Social class and health in the US

A Look on how Social Class Influences Health in the United States

Social class and inequalities in health status among various racial and ethnic groups form a leading and very important chapter in the history of public health in the United States. Inequalities are observed for a wide range of specific conditions, and evolve over time. Little evidence is available to bear the debate that any sizable proportion of this overall inequality is caused by genetic factors operating at the population level. On the other hand, social status, as measured by alternative variables like income and education, which in doubt does provide important information about the black-white differential in health status when used in standard epidemiologic examinations. However, what is often deserted in these examinations, is an attempt to define underlying pathogenic mechanisms that incorporate social processes. Causal explanations based on the broader observation that inequality determined by the structure of social relations is associated with health gaps in all populations offer reasonable theoretic framework. At the same time, the unique character of the experience of specific ethnic subpopulations must be accounted for. Any attempt to account for the impact of race with greater precision will require an attempt to define this demographic variable within the context of social class relations.

For example, women may have a high (mortality) rate due to (socioeconomic status) and (health). Consistently, lower socioeconomic status has been associated with higher rates of mortality. Socioeconomic status generally is measured by occupation, income, or educational attainment. Statistically, minorities have a lower educational attainment than whites do. Lower education in minority attainment ties to direct implications for health. For instance, lower educational attainment decreases the ability to understand written information and instructions from physicians, health care facilities, and on medications. Since a great deal of our health care system is organized around the assumption of literacy in English, many minority populations cannot optimally access and take advantage of health care.

Other disadvantages to poor health may include having few family assets, as mentioned before, having a poorer education during adolescence, having insecure employment, becoming stuck with a bad job, living in poor housing while trying to bring up a family in difficult circumstances, and living on an inadequate retirement pension. These disadvantages tend to concentrate among the same people, and their effects on health accumulation during life. The longer people live in stressful economic and social circumstances, the greater the physiological stress they suffer, and the less likely they are to enjoy a healthy old age.

Many people who suffer from severe stress may also suffer from poor health conditions. Severe stress can be caused in many different situations. Social and psychological circumstances can become a main cause of long-term stress. Continuing anxiety, insecurity, low self-esteem, social isolation and lack of control over work and home life, have powerful effects on health as well. It is very common that stress is caused by poor living conditions in low income households. Because of the poor living conditions in low income households, stress can develop very quickly and can affect health immensely. Unfortunately, poor health conditions, such as stress, can lead to premature death in what tend to be uncontrollable situations.

Continuing relating social status with health, it also becomes clear that lower incomes also equal lower health advantages. It is proven minorities have substantially lower incomes than do whites. According to the National Center for Health Statistics documented in 1994, in 1992, the poverty rate was 33.3 percent for blacks and 29.3 percent for Hispanics, compared with 11.6 percent for whites. Income is an important determinant of socioeconomic status and therefore becomes a powerful variable in explaining health and behavior patterns.

Overall, low education and low family income may be necessary but not sufficient for a group to have poor incidences of health. There is still no answer on how to close the minority-white health status gap.
The sources of these health status gaps are in the social, economic, and medical circumstances of the population. Any reform of the health care system should ideally focus on health outcomes as a goal, not simply provision of universal health insurance. Strategies to close the minority-white health status gap will need to be broad-based, involving not only the health care system but the education and social service systems as well. This also suggests that research to test the efficacy of health status improvement strategies needs to incorporate communitywide clinical trials and to test the health care, education, and social service systems.

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