Explaining Social Gradients in Health

HSCI 130 - Week 12: Explaining Social Gradients Continued

Learning Outcomes

1. Compare explanations for social and occupational gradients in health.

2. Discuss the income inequality hypothesis.

3. Examine the structure-agency issue and consider its implications for solutions to address social determinants of health.

The Link Between Social Class & Health: Socio-Economic Position (SEP)

• Definition: Social and economic factors that influence the positions individuals and groups hold in the social structure of a society.

• Measurement:

  • Individual Level Measures:

  • Occupation

  • Income

  • Income in relation to the poverty level

  • Education

  • Wealth

  • Area Based Measures: Geographic area.

Social Gradient in Health

• The social gradient in a wide range of health outcomes is one of the most consistent findings in the literature of epidemiology.

Explanations of Social Gradient

• The detailed explanations of the social gradient can be found in Segall & Fries editions on specified pages:

  • Edition 1: Pages 134-138

  • Edition 2: Pages 148-153

1. Materialist Explanations

2. Cultural Behavioural Explanations

3. Psychosocial Explanations

Materialist Explanations

• Differential Exposure Hypothesis: Suggests that individuals have varying levels of exposure to psychosocial stressors like financial problems, neighborhood issues, and social isolation.

• People experience both positive and negative exposures throughout their life and these experiences inform their condition as adults, highlighting advantages, disadvantages, and differences in stress exposure which affects biological factors influencing health outcomes.

Materialist vs. Neo-Materialist Explanations

• Materialist Explanations:

  • Emphasizes the material conditions of living environments and their significant impact on health.

  • Highlights aspects of social structures, especially social-economic status (SES), as powerful health determinants, drawing from the political economy perspective (conflict paradigm).

• Neo-Materialist Approach:

  • Suggests health is affected not just by differential access to resources but also by the extent of funding invested in social infrastructure.

Cultural Behavioral Explanations

• Differential Vulnerability Hypothesis: States that while everyone experiences stressors, individuals' positions within the social gradient can exacerbate their experiences.

• Low SES individuals are observed to have poorer health due to engaging in health-related behaviors that are detrimental such as smoking and unhealthy eating habits.

• The assumption is that these individuals often struggle to cope with environmental stressors, leading to worse health.

Psychosocial Explanations

• Refers to how people interpret their place in the social hierarchy, with perceptions of relative deprivation potentially resulting in feelings of low self-esteem, shame, or envy.

• Failure to achieve social comparisons can lead to stress, and these comparisons may yield harmful mental health effects.

Occupation – Whitehall Studies

• Conducted by Michael Marmot, these are classic studies of British civil servants demonstrating that absolute deprivation isn't as significant as where one stands in the hierarchy.

Canadian Evidence - Occupational Gradient

Table 5: Mortality Rates by Occupational Skill Level

• Age-Standardized Mortality Rates (ASMR) per 100,000 person-years at risk:

  • The data reflects rate ratios and excess mortality for specific causes of death across various occupational skill levels from 1991-2006.

  • It shows the correlation between occupational class and health outcomes, exemplifying that higher skill levels correlate with lower mortality rates.

Quality of Work and Health

• The focus on job conditions has shifted from workplace hazards to work organization and employment conditions.

  • Occupational Medicine: Studies chemical and physical hazards and ergonomics that diminish health.

  • New Occupational Health Research: Examines job features that influence health via psychosocial stress mechanisms.

Explanations for Occupational Gradient

• Two Conceptual Models:

  1. Demand-Control Model

  2. Effort–Reward Imbalance Model

Demand-Control Model

• Components:

  • Psychological Demands: The workload and expectations placed upon a worker.

  • Control: The degree of autonomy and discretion an individual has over their work conditions and schedules.

• Low control with high demands leads to negative health outcomes.

Psychosocial Categories of Jobs

• High Demand + High Control/Support: Active jobs (e.g., physician, teacher).

• Low Demand + Low Control: Passive jobs (e.g., security guard).

• High Demand + Low Control: High strain jobs (e.g., serving staff, nurse's aide).

• Low Demand + High Control: Low strain jobs (e.g., scientist, repairman).

Effort-Reward Imbalance Model

• Highlights the significance of social reciprocity in workplace dynamics with adverse health effects arising when the effort is not met with adequate rewards such as income, job security, or career advancement.

Relevance of the Effort-Reward Imbalance Model

• Captures features of contemporary work shaped by economic globalization leading to diminished job security, increased competition, and high pressure.

• Tied to the principle of social reciprocity, showing that perceived inequities in efforts versus rewards have health implications.

Correlation between Job Stress and Health Outcomes

• Studies have established links between stressful work conditions and negative health outcomes, such as:

  1. Coronary heart disease (CHD)

  2. Depression

  3. Sleep disturbances

  4. Musculoskeletal disorders

  5. Alcohol dependence

Precarious Employment & Health

• Definition: Precarious employment encompasses aspects of job insecurity, worker rights, low wages, and economic deprivation.

• Seen as a significant social determinant of health, with studies emphasizing its long-term health impact.

Pathways from Precarious Employment to Health

1. Increased exposure to adverse working conditions

2. Limited control over personal and professional lives leading to stress

3. Material and social consequences of precarious employment, affecting decision-making and family stability.

Income Inequality and Population Health

• Income Inequality: Refers to the unequal distribution of income in society, noted to have risen in many developed countries since the 1980s.

• Wilkinson’s Income Inequality Hypothesis: Higher income inequality correlates with increased social problems and a health gradient.

Measurement of Income Inequality

1. Gini Coefficient: Ranges from 0 to 1, with lower values indicating more equality.

2. Robin Hood Index: Shows income transfer needed to equalize income.

3. Decile Measures: Compares income between top and lowest earning segments of a population.

Reducing Socioeconomic Differences in Health

• Importance of prioritizing health inequalities in policy initiatives.

• Studies indicate that welfare state characteristics and egalitarian political traditions correlate with improved health determinants.

Tips for Better Health**

• General Tips:

  1. Don't smoke; quit or reduce smoking.

  2. Eat a balanced diet rich in fruits and vegetables.

  3. Stay physically active.

  4. Manage stress through relaxation and discussion.

  5. Moderate alcohol consumption.

  6. Protect against sun exposure.

  7. Engage in cancer screening.

  8. Prioritize safety on the roads.

  9. Learn First Aid basics.

• Alternative Tips:

  1. Avoid poverty and its risks.

  2. Manage family wealth and decision-making.

  3. Secure employment in low-stress and well-paid positions.

  4. Benefit from social services and protections if in need.

Note: The study material aims to provide a comprehensive understanding of the connections between socio-economic factors, occupational status, and health outcomes, along with the implications of income inequality in shaping health disparities.