SOCIOECONOMIC STATUS: A Glass Ceiling for Health?
Part II in a two-part series As health researchers become more attuned to the ways that socioeconomic status differentiates people and become less inclined to attribute those differences to race and ethnicity, a new field has opened up to tackle the question: What accounts for a health gradient that persists all the way up to the most well-off in society? Socioeconomic status yields a tangled equation of culture, diet, work environment and social cohesion, each of which, alone or combined, appears to have a graded impact on health. Researchers point to a gradient linking higher SES with lower incidence of morbidity and mortality and lower SES with higher rates of sickness and death (Allison Morgan, American Health Line). A study in the Journal of the American Medical Association last summer found that low income individuals have a mortality rate nearly three times that of their better-off counterparts, even after the authors controlled for behaviors such as smoking and overeating. According to the study, Americans with incomes below $10,000 a year had a death rates 3.22 times that of people making $30,000 or more. Even after the authors adjusted for health risks, the mortality rate was still three times higher.
Stay in School
Like salary, higher education levels seem to buy people more time, said Dr. Nancy Adler of the University of California-San Francisco, noting that as individuals pursue advanced degrees, their mortality rates tend to drop off. However, Adler, who chairs the MacArthur Foundation Research Network on Socioeconomic Status and Health, said the disparity is less pronounced among white women and African Americans. For example, men and women graduating high school have much lower mortality rates than those that do not. The same holds true for college graduates, but only among white men and white women. For individuals in each of those groups, some college education buys more time than their respective counterparts who did not attend college. But researchers have found that the trend does not hold for African-American men and women college graduates -- their mortality rates are lower, but not significantly lower than those with less education. Further, white men with graduate educations again see a drop, but there is no corresponding advantage for graduate-level white women and African-American men and women.
"There may be some harm to your health with bumping into the glass ceiling," speculated Adler. In the case of "highly educated women and African-American men, we know that education doesn't translate into as high incomes" as for white men, but "there's more frustration and there's more stress." More stress, said Dr. Bruce McEwen, director of the laboratory of neuroendocrinology at the Rockefeller Institute, thwarts the body's coping and adaptation systems and causes changes in the body that can lead to disease. (See yesterday's American Health Line for Part I, which focused on the effects of stress on health).
Call to Action
Researchers who gathered last month at the National Institutes of Health for the New York Academy of Sciences' SES conference indicated that a multi-level, multidisciplinary approach is needed to tackle the myriad effects of health disparities. Facilitating social cohesion by creating communities more supportive of individuals might be one route, they said, noting that efforts to teach people to cope with chronic stress might improve health and reduce disparities. Dr. Norman Anderson, associate director of Behavioral and Social Sciences Research at NIH, called for "interdisciplinary research between social, behavioral and biomedical science" -- an indication of the number of levels on which health care disparities could be tackled. Adler singled out education as one way to narrow the health gap. In California, she said, "there's a push to say that [the budget surplus] should go toward education. Well, my guess is that that will have health effects."
Even as the issue moves to the fore and NIH seems to lend an ear -- more than 100 NIH representatives registered for the May conference -- funding is lacking for projects looking at how SES disparities play out in health. The CDC recently analyzed four factors that contributed to premature death, singling out genetics as 20% responsible, the environment as 20%, health care as 10% and health behaviors as 50%, Adler said. "Where is the NIH budget? About 7% is on health behaviors. And if you look at our national health expenditures, less than 2% is preventive and focused on health behavior" (Allison Morgan, American Health Line).