U.S. Health in International Perspective Shorter Lives, Poorer Health (2013) / Chapter Skim
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6 Social Factors
6 Social Factors
Pages 161-191
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From page 161... ...
These factors have been shown to contribute to large health disparities in the United States and other countries and should be considered in efforts to explain disparities in health among countries. Although the science of the social determinants of health is still evolving, a growing body of biological, epidemiological, and social science research has revealed pervasive and strong links between a range of social factors that shape living and working conditions and a wide array of health outcomes.
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From page 162... ...
health disadvantage and that can be compared across high-income countries: income and poverty, income inequality, education, employment, social mobility, household composition, and experiences based on racial or ethnic identification (Galea et al., 2011; Link and Phelan, 1995; Marmot, 2005)
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From page 163... ...
, accumulated wealth (Pollack et al., 2007) , educational attainment (Elo and Preston, 1996; Jemal et al., 2008a; Woolf et al., 2007)
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, suggesting that economic stresses may also affect health through other pathways. Access to employment, educational opportunities, and medical care can be constrained by one's income, particularly in the absence of adequate public transportation (Gordon-Larsen et al., 2006)
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Income Inequality Income inequality in a society has repeatedly been shown to be inversely associated with good health, but there is controversy about the health effects of relative income inequality apart from the effects of absolute poverty or economic hardship (Subramanian and Kawachi, 2004)
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From page 166... ...
Social Status Income, wealth, education, and employment all have implications for prestige and acceptance in society, and hence may affect health through psychosocial pathways involved in perceived position in a social hierarchy. Lower perceived social status has been associated with adverse health outcomes in some studies even after considering objective measures of resources and social status (Singh-Manoux et al., 2003, 2005)
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From page 167... ...
.7 For example, in the United States, W blacks with the same level of education as whites have lower incomes, as well as markedly lower levels of accumulated wealth even at the same level of income (Braveman et al., 2005; Kawachi et al., 2005)
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From page 168... ...
. A relative difference in social standing or a sense of social exclusion for any reason may induce stress and influence one's sense of self-worth or control, which may in turn influence subsequent economic success, health-related behaviors, and health outcomes (Dunn, 2010; Umberson et al., 2008)
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From page 169... ...
For example, the educational attainment and cognitive skills of today's youth could influence the behaviors that contribute to infant and child mortality due to rates of accidents and homicides; adolescent births and sexually transmitted infection; HIV/AIDS; and drugrelated mortality. Chronic material hardship or stressful events in childhood may also manifest their effects in mid- or even late adulthood (Cohen et al., 2010; Goodman et al., 2011)
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From page 170... ...
Readily comparable cross-national data are not available on all relevant factors. For example, racial and ethnic disparities are important to health, but data are lacking to compare the United States with peer countries in terms of the magnitudes of racial and ethnic health disparities. Data are available, however, to examine health disparities by income, education, and other socioeconomic determinants.
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From page 171... ...
Poverty The relative poverty rate,10 defined as the proportion of the population with low incomes relative to the median income, has been higher in the United States than in other high-income countries since at least 1980 (Luxembourg Income Study, 2012)
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By the late 2000s, the relative poverty rate in the United States exceeded that of all 16 peer countries. It also exceeded rates in 31 OECD countries, including Australia, Chile, the Czech Republic, Estonia, Hungary, Japan, Korea, Mexico, New Zealand, Poland, the Slovak Republic, Slovenia, and Turkey (OECD, 2011e)
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NOTES: Poverty rates are based on relative poverty, defined here as incomes below Fig6-1.eps 50 percent of the median income of the country. Poverty rates for Switzerland were not available for certain years.
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FIGURE 6-2 Child poverty in 17 peer countries. NOTES: Poverty rates are based on relative poverty.
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adults aged 25-64 had completed an average of 13.3 years of formal education, ranking fourth among the 17 peer countries examined in Part I The ranking for older adults (ages 45-64)
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.15 As shown in Figure 6-5, among 13 peer countries that provided data for 2009, 10 countries16 exceeded the United States in the percentage of the population who had graduated from upper secondary education.
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Among the 17 peer countries examined in Part I, the United States ranks second in tertiary education among people aged 55-64, third for those aged 45-54, fourth for those aged 35-44, and ninth for those aged 25-34.17 Figure 6-6 shows that college completion among adults aged 25-34 is higher in eight peer countries than in the United States. It is also higher in a number of countries outside the peer group, such as Korea and Russia (OECD, 2011a)
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.18 As of 2006, 10 of the peer countries19 that reported data outperformed the United States on the percentage of the population of the typical graduation age who had received bachelor's degrees (National Center for Education Statistics, 2012c)
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The countries participating in the 2001 PIRLS included 9 of the 17 peer countries examined in Part I and, among these, the United States ranked fifth for combined reading literacy of fourth graders. The 2006 PIRLS included 12 peer countries, among which U.S.
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health disadvantage include people 21 Several peer countries (e.g., Austria, Denmark, Finland, France, Germany, the Netherlands) were not included in one or both years.
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In the 1960s and 1970s, U.S. students had lower scores than those in 13 countries (including 9 of the peer countries examined in Part I)
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reading data that were originally displayed in bar charts were "subsequently removed from the PISA publications for technical reasons." In the 2009 PISA, the U.S. reading score was 487, lower than all but three peer countries.
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. A 2010 OECD report found that nine other OECD countries outranked the United States on the link between individuals' and their parents' earnings, an accepted measure of economic mobility (OECD, 2010a)
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. A study that compared the United States with 16 other countries (including 9 of the peer countries examined in Part I)
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• Since the 1980s, the United States has had among the highest rates of overall poverty and child poverty of all rich nations and many less affluent countries. • The United States ranks high in average years of schooling and edu cational attainment, but other countries (including many emerging economies)
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In particular, overall poverty and child poverty are especially plausible explanations for the pervasive U.S. health disadvantage across multiple causes of illness, unhealthy behaviors, and mortality during the first three or possibly four decades of life.
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health disadvantage. The educational attainment and cognitive skills of today's young adults could, for example, influence the behaviors that can contribute to infant and child mortality due to accidents and homicides; adolescent births and sexually transmitted infections; HIV/ AIDS incidence and mortality; and drug-related mortality.
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. Mediocre performance on education could be a result of disadvantaged home environments, such as a lack of parental stimulation of children's cognitive development, or other disadvantages that could accompany child poverty (Ermisch et al., 2012)
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For example, in a study that compared Sweden and the United States in the 1980s, the authors found that child poverty rates did not differ substantially when measured by household income before social transfers and taxes (Jäntti and Danziger, 1994, p.
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in the United States began to lose pace with other high-income countries in the late 1970s, a trend that has continued to the present. During this same time, as this chapter notes, there has also been a potentially important co-occurrence of worsening social conditions in the United States, notably a rise in income inequality, poverty, child poverty, single-parent households, divorce, and incarceration -- all more pronounced than in other rich nations -- and the loss of the U.S.
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Whether the worsening social conditions in the United States and its growing health disadvantage are causally interrelated, their co-occurrence during the same time span in recent U.S. history certainly warrants further scrutiny.
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