the relationship between socioeconomic status and health.
Health inequality exists in every society. The prevalence of health disparities across different
strata is not a phenomenon unique to a particular country, nor is it unique to our time or even to
our species.
Bhattacharya, Jay, et al. Health Economics, Bloomsbury Publishing Plc, 2013. ProQuest Ebook
Central, http://ebookcentral.proquest.com/lib/nuim/detail.action?docID=4763994.
We can depict the plight of this population with a survival curve, a graph that tracks the fraction of
the group still alive at each age.
figure shows that 18-year-olds who will eventually graduate from college are likely to survive
longer than 18-year-old high-school dropouts
Mortality or life expectancy is an extreme measure of health; two people living out the same
lifespan could enjoy very different levels of health. In fact, health disparities emerge almost no
matter how health is measured. For instance, another commonly used measure of health is
self-reported health status, usually delineated on a scale ranging from 1 (poor health) to 5
(excellent health). High-income individuals routinely self-report better health status on this scale
than low-income individuals
Finally, health disparities between different social groups have been found even in nonhuman
societies. Biologist Robert Sapolsky has spent decades studying social interactions and
hierarchies among baboon troops in East Africa. He consistently found that dominant baboons at
the top of their social hierarchies are in better health than subordinate baboons.
https://doi.org/10.26504/rs193
Lone mothers1 in the GUI study are younger than mothers in couples, have lower educational
qualifications and are less likely to live in owner occupied housing.
Lone parent families are smaller than two parent families and this difference widens over time.
By the time the study child is aged nine years, 34 per cent of lone parent families have only one
child compared to 8 per cent of two-parent families.
Disparities exist between never married and previously married lone parents, with the latter
showing higher education levels and greater likelihood of being a home owner
Employment rates rise over time with the child’s age and improving labour market conditions: at
the 9-year interview 57 per cent of lone mothers are employed compared to 64 per cent of
coupled mothers.
However, throughout the period lone parent families faced a higher risk of economic vulnerability
than two-parent families.
Becoming a lone parent leads to a significant increase in economic vulnerability
Those who become lone parents are almost three times more likely to be economically
vulnerable compared to those who remain in two-parent families, even when adjusting for
previous vulnerability experience and other characteristics.
This points to the persistent difficulties lone parents face in the labour market, including
constraints on their hours of work due to the care needs of their children, low pay and higher
levels of in-work poverty.
Lone parents and their families are consistently among the most economically disadvantaged
groups in Ireland. They experience much higher than average levels of income poverty, material
deprivation, consistent poverty (e.g. Roantree et al., 2021), economic vulnerability (Maître et al.,
2021), in-work poverty (Roantree et al., 2022), inadequate housing conditions (Laurence et al.,
2023) and discrimination in access to housing (Grotti et al., 2018).
Additionally, in an EU wide study Calegari et al. (2024) found that prior material and social
deprivation is a strong predictor of current deprivation for all household types, but stronger
among lone parent households than households with two adults and children.
Lone mothers may also be more likely to experience discrimination in the labour market: lone
parents in Ireland were more likely to report discrimination in their search for work than partnered
parents (McGinnity et al., 2017, though this difference was statistically insignificant when other
characteristics were taken into account such as ethnicity and age). There is also evidence for
Ireland that lone mothers are significantly more likely to have low paid jobs compared to other
women with the same levels of education and family characteristics (Hingre et al. 2024).
The measure of economic vulnerability was developed in an earlier report on child poverty
(Maitre et al., 2021) and is based on three indicators associated with the experience of poverty
and social exclusion: low income, economic stress and material deprivation. This measure
follows from a conception of poverty as a multidimensional experience and incorporates risk
exposure as well as the current situation (Chambers, 1989; Breen and Moisio, 2004; Watson et
al., 2015; Watson et al., 2014).
Previous research from the Growing Up in Ireland study reveals that lone parents and their
children are considerably more prone to persistent poverty compared to two-parent families
(Maître et al., 2021).
Having more children increases the risk of economic vulnerability; having a disability, lower
education levels, few working hours and non-employment all increase the risk among lone
parents.
Aartsen, M., Veenstra, M. and Hansen, T. (2017), “Social pathways to health: On the
mediating role of the social network in the relation between socio-economic
position and health”, SSM - Population Health, Vol. 3, pp. 419–426, doi:
10.1016/j.ssmph.2017.05.006.
Berkman, L.F., Kawachi, I. and Glymour, M.M. (2014), Social Epidemiology, Oxford
University Press.
Moreover, socioeconomic inequalities in health status are not just a threshold effect of poverty;
there is a “gradient” in health across the SES hierarchy such that the higher the level of
household income, wealth, education, or occupational ranking, the lower the risks of morbidity
and mortality. The gradient of health is observed almost throughout the range of socioeconomic
status, so that the middle class have better health than the poor, and the wealthy have better
health than the middle class (2).
The lower an individual’s position in the occupational hierarchy of a workplace, the worse their
health status; and the lower someone’s educational attainment, the lower their health
achievement.
In other words, individuals are constrained to behave in unhealthy ways by their social
circumstances, which render other behaviors extremely costly or impossible, and no amount of
health information or good intentions will induce a long-term change.
A limitation of fundamental cause theory is that it does not imply anything specific about the
linkages between different resources (knowledge, money, prestige, beneficial connections) and
specific health outcomes. What it tells us is that the high-SES groups will tend to do better no
matter what.
Even if there were a static, unchangeable SES indelibly stamped on us from birth, it would be
implausible to suggest that shocks to income and education have no impact on the consumption
of goods or behavioral choices people make, many of which may be relevant to health.
people may take advantage of their good health to improve their social resources, for example by
accepting hazardous but high-paying employment
although different SES domains are interrelated (education affects income, income affects
wealth), each of them constitutes a different set of health-relevant resources, and their effects on
health may be fundamentally different.
In order to identify effective approaches to address social inequalities in health, it is critical to
incorporate the dimension of time and, in particular, the differential influence of stages of the
lifecourse.
Accumulation of risk models imply that each additional episode of low SES adds to an
ever-growing health disadvantage.
This is related to the more psychologically based “status inconsistency theory” (à la Robert
Merton) that people from low-SES backgrounds don’t “fit” in high-SES society (the “Eliza Doolittle
effect”), and that this may lead to stress and bad health outcomes. There are some documented
examples of this in recent research; for example, in a longitudinal study of 102 adolescents,
Marin et al. found that a socioeconomic trajectory starting with low early-life SES that increased
through childhood was associated with the highest blood pressure levels in adolescence (36).
In another follow-up of a representative sample of 489 African American youth living in the rural
South, those adolescents who exhibited high levels of competence at ages 11–13 (as reported
by their teachers on ratings of diligence, patience, and social skills) were more likely to be
enrolled in college at age 19. The authors interpreted their findings as a corroboration of
Sherman James’s John Henryism hypothesis (38), that is, active striving to achieve upward
social mobility can lead to deleterious health consequences for disadvantaged groups, in this
instance, rural black Americans.
the relation between income and overweight/obesity is partially driven by reverse causation, that
is, it is not that lack of income causes people to gain weight; rather, it is overweight/obesity that
leads to loss of income.
Historically, there have been tremendous differences in both quantity and quality of education
both between races (de jure racial segregation of schools prevailed in much of the US until 1954,
and de facto segregation continues today), across place of residence at both a
local/neighborhood and regional level, and by parental SES
Educational differences are sometimes dismissed as spurious on the grounds that it is really
income that affects health.
social inequalities in health may increase over time if some individuals are moved out of the
most disadvantaged social categories, for example, if population-average education is increased.
The UK Black Report was the first to entertain this possibility, namely, that upward social mobility
would leave behind a (shrinking) pool of the most disadvantaged people, resulting in apparent
widening of health inequalities