Reaching for a Healthier Life
Facts on Socioeconomic Status and Health in the U.S.
Nancy Adler (director) and Judith Stewart (network administrator) with Sheldon Cohen, Mark Cullen, Ana Diez Roux, William Dow,
Gary Evans, Ichiro Kawachi, Michael Marmot, Karen Matthews, Bruce McEwen, Joseph Schwartz, Teresa Seeman and David Williams.
John D and Catherine MacArthur Foundation - Research Network on Socioeconomic Status and Health, 2007-12-17
There are substantial disparities in health and longevity among different sectors of the US population.
Who suffers from poorer health and greater premature mortality? How do these differences come about? What can be done to eliminate these disparities?
Available online as PDF file [52p.] at: http://www.macses.ucsf.edu/News/Reaching%20for%20a%20Healthier%20Life.pdf
“……Reaching for a Healthier Life is the result of a decade of work by the MacArthur Foundation Research Network on SES & Health. This multidisciplinary group of scientists has examined the pathways by which socioeconomic status “gets into the body” to affect health and longevity. There is no single pathway by which this occurs. Rather, resources associated with where people stand on the social ladder shape multiple aspects of their lives in ways that affect their health and well-being. ……”
TABLE OF CONTENTS
Introduction
Fact 1: Social Status Matters for Health, from Birth to Death
Fact 2: Neighborhoods Matter
Fact 3: Employment Conditions Matter
Fact 4: Personal Behaviors Matter
Fact 5: Health Care Matters
Fact 6: Race Matters
Fact 7: Stress Matters
Fact 8: Our Bodies Pay the Price
Policy Implications
Reaching for a Healthier Life: Synopsis
Key findings are:
(1) The effects of socioeconomic status are substantial. They are not limited to the effects of poverty but occur at all levels. Premature death is more than twice as likely for middle income Americans as for those who are the best off, and more than three times as likely for those who live near or in poverty compared to the most privileged.
(2) Throughout life, from birth onward, our access to socioeconomic resources affects our chances for living a healthy life. The conditions we live in during childhood affect our health throughout our lives.
(3) Health care is important when we are ill but accounts for only a small portion of health disparities. More important are factors that determine if we fall ill in the first place.
(4) Each step up the social ladder provides greater access to social and physical environments that enable individuals to engage in health protective behaviors, (e.g., safe places to walk and access to healthier foods).
(5) Conditions at work can contribute to health and health disparities. Jobs held by those lower on the ladder are more likely to involve shift work and physical hazards, low control over how and when tasks are done, job insecurity, and conflicts between family obligations and work requirements.
(6) Exposure to extreme and prolonged stress,( “toxic stress”), is more common lower on the social ladder. Stressors that last a long time, like financial insecurity, interpersonal disputes, work-induced exhaustion, or chronic conflict are recorded in the body.
(7) The biological consequences of exposure to stress are not transitory; they are cumulative. The normal functioning of the cardiovascular, immune, metabolic and nervous systems is disrupted. This disruption is made worse by poor health habits molded by social and physical environments lacking health-promoting alternatives.
What can be done?
Two kinds of policies are required to reduce premature death and eliminate health disparities:
1. Policies that impact income and wealth distribution, educational attainment and occupational mobility, and
2. Policies that buffer individuals from the damaging conditions of living below the top rungs.
Supporting educational attainment, assuring a living wage, reducing crime, increasing opportunities for control at work, banning sale of soft drinks and junk food in schools are just a few policies with health consequences. Economic, education, labor and zoning policies are all health policies.
The facts contained in this document support the case that policies to support healthy living conditions for all citizens are needed. The cost of implementing such policies would be offset by subsequent savings through increased productivity and lower health case costs. The initial investment would be money well spent. The one thing we cannot afford to do is nothing.
Reaching for a Healthier Life is available electronically, or write the network office to request a hardcopy at michael.daluz@ucsf.edu or judith.stewart@ucsf.edu.
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