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Socioeconomic Status and Health

By March 9, 2011Commentary

Why do people with lower socioeconomic status (lower income, education and occupation) have worse health outcomes?  Researchers have examined this question extensively, and the answers are important in guiding policies to improve the health of these people.  A study published in the Public Library of Medicine provides the latest look at the issue.   (PLoM Study) The study compared a long-running survey of a British population of about 9771  with one in France of about 17,760, looking at health status and behaviors over time, in this case over 15 years in both populations.

The primary goal of the study was to identify any link between socioeconomic status, health behaviors and outcomes, particularly mortality.  It is fairly well-established that lower socioeconomic status is associated with poorer health behaviors and health outcomes, but causation is unclear.  This study found, as expected, that in both populations higher mortality was associated with lower socioeconomic status and worse health behaviors were also associated with being in a lower socioeconomic group.  While the health behaviors appeared to explain about 70% of the higher mortality in the British population, they only seemed to account for 20% in the French one.  The primary reason for this appears to be that there is less of a spread in unhealthy behaviors across the French population than the British one.   Cultural factors may tend to influence health behaviors as much as socioeconomic status.

Other factors than health behaviors which might influence the health/socioeconomic status relationship include stress, social support and material deprivation.  The study raises interesting questions about how the link, if any, between socioeconomic status, health behaviors and health outcomes varies by country or culture.  This analysis may also have some weaknesses because it deals with an employed population that may not well represent the majority of people in lower socioeconomic groups.  The authors also did not look at any workplace wellness programs, which are increasingly used internationally, to determine potential effects of those.

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