New Horizons in Health An Integrative Approach (2001) / Chapter Skim
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The Influence of Inequality on Health Outcomes
The Influence of Inequality on Health Outcomes
Pages 100-117
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From page 100... ...
Better understanding of the mechanisms involved may suggest concrete ways to improve the health of both individuals and population subgroups. SOCIOECONOMIC STATUS AND HEALTH Health is related to both the quantitative and qualitative aspects of material and social change.
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From page 101... ...
Widening health disparities appear to be primarily driven by larger improvements in the health of high-SES groups compared to their lower-SES counterparts. For some health conditions, however, there has been no change in health or worsening health status over time for economically disadvantaged populations (Williams and Collins, 1995~.
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From page 102... ...
Most studies attempting to identify stressful life experiences and other features that predict later disease and mortality have incorporated neither long-term processes nor cumulative experience. There is a singular lack of studies integrating community-level and individualleve!
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. Two stressors in the family complex provide a 5 percent rise in the disorder rate; three stressors a 6 percent increment, and four or more stressors a 21 percent increment in the rate of childhood psychiatric disorders.
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An important research topic for the future is further investigation of linkages between cumulative SES-related adversity and cumulative physiological risk, represented by allostatic load, as well as assessment of psychosocial and behavioral factors that can offset the accumulation of such load. The Need for Integrative Longitudinal Studies There are few longitudinal data sets that both cover long stretches of lives (e.g., 35 plus years)
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From page 105... ...
These data have afforded an evidential basis for linking cumulative economic and relational adversity to high allostatic load (Singer and Ryff, 1999~. WLS and the British birth cohorts represent the best of what is currently available on psychosocial experience across multiple life domains through time.
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From page 106... ...
Native Americans have lower death rates than whites for heart disease and cancer but higher mortality rates from injuries, flu and pneumonia, diabetes, suicide, and cirrhosis of the liver. In addition, the health status of the 60 percent of Native Americans who are covered by the Indian Health Service (a federal agency that provides medical care to Native Americans who live on or near reservations)
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From page 107... ...
For example, the Hispanic category encompasses more than 25 national origin groups that share a common language, religion, and traditions but that vary dramatically in terms of the timing of immigration, regional concentration, incorporation experiences, and socioeconomic status. Not surprisingly, there is considerable variation in health status within the Hispanic group (Sortie et al., 1993; Vega and Amaro, 1994~.
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From page 108... ...
Racism can affect racial disparities in multiple ways. First, racial differences in socioeconomic status, one of the strongest predictors of variations in health, partly reflect the impact of economic discrimination produced by large-scale societal structures.
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From page 109... ...
Other recent epidemiological studies reveal that perceptions of discrimination are adversely related to other measures of physical and mental health for a broad range of population groups (Kessler et al., 1999; Noh et al., 1999; Williams et al., 1999; Dion et al., 1992~. Two recent studies have found that perceptions of discrimination make an incremental contribution over education and income in accounting for racial differences in self-reported measures of physical health (Williams et al., 1997; Ren et al., 1999~.
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From page 110... ...
Resources The lower levels of suicide for African Americans compared to whites is consistent with other mental health data and reflect a well-documented paradox. Blacks tend to have higher levels of ill health for most measures of physical health and are disadvantaged compared to whites on measures of subjective well-being, such as life satisfaction (Hughes and Thomas,
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From page 111... ...
Research that conceptualizes and operationalizes the specific beliefs and behaviors that may be promotive of health is an important frontier of research on social inequalities and health. RECOMMENDATIONS Moving beyond the current NIH initiatives on socioeconomic status and health, the committee recommends the following: · characterization of behavioral and environmental risks associated with educational, economic, and occupational disparities; · elaboration of the subjective experiences of racism, discrimination, and stigmatization and their effects on behavior as well as their neurobiological substrates; · assessment of health-related impacts of large-scale societal structures (e.g., racial segregation, economic discrimination, differential access to services and medical care)
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From page 112... ...
Berkman LF, Syme SL. 1979 "Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents" American Journal of Epidemiology 109/ 2:186-204.
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The Adverse Childhood Experience (ACE) Study" American Journal of Preventive Medicine 14/4:245-258.
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George L, Weissman M, Bednarski P 1986 "The increased risk for specific psychiatric disorders among persons of low socioeconomic status" American Journal of Social Psychiatry 6/4:259-271.
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Marmot MG, Syme SL. 1976 "Acculturation and coronary heart disease in Japanese-Americans" American Journal of Epidemiology 104/3:225-247.
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1995 "Infant mortality in the United States: Trends, differentials, and projections, 1950 through 2010" American Journal of Public HealtI7 8517:957-964. Singh GK, Yu SM.
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1997 "Childhood influences on adult health: A review of recent work from the British 1946 national birth cohort study, the MRC National Survey of Health and Development" Pediatric and Perinatal Epidemiology 11/1:2-20.
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