socioeconomic differentials in health

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Socio-economic differentials in health

Socio-economic status (SES) is an important factor in health, illness and health care. SES is usually defined in terms of occupation, education or income, but it is a complex and multi-dimensional construct, which defies simple definition (Marks, 2000). This construct has been found to control large amounts of variance in health outcomes (Alder et al, 1994) and data from many hundreds of studies have shown that SES is strongly correlated will both morbidity and mortality.

The relationship between SES and health has often been seen as the 'health divide', however, this would more accurately be described as a 'health gradient' (Graham, 1998). It has been found that each step up the socio-economic ladder is correlated with an improvement in health. The importance of SES as a 'determinant' in its own right was stressed by Carroll, Davey-Smith & Bennett (1996), who suggested SES-health differentials are not transitory phenomenon, are substantial (Angell, 1993), and are continuous (the health gradient).

Explanations for this 'graded relationship' have largely been based on the 'material/structural' environment (occupation, income, housing) and on 'behavioural/cultural' issues (diet, exercise, risk behaviours). Recent approaches however, have focused on the 'psychological mechanisms' such as social support, social cohesion and personal control. Other researchers have also found evidence to support claims of 'social selection', and have used such verification to explain SES differentials in health.

Social selection holds that "those in poor health tend to move down the social scale, whereas those in good health move up" (Davey-Smith et at, 1996). From this perspective it is expected that health determines SES, a person may become ill after entering the labour marker, and subsequently show a downward drift due to reduced earnings. This would lead to a concentration of those with high mortality risk in the lower SES groups. Meadows (1961) presents evidence for this view suggesting, men with chronic bronchitis suffer just such downward mobility.

Social selection, however, has been criticised on many accounts. Blane (1985) suggests that the SES gradients for ...