Socioeconomic Status and Health Flashcards
Social Inequities in Health
- Large
- Widespread in different societies
- Present for mortality, morbidity and health behaviors
- Persistent and widening
- Gradient effect – inequalities occurs at all dimensions of SES
- Occurs at all stages of the life course
What is the term socioeconomic status trying to capture?
Position within the social hierarchy, based on prestige and access to resources
Common explanations of the SES gradient
***need further explanation
Health inequalities exist along all three dimensions of SES
- Reverse Causation - some associations reflect reverse causation (poor health outcomes linked to SES)
- Access to Health Care
- Lifestyles
SES and Health Across the Lifecourse
- Critical/Sensitive Period Model
- Accumulation of Risk Model
- Trajectory/Chain-of-risk Model
- How timing of social exposures influence health
–Critical, or sensitive period model: exposures during specific developmental period have reverberating consequences later
–Accumulation of risk model: each additional episode of low SES adds to an ever-growing health disadvantage
–Trajectory of chain-of-risk model: low SES is primarily unhealthy bc it begets future low SES, and only in later life does SES become biologically embedded as ill health
SES as Fundamental Cause of Health Inequality
SES differences in health persist over time bc
SES determines range of resources, including money, knowledge, prestige, power and social connections
Resources can be used to protect health no matter what the current risks/tx/diseases
Greater Attention Must Be Paid to Basic Social Conditions
- Individually-based risk factors must be contextualized – what social factors put people at risk of risks?
- These social factors are the “fundamental causes”
- -demonstrates access to important resources
- -affects multiple disease outcomes through several mechanisms
- -maintain an association with disease even when the mechanism changes
Major Indicators of Socioeconomic Status
Education
Income
Occupational Status
Education and Health (3)
-what does it capture/indicate:
- Captures transition from parents’ SEP to adulthood SEP
- Strong determinant of future employment and income
- Knowledge and skills attained through education may affect cognitive functioning; more receptive to health education messages, more able to communicate with and access appropriate health services
Mechanisms linking Education to Health
- Education may convey info relevant for preventing disease/delaying disability + death
- Education may form a set of enduring cognitive or emotional skills that foster health-promoting decisions
- Time spent in school = time not spent in harmful activities
- Education may improve long term health by increasing chances that you have an educated social circle (influence behavior)
Advantage of Education as an Indicator
- Routinely available
- Garners high response rate
- Short and simple to assess
- Accurately reported
- Fairly stable beyond early adulthood (least reversible to reverse causation)
Disadvantage of Education as an Indicator
- Restricted range
- Varies by age cohort
- Differential economic and social returns by race and gender
- Tricky to assess quality of education
- Doesn’t incorporate nontraditional education experiences
- Pay little attention to timing educational experiences or preschool activities
How is Income Measured?
Will vary depending on your research question
What do we include in income? - non-monetary income is largely un-measurable
What is the income unit? - Relation between household income and individual welfare depends on intra-household transfer, gender inequality, etc.
Over what period is income measured? - short run vs. long run
Mechanisms Linking Income to Health
- High income may enable better access to means to produce good health, including
- better access to health care
- other forms of health consumption, like other housing, transportation, clothing.
Advantages of Income as an Indicator of SES
- Continuous and spread along a very broad range from low (depths of poverty) to high (extreme wealth)
- The best single indicator of material living standards
- Captures dynamic component of SES
Disadvantages of Income as an Indicator of SES
- High Refusal
- False reporting and errors
- Unstable
- Complex definition - need to take account of household size and composition
- Susceptible to reverse causation
- Doesn’t take into account wealth - home ownership, liquid assets (bonds, savings), liabilities (credit card debt, unpaid loans, mortgage)
