Socioeconomic status and health: The challenge of the gradient.

Adler, Nancy E.; Boyce, Thomas G.; Chesney, Margaret A.; Cohen, Sheldon; Folkman, Susan; Kahn, Robert L.; Syme, S. Leonard

doi:10.1037/0003-066x.49.1.15

Cited by 2,485 publications

(1,918 citation statements)

References 76 publications

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“…(Case et al, 2002 provide evidence for the US, and Currie and Stabile, 2004 for Canada. ) This research suggests that childhood health may be an important contributor to the "gradient", the widely documented positive association between good health and higher economic status observed in adulthood (Adler et al, 1994).…”

Section: Introductionmentioning

confidence: 73%

“…The hypothesis that β h is non-zero-that health affects future social status-is often referred to in the epidemiological literature as the "health selection" or the "social drift hypothesis" (Adler et al, 1994). The literature on pathways models argues that although some early health problems-in particular severe forms of mental illness such as schizophrenia or major depression-may affect future socioeconomic status, there is little evidence that current health affects future economic status (Chandola et al, 2003).…”

Section: Empirical Frameworkmentioning

confidence: 99%

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The lasting impact of childhood health and circumstance

Case

Fertig

Paxson

2005

Journal of Health Economics

1,339

1,054

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We quantify the lasting effects of childhood health and economic circumstances on adult health, employment and socioeconomic status, using data from a birth cohort that has been followed from birth into middle age. Controlling for parental income, education and social class, children who experience poor health have significantly lower educational attainment, poorer health, and lower social status as adults. Childhood health and circumstance appear to operate both through their impact on initial adult health and economic status, and through a continuing direct effect of prenatal and childhood health in middle age. Overall, our findings suggest more attention be paid to health as a potential mechanism through which intergenerational transmission of economic status takes place: cohort members born into poorer families experienced poorer childhood health, lower investments in human capital and poorer health in early adulthood, all of which are associated with lower earnings in middle age-the years in which they themselves become parents.

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Section: Introductionmentioning

confidence: 73%

Section: Empirical Frameworkmentioning

confidence: 99%

The lasting impact of childhood health and circumstance

Case

Fertig

Paxson

2005

Journal of Health Economics

1,339

1,054

View full text Add to dashboard Cite

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“…The first approach concentrates on the diminishing returns of individual income: earning an extra dollar is more beneficial at the lower end of the income distribution. The second approach connects social ranking to mortality/morbidity through the gradient effect (Adler et al, 1994;Marmot et al, 1991): social status is symbolic, and individuals compare themselves to others, with unfavorable relative comparisons being harmful. The third perspective suggests an adverse effect of aggregated levels of income inequality, even after controlling for individual income.…”

Section: Income Inequality and Health: Evidence And Debatementioning

confidence: 99%

Recalibrating the spirit level: An analysis of the interaction of income inequality and poverty and its effect on health

Rambotti

2015

Social Science & Medicine

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The publication of The Spirit Level (Wilkinson & Pickett, 2009) marked a paramount moment in the analysis of health and inequality, quickly attracting a remarkable degree of attention, both positive and negative, both in academic and in public discourse. Following at least 20 years of research, the book proposes a simple and powerful argument: inequality per se, more specifically income inequality, is harmful to every aspect of social life. In order to confirm this idea, the authors present a series of bivariate, cross-sectional associations showing comparisons across countries and within the United States. Despite the methodological limitations of this approach, the authors advance causal claims concerning the detrimental effects of income inequality. They also rule out poverty as a plausible alternative explanation, without directly measuring it.Meanwhile, over the last decade stratification scholars have demonstrated the nonlinear effect of economic factors, especially income, on health. The results suggest that a relative approach is best for analyzing dynamics at the top of the income distribution, whereas an absolute approach seems most appropriate for studying the bottom of the distribution.Consistent with this perspective, here I reanalyze data from The Spirit Level, adding a measure of poverty, in order to control the effect of inequality and explore its interaction with poverty. The findings show that inequality and poverty-which I contend are two interdependent but nonetheless distinct phenomena-interact across countries, such that the detrimental effects of inequality are present or stronger in countries with high poverty, and absent or weaker in countries with low poverty; poverty replaces inequality as the favored explanation of health and social ills across states. The new evidence suggests that income distributions are characterized by a complex interplay between inequality and poverty, whose interaction deserves further analysis.

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“…People of higher socioeconomic status (SES) live longer, enjoy better health and suffer less from disability, while those of lower SES die younger and suffer a greater burden of disease and disability (Dalstra, Kunst, Borrell, Breeze, Cambois, Costa et al, 2005;Huisman, Kunst, Bopp, Borgan, Borrell, Costa et al, 2005;Mackenbach, Kunst, Cavelaars, Groenhof, Geurts, Andersen et al, 1997;Marmot, Bosma, Hemingway, Brunner, & Stansfeld, 1997;Marmot, Rose, Shipley, & Hamilton, 1978;Minkler, Fuller-Thomson, & Guralnik, 2006). In many cases the associations between SES and health outcomes take the form of a gradient -the higher the SES the better the health (Adler, Boyce, Chesney, Cohen, Folkman, Kahn et al, 1994;Marmot, 2006). Many different explanations for socioeconomic gradients in health have been proposed, but the causal pathways through which SES determines health in such an orderly way, are not well established (Adler et al, 1994;Steptoe & Marmot, 2002).…”

Section: Introductionmentioning

confidence: 99%

“…In many cases the associations between SES and health outcomes take the form of a gradient -the higher the SES the better the health (Adler, Boyce, Chesney, Cohen, Folkman, Kahn et al, 1994;Marmot, 2006). Many different explanations for socioeconomic gradients in health have been proposed, but the causal pathways through which SES determines health in such an orderly way, are not well established (Adler et al, 1994;Steptoe & Marmot, 2002). Nevertheless, the existence of socioeconomic gradients in health suggests that causal processes do not operate only below a certain threshold through an impact of poverty, instead it points to a generic effect of SES on the health of all people.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic status and health: The role of subjective social status

Demakakos

Nazroo

Breeze

et al. 2008

Social Science & Medicine

586

519

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Studies have suggested that subjective social status (SSS) is an important predictor of health. This study examined the link between SSS and health in old age and investigated whether SSS mediated the associations between objective indicators of socioeconomic status and health. It used crosssectional data from the second wave (2004-05) of the English Longitudinal Study of Ageing, which were collected through personal interviews and nurse visits. The study population consisted of 3368 men and 4065 women aged 52 years or older. The outcome measures included: self-rated health, long-standing illness, depression, hypertension, diabetes, central obesity, high-density lipoprotein cholesterol, triglycerides, fibrinogen, and C-reactive protein. The main independent variable was SSS measured using a scale representing a 10-rung ladder. Wealth, education, and occupational class were employed as covariates along with age and marital status and also, in additional analyses, as the main independent variables. Gender-specific logistic and linear regression analyses were performed. In age-adjusted analyses SSS was related positively to almost all health outcomes. Many of these relationships remained significant after adjustment for covariates. In men, SSS was significantly (p≤0.05) related to self-rated health, depression, and long-standing illness after adjustment for all covariates, while its association with fibrinogen became non-significant. In women, after adjusting for all covariates, SSS was significantly associated with self-rated health, depression, long-standing illness, diabetes, and high-density lipoprotein cholesterol, but its associations with central obesity and C-reactive protein became non-significant. Further analysis suggested that SSS mediated fully or partially the associations between education, occupational class and self-reported and clinical health measures. On the contrary, SSS did not mediate wealth's associations with the outcome measures, except those with self-reported health measures. Our results suggest that SSS is an important correlate of health in old age, possibly because of its ability to epitomize life-time achievement and socioeconomic status.

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Socioeconomic status and health: The challenge of the gradient.

Cited by 2,485 publications

References 76 publications

The lasting impact of childhood health and circumstance

The lasting impact of childhood health and circumstance

Recalibrating the spirit level: An analysis of the interaction of income inequality and poverty and its effect on health

Socioeconomic status and health: The role of subjective social status

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