Health and Socio-economic Position: A Commentary

From Suet Pudding to Superhero: Representations of Men’s Health for Women

Men’s health has been receiving increasing attention in recent years, both in the media and in academic literature. In February 1998 a British Sunday newspaper, The Mail on Sunday, ran a three-week special feature on ‘A woman’s guide to men’s health’. Linguistic representations of health in popular media are revealing of social concerns regarding both the control of health and health care, therefore we critically analysed these texts using post-structuralist, discourse analytic techniques. Men’s health was constructed as ‘in crisis’ and men tended to be aligned with culture (and work) and women with nature (and health). Paradoxically, certain traditional gender dichotomies were both challenged and reinforced within the texts. However, within the five patterns of discourse we identified (men’s health in crisis, woman as nature/man as culture, the risk-taking superhero, man as infant and health for productivity), women’s current position in society was negatively portrayed and functioned to persuade women that it is in their interests to be responsible for men’s health, although without taking overt control. We conclude that the main representations of men’s health for women in this series reinforce unequal social relations which does little to benefit women or men.

Health Psychology 2000:The Development of Professional Health Psychology

This Final Report of the European Federation of Professional Psychologists' Associations (EFPPA) Task Force on Health Psychology defines the nature and scope of health psychology and its possible future development to the year 2000 and beyond. Training needs and objectives are specified for professional health psychologists working in Europe. Practical and policy implications of medical progress and societal changes are discussed. The future development of health psychology as a profession depends on putting theory and policy into practice through the implementation of high quality training. Currently there are relatively few European countries where this has yet happened. Training programmes need to be introduced in all European countries within the framework of each member- country's national laws, regulations and practices.

Relations among Socioeconomic Status Indicators and Health for African-Americans and Whites

This investigation explored the relationship of socioeconomic status (SES) to physical and mental health in two nationally representative samples of whites and African-Americans. We examined the interrelations among SES variables and assessed their contribution to health for the two racial groups. Throughout, we assessed the contribution of a less traditional indicator of SES-wealth-in the SES-health relationship. As we expected, African-Americans had lower levels of education, household income, and wealth than whites. Unexpectedly, however, the strength of the interrelationships among the three SES indicators did not differ for African-Americans and whites. In addition, we found that SES operated to affect health in a very similar fashion for African-Americans and whites. We found that wealth, in addition to more traditional indicators of SES (education and household income), made a unique and significant contribution to explaining both physical and mental health. Examining relations of different SES indicators to health across groups is critical to eliminating persistent social inequalities in health.

The Relationship of Socio-economic Status, Labor Force Participation, and Health among Men and Women

Using survey data from an extensive sample of Californians in the United States, we examined the relationship among indicators of socio-economic status (SES) and health for men and women in and out of the paid labor force. In contrast to data reported from the mid-1980s in which correlations among SES variables were stronger among men than among women, correlations among education, income, and occupation were similarly high among women and men. All SES variables were significantly related to health, such that as SES increased, self- reported health status increased. Multiple regression analyses demonstrated an additive effect of labor force participation and SES in predicting health among men, with main effects both of labor force participation and of income and education on health. Among women, there was an interactive effect of these variables, such that the relationship of income and of education to health was more pronounced among women who were not in the paid labor force.

The wealthy get healthy, the poor get poorly? Lay perceptions of health inequalities

Research repeatedly identifies an association between health and socio-economic status-richer people are healthier than poorer people. Richard Wilkinson has posited that socio-psychological mechanisms may be part of the explanation for the fact that socio-economic inequalities run right across the social spectrum in wealthy societies. He argues that polarised income distributions within countries have a negative impact on stress, self-esteem and social relations which, in turn, impact on physical well-being. How people experience and perceive inequalities is central to his thesis. However, relatively little empirical work has explored such lay perceptions. We attempt to address this gap by exploring how people see inequality, how they theorise its impact on health, and the extent to which they make personal and social comparisons, by drawing on 14 focus group discussions in Scotland and the north of England. Contrary to other research which suggests that people from more deprived backgrounds are more reluctant to acknowledge the effects of socio-economic deprivation, our findings demonstrate that, in some contexts at least, people from less favourable circumstances converse in a way to suggest that inequalities deeply affect their health and well-being. We discuss these findings in the light of the methodological challenges presented for pursuing such research.

Does income inequality harm health? New cross-national evidence

The provocative hypothesis that income inequality harms population health has sparked a large body of research, some of which has reported strong associations between income inequality and population health. Cross-national evidence is frequently cited in support of this important hypothesis, but the hypothesis remains controversial, and the cross-national work has been criticized for several methodological shortcomings. This study replicates previous work using a larger sample (692 observations from 115 countries over the 1947-1996 period), a wider range of statistical controls, and fixed-effects models that address heterogeneity bias. The relationship between health and inequality shrinks when controls are included. In fixed-effects models that capture unmeasured heterogeneity, the association between income inequality and health disappears. The null findings hold for two measures of income inequality: the Gini coefficient and the share of income received by the poorest quintile of the population. Analysis of a sample of wealthy countries also fails to support the hypothesis.

Income differences in mortality: a register-based follow-up study of three million men and women

OBJECTIVES

We analyse whether the relationship between net household income and mortality form a continuous linear gradient or is curvilinear, assess the attenuation of this association after adjusting for confounding and reverse causality, and assess the strength of the association by age and cause of death.

DESIGN AND SETTING

Prospective study of mortality in Finland among all men and women over 30 years old. Information on household income and sociodemographic factors was from the records of the Finnish tax authorities and the 1990 census. Income data were available for more than 95% of the cohort. Follow-up was by record linkage to death certificates in 1991-1996; altogether about 261 000 deaths.

RESULTS

The all-cause mortality ratio between the lowest and the highest household income decile is 2.37 (95% CI : 2.30-2.44) among men and 1.73 (95% CI : 1.67-1.80) among women. Adjusting for household structure, spouse's economic activity, social class, education and own economic activity attenuates the relationship by 61% among men and 52% among women. The association between income and mortality is mainly linear before and after adjusting for confounding, and the association is strong for all 5-year age groups below 60-64 years, after which it declines rapidly in strength.

CONCLUSIONS

The mainly linear nature of the relationship and the strong attenuation after adjustment for other socioeconomic factors and economic activity status, and the age pattern of the relationship indicate that a large part of the relationship is unlikely to be due to direct causal effects of poverty and material hardship. Rather, income seems to be related to accumulation of factors that increase mortality over the whole range of incomes.

Social psychophysiology, social circumstances, and health

Health varies markedly with social circumstances. While we are still without a comprehensive account of the mechanisms which underlie this variation, it is clear that psychological factors are involved and that key pathways may prove to be psychophysiological. Thus, social psychophysiological research of the kind illustrated in this Special Issue is ideally placed to help unravel some of the mechanisms by which social circumstances impact on health. Nevertheless, the success of this sort of social psychophysiological enterprise most likely depends on reconceptualizing psychophysiological reactivity as a situational, or psychological exposure, concept rather than as an individual difference concept. This shifts the research goal from one of identifying individuals at risk for disease to identifying the psychological exposures that put individuals and groups at risk.