V. Socioeconomic Status (SES) and Health

SES Gradient

The linear pattern showing hierarchies in health status by different levels  of SES

Whitehall Studies

The first modern public health study to demonstrate the SES gradient among British civil servants based on employment grades

• Longitudinal data

• homogenous population

• Pathways between key SES markers and health: 

  • education

  • income

Pros and Cons of education as a measure of SES

• pros: stable, easy to collect, also a marker of early life circumstances, limited reverse causation

• cons: no consideration of education quality, gives no indication of current life

Pros and Cons of income as a measure of SES

• pros: insight into quality of life, can be applied to a family/household

• cons: income only measured at a single point in time provides limited information about someone’s lifetime economic status, no guarantee that all income is available for use, subject to reverse causation

Reverse causality

when health “causes” income

Absolute vs. relative income

absolute income - income effects on health result from access to tangible resources like food, clothing, and shelter

relative income - income effects on health result from symbolic resources such as status, prestige, or control over their life

Pathways to Health

1. Disinvestment in Human Capital: The well-off divesting from public services (e.g., public education). 

• ex) putting your kids in private school instead of public school

2. Psychosocial Pathway: Erosion of Social Cohesion: Inequality encourages hostility, limiting social integration (strongly linked to homicide). 

3. Psychosocial Pathway 2: Theory of Social Comparison: Negative emotions (shame, distrust) resulting from the perceived gap between one's  lifestyle and the expected standard of living ("dis-consonance"). ex. - you have an idea of what a middle class lifestyle is for example, then you have negative thoughts if your life does not look like that