Socioeconomic Effects on Healthcare - What Is the Gradient?

Published: 2021-06-29 07:11:26
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"One of the central tenets of sociology is that social stratification results in the unequal distribution of desirable resources and rewards in society. In Keeping with this expectation, some of the earliest mortality records indicate the existence of a strong inverse association between socioeconomic status (SES) and mortality: persons of high social status lived longer than their less favored counterparts." (Williams 1990)

Poorer people die younger and are sicker than richer people; indeed, mortality and morbidity rates are inversely related to many correlates of socioeconomic status such as income, wealth, education, or social class. That economic deprivation is strongly related to ill health was perhaps first scientifically documented by René Villermé, who compared mortality rates and poverty across the arrondissements of Paris in the 1820s, although references to the relationship can be found in ancient Greek and Chinese texts. A gradient of health with social class (defined through occupation) has been documented in the United Kingdom since the first census in 1851. In the United States, the landmark study by Evelyn Kitagawa and Philip Hauser merged census and death records to document the relationship between mortality on the one hand and education, income, occupation, race, and place of residence on the other. The gradient persists in recent data. The National Longitudinal Mortality Study (NLMS) merged data from death records with responses from household surveys around 1980. People whose reported family incomes in 1980 were less than $5,000 in 1980 prices are estimated to have a life expectancy around 25 percent lower than those whose family incomes were above $50,000.(Rogot, et al, 1993)
What Is The Gradient?
The relationship between health and income is referred to as a "gradient" to emphasize the gradual relationship between the two; health improves with income throughout the income distribution, and poverty has more than a "threshold" effect on health. In the NLMS data the proportional relationship between income and mortality is the same at all income levels, which implies that the absolute reduction in mortality for each dollar of income is much larger at the bottom of the income distribution than at the top. The gradient is often assessed in terms of other variables; mortality declines with wealth, with rank, and with social status.
Addressing health inequalities.
Many people find it unjust that people should not only be unequal in the amount of goods and services they receive but also in the length and quality of their lives. They believe that addressing these income-related inequalities in health is an urgent task of health policy. The current British government sees the reduction of health inequalities as its primary health-related goal. Other commentators go further and see the economic and social structure of society--especially low income, income inequality, discrimination, and social exclusion--as the ultimate determinants, the "causes of causes," of disease and death. From this perspective, a thoroughgoing redistribution of income and wealth is the key to improving population health. Focusing on "downstream" causes such as the control of health-related behavior or health delivery systems is likely to be futile if the "upstream" causes in the underlying socioeconomic structure remain unreformed. Britain's Acheson report on health inequalities, commissioned by the first Blair government, is the leading example of a set of redistributive policy prescriptions for addressing health inequalities through primarily "upstream" policies. It subsequently formed the basis for a set of government proposals, including general income-support policies such as family and child tax credits, and increases in the minimum wage, which are justified on health grounds. (Mitchell, Shaw, Dorling 2000)

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