Socioeconomic status (SES) is the social and economic position of an individual in a given society. Indicators of socioeconomic status such as occupation, education, and income are what influence health outcomes. Higher SES is associated with a lower risk of mortality and morbidity whereas an inverse relationship is seen with low SES (Adler & Newman, 2002; American Psychological Association, 2015). Health problems experienced in low SES groups include low birthweight, cardiovascular disease, hypertension, arthritis, diabetes and cancer. In Canada, only 43% of people with the lowest incomes reported having very good or excellent health compared with 73% of people with the highest incomes (Public Health Agency of Canada, 2013). The former group also had a greater risk of early death and more illnesses. Given these observations, the relationship between SES and health can be strongly attributed to income; however, could the aforementioned relationship be due to other social and psychological factors independent of wealth?
In a prospective study that observed middle-aged British civil servants, subjective SES was compared against objective SES to determine which better predicted health status and health status decline over time (Singh-Manoux, Marmot, & Adler, 2005). The study found that subjective feelings, such as financial security, better predicted health outcomes than objective measures like as education and income. These findings suggest that the perception of wealth rather than wealth itself better accounts for the relationship between SES and health.
Another study that demonstrated that SES influences health regardless of income was performed by Redelmeier and Singh in 2001. Their study assessed whether actors and actresses who had won Academy Awards had a greater life expectancy than those who had not won. The researchers found that Academy Award winners lived approximately 3.9 years longer compared to non-winners despite the number of nominations, and the survival advantage remained consistent after adjustments for sex, age, ethnicity, country of origin, name changes, age at first film release, and total career films. Total career films measured income indirectly, and this measure was not associated with death rates, thus supporting the notion that status alone can improve health outcomes regardless of income.
An animal study has also provided some insight into the relationship between social position and health. An experiment, conducted by Tung et al. (2012), on primates (female rhesus macaques) sought to determine the biological mechanisms that underlie the effects of social environments on health. The study demonstrated that dominance rank within a social group influenced gene expression and activity to such a degree that a blood test alone could determine the social status of a specimen with 80% accuracy. Additionally, this gene expression was implicated in the development of various chronic diseases, although these were not explicitly discussed in the research (Egger, 2012). Seeing as the animal subjects lived in carefully controlled environments, this study provides evidence that social standing alone can influence health outcomes.
In conclusion, the aforementioned studies imply that SES can affect health in a way that is independent of income. Therefore, attempting to reduce health disparities by focusing solely on income-based solutions is an inadequate strategy that over-simplifies the link between SES and well-being. Furthermore, these research findings highlight the role of psychological factors and subjective social position in determining health status.
Adler, N.E., & Newman, K. (2002). Socioeconomic disparities in health: Pathways and policies. Health Affairs, 22(2), 60-76.
American Psychological Association. (2015). Work, stress, and health & socioeconomic status. Retrieved from http://www.apa.org/pi/ses/resources/publications/factsheet-wsh.aspx
Egger, G. (2012). In search of a germ theory equivalent for chronic disease. Prev Chronic Dis, 9, e95.
Public Domain Pictures (Photographer). (2014). Chess [Photograph], Retrieved from https://pixabay.com/en/chess-strategy-chess-board-316658/
Public Health Agency of Canada. What makes Canadians healthy or unhealthy. Retrieved from http://www.phac-aspc.gc.ca/ph-sp/determinants/determinants-eng.php#income
Singh-Manoux, A., Marmot, M.G., Adler, N.E. (2005). Does subjective social status predict health and change in health status better than objective status? Psychosomatic Medicine, 67, 855-861.
Tung, J., Barreiro, L.B., Johnson, Z.P., Hansen, K.D., Michopoulos, V., Toufexis, D., … Gilad, Y. (2012). Social environment is associated with gene regulatory variation in the rhesus macaque immune system. PNAS, 109(17), 6490-6495.
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