inequalities in health wk11

Health gradient

1. some people (low SES) are chronically ill and never seem t fully recover even with medications and interventions (Michael marmot)

2. Perceived class differences (psychological experienced for perceived rank can affect health) Nancy Adler 

   1. effect of additional income on health greatest for the poorest groups 

   2. most health disparities associated with ses occur in middle income group

   3. most effect on cardiovascular disease, arthritis, diabetes, chronic respiratory diseases, and cervical cancer, as well as for the psychiatric disorders of schizophrenia, substance abuse, and anxiety.

3. lower SES worse health

evidence: Whitehall study (10 yr survival increased with occupational grade. effect remained 25 years later even after retirement

• London service sector has high emphasis on rank and category, but same health benefits 

• Yet, there is still strong association between employment rank and mortality  rates 

• SES - health relationship cannot be fully explained by lack of access to health care 

psychosocial processes (mechanisms)

environment

• physical (toxins and pathogens, water supply)

  • Noise, pollution and crowding

  • poor infrastructure - accidents

  • physically dangerous jobs

  • limited access to recreational facilities, quality health care, healthy food

• social

  • crime and violence

  • social conflict

  • less social support

psychological response

• affect

  • awareness of neg stereotypes being treated differently, and discrimination

  • daily distress

• cognition

  • low sense of personal control (perceived control at work explained more than half of the health gradient among civil servants low optimism - hopelessness, hostility and anger —> greater risk of chronic health disorders (CHD)

  • slower recovery from major surgeries (coronary bypass surgery)

—>health compromising behaviors

• stress relieving behaviors - eg smoking sedentary lifestyle, high fat diet

• low adherence to medical treatments among the less educated 

  • high ses diabetics showed better blood sugar control than low ses

  • fully explained by adherence to treatment / interventions

—> biological responses 

• allostatic load (AL) cumulative wear and tear from chronic exposure to stress 

  • AL score - sum of indicator in highest risk quartile (top 25%)

  • BP, waist to hip ratio, cholesterol, blood glucose, cortisol, DHEA (dehydroepiandrosterone), epinephrine, and norepinephrine.

• —> higher disease risk and mortality, poorer physical health, cognitive function and mortality

•  lower ses elderly had higher baseline

Social level

income, education, jobs, happiness, housing, health, stress, background, opportunities

hierachy and health

Those at the bottom of the hierachy have high cortisol and stress response. 

• alpha  monkeys died off —> rank distinction broke down —> baboons recovered and thrived, and social affliation became the norm. absense of stress = less high BP etc 

social class (SES)

objective social class - concrete and enduring —> income, education, occupation (or your parent’s occupation)

subjective social class - own judgement of where you stand along the social ladder in society, relative to others - related to but also independent of objective ses

• social ladder

• “would you consider yourself to be lower class middle class or upper class”

• relation .3-.6 overlap

• better indicator of cardiac index, body fat distribution, cortisol response, awakening cortisol 

• WHY? 

  • subjective ses includes objective ses and non material resources such as optimism, fin stability, psychological resources, lifetime social experience 

  • can capture influences of psychological stressor - social comparison, being subordinate to others, discrimination, social rejection

Psychosocial Processes in Explaining the Gradient Between Socioeconomic Status and Health

as ses declines demands increase and resources for dealing with demands decrease —> exposed to more stress —> larger psycholgical responses —> stress and stress reactivity, cumulative effects of repeated adaptations —> less capacity to respond to envrionemental challenges —> more vulnerable to disease

• income inequality —> highetened social anxiety, diminished social trust, underinvestment in infrastructure —> higher mortality 

• links to racial inequality

• in areas with low women’s equality, husbands status is a better predictor of health than the women’s

• The SES-health gradient is strongest at birth (i.e., infant mortality) and in mid to late adulthood.

• length of time spent living in low- SES conditions are also important predictors of adult health outcomes.

• reverse causality 

psychosocial buffers

• protective factors that reduce stressors leading to poor health

  • social support

  • psychological beleifs (sense of control, optimism, non essentialist (genetic) beleifs

  • resilience strategies (shift and persist)

• some low ses individuals do not show health deficits and have comaprable health with high ses

• can identofy psychological inteventions and policies to reduce ses disparities in health

Shift and persist (psychological response) 

• protective strategy against stressors, esp for low ses children, adolescents and young adults, minority groups, chronic illness 

shift: accept  and reappraise situation —> facilitates secondary control

1. accept stressor 

2. reappraise stressors to adjust to external env — reevaluating a stressful situation to reduce emotional impact —> higher emotional wellbeing

   1. learning from situation, thinking abt gd in the situation

persist: meaning and optimism  —> sustains secondary control

1. find meaning in life - reconcile stressful encounters with own beliefs

2. maintain optimism abt future 

high Shift and high persist: health gradient between high and low ses not steep (inflammation and obesity studies)

why useful: low resources - changing self (secondary control) more viable than primary control / changing the environment

Shift and persist as a strategy for health

1. stable and positive role models 

2. attachement, socialisation of behaviors, future orientation

   1. emotional regulation and coping responses (shift)

   2. keep children focused on future (persist)

   3. successful role models inspire

   4. positive attachment figures

      1. increase optimism

      2. social support - trust thier world and can seek help

3. shift and persist

4. psychological response