By the 20th century, the royal edge had shrunk, and today, ordinary citizens live almost as long as royals.
Figure 1 Difference between age at death and royal member’s lifetime average life expectancy at birth of the population
Notes: Y-axis: difference between age at death and royal member’s lifetime average life expectancy at birth of the population. X-axis: year of death of the royal member. Horizontal line is the 0 line where the royal member’s age at death and average life expectancy are the same. Possible inverse-U shaped relationship between royal member’s lifespan vs population life expectancy, with the largest difference around the end of the 1800s and then inverting, with the trend coming closer to 0 by the 21st century. The negative differences identify early royal deaths (mostly royals not in power but includes some kings and queens).
The decline of the royal advantage highlights an often-overlooked success story: public health. While privilege still matters for health outcomes, the dramatic reduction in the gap between royals and their subjects shows how modern medicine and social progress can level the playing field. Yet, the persistence of a small edge for monarchs also reminds us that status, purpose, and control may carry biological dividends through eustress that derives from the sense of control and agency in society. Health inequality is not only about wealth and access; it may also be about how much agency people feel they have over their lives.
Ruling royals and positive stress
Within royal households, monarchs – kings and queens – outlived their siblings and consorts. Why did rulers outlive even their royal kin, who enjoyed the same wealth, upbringing, and privileges? The answer may lie in stress. Psychosocial stress offers a key explanation for the link between status and health: while lower-ranking individuals, as shown in Sapolsky (2015) baboon studies, experience chronic distress that harms health, higher-status individuals are often shielded from such stress and better equipped to cope, sometimes even benefiting from positive stress (eustress). Human research supports this, showing that stress type and coping resources vary with status (Cutler et al. 2006). Instead of cutting their lives short, the responsibility of ruling may have provided the positive stress of purpose and control, which can strengthen resilience and health.
Psychologists distinguish between distress, the toxic stress of uncertainty and lack of control, and eustress, the positive stress that comes with purpose and agency deriving from occupying apical roles of command, responsibility, and leadership. Monarchs, unlike their siblings and consorts, carried the burden of ruling, which, far from being purely harmful, may have shielded them from the corrosive effects of powerlessness. Having a clear sense of purpose and a large locus of control exposed them to the positive side of stress, linked to better health, stronger immunity, and longer lives. In this sense, the crown’s weight added years of life rather than taking them away.
Policy lessons
The story of royal longevity is not just an account of dynastic history – it offers a lesson for today. Public health advances have already narrowed the once-vast survival gap between royals and their subjects, showing how investments in sanitation, healthcare, and nutrition can democratise privilege. But the persistence of a small edge for rulers highlights another dimension: the health dividend of agency, purpose, and stability.
Modern health policy often focuses on resources and access, but it should also pay attention to the social and psychological foundations of health. Secure roles, meaningful work, and a sense of control can act as protective factors much like vaccines or clean water once did. In other words, spreading ‘royal health’ in the 21st century means not only equalising material conditions, but also empowering people to feel that their lives are guided by purpose rather than precarity.
Health-inequality policies should tackle the social hierarchies that influence wellbeing. Fostering inclusive institutions, fairer labour markets, and stronger social safety nets can help ensure that the health advantages associated with status are not confined to a privileged minority, but become part of a collective longevity gain shared across society.
Source : VOXeu
