Living in a Social World
Psy 324: Advanced Social Psychology
Spring, 1998

Health and Socioeconomic Status
By
Riki Evans

Although socioeconomic status is often considered a variable when conducting psychological research about health, the actual variables within socioeconomic status that lead to disparities among classes are often ignored (Adler, Boyce, Chesney, Cohen, Folkman, Kahn, & Syme, 1994). Socioeconomic status is a variable predictive of rates of almost every disease and ailment and the mortality and morbidity rates that can result. Socioeconomic status is linked to health at every level of class. Individuals who are below the poverty line are certainly at risk for lower health due to lack of and under utilization of health care due to financial constraints. However, the relation between socioeconomic status and health appears at every level of the socioeconomic status, not just around the poverty line. Thus, even those individuals just a few points above on the socioeconomic status hierarchy enjoy better health than those directly below.

    Socioeconomic differences have been found in respiratory illness in infants (Margolis, Greenberg, Keyes, LaVange, Chapman, Denny, Bauman, & Boat, 1992), cardiovascular disease (Winkleby, Jatulis, Frank, & Fortmann, 1992), and depression (Adler, et al., 1994). Other factors that can contribute to disease and disorder are also more prevalent among those of lower socioeconomic status such as smoking, small amounts of physical activity (Adler, et al., 1994), obesity (Sobal & Stunkard, 1989), hostility, and large amounts of stress (Adler, et al., 1994). Stress manifests itself in two main ways; through exposure to life events that cause stress, and through a perceived inability to cope with demands. Those of higher class standing avoid experiencing this degree of stress due to less stressful factors in the surrounding environment and access to a larger number of social supports and resources than available to those of lower class. In addition to increased stress, lifestyle incongruity (living beyond one’s means) was also found to be associated with family health (Dressler, 1994). The lower in socioeconomic status one is the harder it might be to purchase needed, as well as desired items without overextending one’s budget.

    Haan, Kaplan, and Camacho (1987) found that sociophysical environment factors may be important contributors to the relationship between health and socioeconomic status. This study held constant: baseline health status, race, income, employment status, access to medical care, health insurance coverage, smoking, alcohol consumption, physical activity, body mass index, sleep patterns, social isolation, marital status, depression, and personal uncertainty, yet the relationship between socioeconomic status and health persisted. The association between SES and poor health continued despite individual behaviors.

    Adler, Boyce, Chesney, Cohen, Folkman, Kahn, and Syme (1994) provide evidence of the relation between socioeconomic status and health. The authors claim that although socioeconomic status is not a standardized measure, all measures used such as economic status (measured by income), social status (measured by education), and work status (measured by occupation) have been found to demonstrate differences in socioeconomic level health outcomes in terms of disease prevalence, duration, and mortality rates. For example studies by the British Civil Service and in the United Kingdom indicated that morality rates were inversely related to work status as measured by occupational level, while studies in the United States using educational level were also predictive of mortality rates. In all measures of socioeconomic status, mortality rates, and disease rates were inversely related.

    Most research has looked at affects of material differences between the social classes for explanations as to why the health differs. Yet, even access to health care, a view taken by many, was found to not be able to explain the association completely (Burstin, Lipstiz, & Brennan, 1992). Those who are uninsured are more likely to be at risk for substandard medical care, however, socioeconomic status was not independently associated with risk to substandard medical care. Thus, other psychological and behavioral variables have started to be researched.

    Pincus and Callahan (1995) suggest that there are many impacting variables that contribute to the lower health of low socioeconomic status groups. The authors claim that it is true that the lower health is in part a result of lack of availability and utilization of care as well as personal health behaviors. However, Pincus and Callahan argue that psychological and cognitive constructs related to lower socioeconomic status such as "social support, anxiety, depression, health locus of control, learned helplessness, sense of coherence, self-efficiency, optimism, time preference, and health knowledge" are all mechanisms that combined increase the disparity in low socioeconomic status health outcomes primarily due to lower education levels. Educational levels were the most significant predictor of disease and decreased health in many studies offered for examination by Pincus and Callahan (1995). The authors illustrate the point that all factors examined in this paper are interrelated, especially those of health and education.

    Lachman and Weaver (1998) suggest that those with lower income not only have lower health, but also lower perceived control over their environment. In all income groups the authors accessed, those individuals with larger perceived control had better health. In addition, those in the lower socioeconomic group that had higher perceived control demonstrated health comparable to that of those in the high socioeconomic status groups. Thus, a sense of control may be a moderator of socioeconomic status health differences, that is in general lower in the lower social classes. Adler (1994) adds that the sense of control one perceives themselves to have can also affect choices about "education, occupation, housing, medical care, and other parts of the social class experience."

    Adler, Boyce, Chesney, Cohen, Folkman, Kahn, and Syme (1994) propose three possible mechanisms through which to view the inverse relationship between socioeconomic status and health. One possible mechanism is that some individuals are genetically predisposed to be concurrently in lower socioeconomic status levels and have poorer health. This is unlikely, however, since genetic factors such as height have been shown to not significantly differ due to social class. It has also been shown that compliance with medical advice is reliably unrelated to intelligence or education.

    The second mechanism is often referred to as the drift hypothesis. This explanation indicates that low health is predictive of SES, not SES predictive of poor health. Research on schizophrenia done by Goldberg and Morrison (1963), for instance, shows a tendency for those with schizophrenia to descend in economic status as their disease progresses. However, in further research this hypothesis also appears unlikely since although there is somewhat of a shift in socioeconomic status with poor health it is too small to explain the relationship of health and socioeconomic status. Dorenwend, Levav, Shrout, Schwartz, Naveh, Link, Skodol, and Stueve (1992) suggest that perhaps the tendency for schizophrenia to result in shifts downward in socioeconomic status is unique to schizophrenia. The authors found that social selection was important for schizophrenia, but that other disorders such as depression (for women), antisocial personality disorders, and substance abuse disorders (for men) are more a result of social causation. Research done to look at reduced health in the elderly population has revealed that there is a link between deterioration of health and education level. However, health can not logically affect past education levels. In addition, if it is assumed that poor health results in lower socioeconomic status than it would be expected that their would be no direct association for family members. However, when measuring socioeconomic status by income or occupation of the head of the household, for families and for retired individuals (whose financial income status is no longer dependent on earned income) the associations are generally as strong as for the heads of the households.

    The third mechanism and the one most highly supported by Adler, Boyce, Chesney, Cohen, Folkman, Kahn, Syme (1994) suggests that socioeconomic status effects biological functioning which influences health status. Although little is known about the association between socioeconomic status and biological functioning, it is hypothesized that it may be due to the high degree in which the components of one’s life such as income, education, and occupation affect some key domains of life. The physical environment in which one lives may be dangerous due to exposure to environmental hazards. The quality of the social environment can be affected by aggression and violence as well as ability to find social support. Socialization and life experiences influence mood and other aspects of psychological development, cognition, and health behaviors. Thus, it is the impact of living a lower socioeconomic life that can lead to the development of poor health. The research in this area is not complete, but quickly gaining momentum as more and more researchers recognize and acknowledge the issue.

Back to Top

Back To Psy 324 Home Page
Back to Psybersite

References

    Adler, N. E., Boyce, T., Chesney, M. A., Cohen, S., Folkman, S., Kahn, R. L., & Syme, S. L. (1994). Socioeconomic status and health: the challenge of the gradient. American Psychologist, 49, 15-24.

    Burstin, H. R., Lipstiz, S. R., & Brennan, T. A. (1992). Socioeconomic status and risk for substandard medical care. JAMA, 268, 2383-2387.

    Dorenwend, B. P., Levav, I., Shrout, P. E., Schwartz, S., Naveh, G., Link, B. G., Skodol, A. E., & Stueve, A. (1992). Socioeconomic status and psychiatric disorders: the causation-selection issue. Science, 255, 946-952.

    Dressler, W. M. (1994). Social status and the health of families: a model. Social Science Medical Journal, 39, 1605-1613.

    Goldberg, E. M., & Morrison, S. L. (1963). Schizophrenia and social class. British Journal of Psychiatry, 109, 785-802.

    Haan, M., Kaplan, G. A., & Camacho, T. (1987). Poverty and health. Journal of Epidemilogy, 125, 989-999.

    Lachman, M. E., & Weaver, S. L. (1998). The sense of control as a moderator of social class differences in health and well-being. Journal of Personality and Social Psychology, 74, 763-773.

    Margolis, P. A., Greenberg, R. A., Keyes, L. L., LaVange, L. M., Chapman, R. S., Denny, F. W., Bauman, K. E., & Boat, B. W. (1992). Lower respiratory illness in infants and low socioeconomic status. American Journal of Public Health, 82, 1119-1125.

    Pincus, T., & Callahan, L. F. (1995). What explains the association between socioeconomic status and health: primarily access to medial care or mind-body variables? Advances: The Journal of Mind-Body Health, 11, 4-37.

    Sobal, J., & Stunkard, A. J. (1989). Socioeconomic status and obesity: a review of the literature. Psychological Bulletin, 105, 260-275.

    Winkleby, M. A., Jatulis, D. E., Frank, E., & Fortmann, S. P. (1992). Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. American Journal of Public Health, 82, 816-819.

Please note:  Original materials in these pages can be used for research and education, but please credit the authors and the source.  All copyrighted materials are used here with permission and may not be reused without contacting the copyright holder.