People whose socioeconomic status is low are more likely to act in ways that harm their health compared with those higher on the ladder of income and social stature. On average, they smoke more, exercise less, have poorer diets, and more often ignore health advice and fail to comply with treatment. As a group, they are even less likely to use seatbelts.
Researchers have proposed many theories to explain why this is so, and these involve more than the inability to pay for goods and services that promote health.
Investing less in health behavior may be a positive adaptation to socioeconomic deprivation, according to a theory inspired by evolutionary biology. In other words, it’s like deciding to spend little on car maintenance when you live in a neighborhood of rampant car theft. Living under threat of high mortality from outside causes may set a limit on how much energy it is worth to put into lowering mortality from internal causes.
So far, there is no grand unified theory that accounts for all social, psychological and political forces that press on people on the lower rungs of the socioeconomic ladder. In an informative review, Fred C. Pampel, Patrick M. Krueger, and Justin T. Denney break down the evidence for and against nine major pathways by which socioeconomic status shapes health behavior. Learn about those pathways.
People with low socioeconomic status are more likely to act in ways that harm their health compared with those higher on the ladder of income and social stature.
On average, they smoke more, they exercise less and their diet is less wholesome. As a group, they are even less likely to use seatbelts. Researchers have struggled for years to understand why this is so. It involves more than the inability to pay for goods and services that promote health. Cigarettes are expensive, after all. Walking and many other forms of exercise don’t require money, and neither does clicking a seatbelt.
Photo by Roman Pavlyuk via Flickr
One explanation that’s drawing a lot of media attention, perhaps to the point of going overboard, is the idea that poverty overloads the capacity of the brain to make sound decisions. This is the hypothesis advanced in “Scarcity,” an important, fascinating – and expertly publicized – book by behavioral economist Sendhil Mullainathan and cognitive psychologist Eldar Shafir that has been the basis for dozens of news reports since it was published in August. Continue reading
Image by Jay Reimer via flickr.
Medical study authors routinely claim to have “controlled” for socioeconomic status.
That kind of sweeping assertion should set off alarm bells. The authors probably haven’t come close to fully accounting for something as difficult to measure as a person’s place in the hierarchy of self-determination and power, neighborhood quality, working conditions, job security, income and wealth.
To assume otherwise is a mistake that can lead to misleading conclusions.
Consider, for example, a recent study in the journal Nature Medicine describing a genetic variation that might account for lower heart disease survival among African Americans. News coverage of the study caught my attention because whatever role genetics plays in the black/white disparity in heart disease, it’s probably small.
Some researchers have concluded that socioeconomic disadvantage is the most significant root of the problem, not genetic differences. And there is pretty good evidence that the traditional risk factors (diabetes, high blood pressure, lack of physical activity, obesity, smoking) account for all of the difference in heart disease mortality between black and white men in the United States, and most of the difference between black and white women. Continue reading
Dozens of news stories over the past year have reported on the disturbing data showing that Americans are dying younger than people in other wealthy countries and falling behind in many other measures of population health.
But much of the reporting I’ve seen shies away from covering a crucial part of the story: How social inequality may be the most important reason why the health status of Americans is failing to keep up with progress elsewhere.
Being born into poverty, growing up with curtailed opportunities for education and employment, living in a disadvantaged neighborhood – these social determinants of health are like the cards you’re dealt in a game of poker. It’s hard to win if the deck is stacked against you.
Researchers in sociology and public health have developed a fair amount of evidence that social status (typically measured by income or education) may be the most significant shaper of health, disability and lifespan at the population level. In the picture that is emerging, social status acts through a complicated chain of cause-and-effect. Education equips people with knowledge and skills to adopt healthy behaviors. It improves the chances of securing a job with healthy working conditions, higher wages, and being able to afford housing in a neighborhood secure from violence and pollution. The job security and higher income that tend to come with more education provide a buffer from chronic stress – a corrosive force that undermines health among lesser educated, lower income people. Research consistently shows that more education gives people a greater sense of personal control. Positive beliefs about personal control have a profound impact on how people approach life, make decisions about risky behavior, and cope with illness. Continue reading