Health Implications of Socioeconomic Characteristics,Subjective Social Status,and Perceptions of Inequality: An Empirical Study of China

This study explores how health is associated with socioeconomic status, subjective social status, and perceptions of inequality simultaneously. Two health outcomes (self-reported health and psychological distress) are examined, and the subtlety of their relationships with each of the three dimensions of inequality is probed. Data used come from a nationally representative sample survey conducted in China. Several findings emerge from empirical analyses: (1) Overall, the three dimensions of social inequality are associated with self-reported health and psychological distress net of each other and other control variables; (2) among focal socioeconomic characteristics, income and Chinese Communist Party membership are significantly associated with both health outcomes, education exhibits a robust effect on self-reported health, and rural and migrant statuses are linked to less distress; (3) subjective social status in comparisons with both socially proximal and broad referents is associated with both health outcomes, and the association with downward comparisons is more salient than with upward comparisons; and (4) perceived degree and perceived sources of inequality in society show varying relationships with the two health outcomes. These findings add to our understanding of the multidimensionality and complexity of social inequality in relation to health.     

Health and the Quality of Life

The aim of this investigation was to explain theimpact of peoples self-reported health on theirlevels of satisfaction with their health, and theimpact of these things plus satisfaction with otherspecific domains of their lives on the perceivedquality of their lives. The latter was operationalized as general happiness, satisfactionwith life as a whole and overall satisfaction with thequality of life. Seven hundred and twenty-three (723)usable questionnaires returned from a mailout randomsample of 2500 households of Prince George, BritishColumbia in November 1998 formed the working data-setfor our analyses. Among other things, mean respondentscores on the SF-36 health profile were found to belower than published norms from the UK, USA,Netherlands and Sweden, but higher than scores fromAberdeen, Scotland. Mean scores on the CES-Ddepression scale also indicated that our respondentstended to have more depressive symptoms thancomparison groups in Winnipeg and the USA. A review oftrends in mean scores on 17 quality of life items(e.g., satisfaction with family life, financialsecurity, recreation, etc.) from 1994, 1997 and 1998revealed that there were only 7 statisticallysignificant changes across the four year period andthey were all negative. Multivariate regressionanalysis showed that health status measured with avariety of indicators could explain 56% of thevariation in respondents reported satisfaction withtheir health. A combination of health status plusdomain satisfaction indicators could explain 53% ofthe variation in respondents reported happiness, 68%of reported life satisfaction and 63% of reportedsatisfaction with the overall quality of life. Sixtypercent of the explained variation in happiness scoreswas attributable to self-reported health scores, whileonly 18% of the explained variation in satisfactionwith life and with the overall quality of life scoreswas attributable self-reported health scores.     

Subjective Health-Related Quality of Life in Homeless and Vulnerably Housed Individuals and Its Relationship with Self-Reported Physical and Mental Health Status

Although the association between homelessness and objective indicators of poor health is well-established, little research has focused on the subjective health-related quality of life of homeless and vulnerably housed (HVH) individuals. This study examined the subjective health-related quality of life of HVH individuals, using the Multiple Discrepancies Theory (MDT) Scale for Health of the Quality of Life for Homeless and Hard-to-House Individuals (QoLHHI) Inventory, and its association with self-reported functional health status, as measured by the SF-12, and self-reported physical and mental health conditions in a sample of 100 HVH individuals recruited in Vancouver, Toronto and Ottawa. Our findings indicate that physical and mental health conditions are highly prevalent among HVH individuals and that the SF-12 Physical and Mental Component Summary scores are substantially lower compared to US population norms. The MDT Health items were not statistically significantly associated with physical or mental health conditions and only showed correlations of small to moderate magnitude with the SF-12 Component Summary Scales. These findings suggest that the QoLHHI MDT Scale for Health can provide information about HVH individuals’ subjective health experiences that is different from, and can serve as a valuable complement to, health status information for use in research and evaluation studies, as well as for policy purposes to make informed decisions based on subjective health-related quality of life data from HVH individuals.     

Social Networks,Social Cohesion,and Later-Life Health

Our study contributes to the literature acknowledging the joint role of social networks and social cohesion in shaping individual’s health, focusing on the older population aged 50 and over. Exploiting rich ego-centered social network data from the Survey of Health, Ageing and Retirement in Europe and following the conceptual model of social integration and health proposed by Berkman et al. (Soc Sci Med 51:843–857. doi:10.1016/S0277-9536(00)00065-4, 2000), we estimate multilevel models of self-reported and observer-measured later-life health outcomes. These models simultaneously account for (a) characteristics of 39,551 respondents’ personal social networks and (b) a measure of social cohesion—namely, participation in social organizations—across 57 Continental European regions, clustered in 14 countries. We find significant associations between individuals’ health and various social network characteristics (size, support, quality) as well as social cohesion. Moreover, cross-level interaction effects suggest that the social-network-health nexus is contextually bound. We conclude with a discussion of limitations and perspectives for future research.     

Measuring socioeconomic status in health research in developing countries: Should we be focusing on households,communities or both?

Research on the effects of socioeconomic well-being on health is important for policy makers in developing countries, where limited resources make it crucial to use existing health care resources to the best advantage. This paper develops and tests a set of measures of socioeconomic status indicators for predicting health status in developing countries. We construct socioeconomic indexes that capture both household and community attributes so as to allow us to separate the social from the purely economic dimensions of the socioeconomic status within a cross-national perspective, with applications to data from Demographic and Health Surveys (DHS) fielded in five African countries in the 1990s. This study demonstrates the distinctive contributions of socioeconomic indexes measured at the household vs. community level in understanding inequalities in health and survival and underlines the importance of going beyond the purely economic view of socioeconomic status to cover the multidimensional as well as multilevel concept of economic and social inequality.     

Early life exposures and the occurrence and timing of heart disease among the older adult Puerto Rican population

Few studies have examined the effects of early life conditions on the timing of the onset of heart disease. We use the remarkable example of a representative sample of the population of older Puerto Ricans aged 60– 74 who lived in the countryside during childhood (n = 1,438) to examine the effects of seasonal exposures to poor nutrition and infectious diseases during late gestation on the timing of the onset and the probability of ever experiencing adult heart disease. Cox and log logistic hazard models controlling for childhood conditions (self-reported childhood health status and socioeconomic status [SES], rheumatic fever, and knee height) and adult risk factors (adult SES, obesity, smoking, texercise, and self-reported diabetes) showed that the risk of onset of heart disease was 65% higher among those born during high-exposure periods compared with unexposed individuals. However, there were no significant differences in median time of onset for those ever experiencing heart disease. As a comparison, we found that there were no significant seasonality effects for those who lived in urban areas during childhood. We conclude that early exposures in utero have important ramifications for adult heart disease among the older Puerto Rican population. We show, however, that while exposure is associated with the probability of ever experiencing adult heart disease, it is not associated with the timing of onset among those who do experience it.     

The Relationship between Health Survey and Medical Chart Review Results in a Rural Population

The objective of this study was to understand the relationship between health survey and medical chart based information. The study population consisted of adult patients (17 years of age and older) attending the Bella Coola Medical Clinic who also completed a detailed Health and Quality of Life Survey. A total of 674 adults completed the Health and Quality of Life Survey. Demographically there was excellent agreement between self-report and clinic data for age, sex, height, weight and Aboriginal ancestry. For morbidity, there was excellent agreement between self-reported and clinically recorded diabetes. Good agreement was observed for diagnoses of cancer, heart problems, hypertension, arthritis and breathing problems. Poor agreement was observed for diagnoses of depression, back/neck problems, eye problems, walking problems, stroke, hearing problems and bone/joint problems. There was poor agreement between the number of self-reported and charted clinic visits. Excellent agreement was shown between self-reported height and weight and clinic height and weight. When BMI was calculated good agreement was achieved between self-report and chart data. It can be concluded that the relationship between chart review and self-report health information observed in this rural population is similar to findings from other populations. Researchers who use self-report data on co-morbidity and obesity measures should be aware of possible error in their estimates and how these errors could affect their findings.     

Individual- and Neighbourhood-Level Indicators of Subjective Well-Being in a Small and Poor Eastern Cape Township: The Effect of Health,Social Capital,Marital Status,and Income

Our study used multilevel regression analysis to identify individual- and neighbourhood-level factors that determine individual-level subjective well-being in Rhini, a deprived suburb of Grahamstown in the Eastern Cape province of South Africa. The Townsend index and Gini coefficient were used to investigate whether contextual neighbourhood-level differences in socioeconomic status determined individual-level subjective well-being. Crime experience, health status, social capital, and demographic variables were assessed at the individual level. The indicators of subjective well-being were estimated with a two-level random-intercepts and fixed slopes model. Social capital, health and marital status (all p < .001), followed by income level (p < .01) and the Townsend score (p < .05) were significantly related to individual-level subjective well-being outcomes. Our findings showed that individual-level subjective well-being is influenced by neighbourhood-level socioeconomic status as measured by the Townsend deprivation score. Individuals reported higher levels of subjective well-being in less deprived neighbourhoods. Here we wish to highlight the role of context for subjective well-being, and to suggest that subjective well-being outcomes may also be defined in ecological terms. We hope the findings are useful for implementing programs and interventions designed to achieve greater subjective well-being for people living in deprived areas.     

Older Women on the U.S.-México Border: Exploring the Health of Hispanics and Non-Hispanic Whites

ABSTRACT

Research on ethnicity and socioeconomic status (SES) suggests that Hispanics are more likely than non-Hispanic Whites to experience poverty and low levels of education, which may relate to poorer health status. This study used a health survey to examine income, education, ethnicity, birthplace, and age on self-reported health factors of women age 60 and older on the U.S.-México border. Results show that income, age, and education were significantly associated with several health factors (Physical Health, Emotional Health, General Health, Energy Level, and Activity Potential). Older women with lower SES, regardless of ethnicity, reported poorer health than younger-old women with higher SES.     

Socioeconomic Inequalities and Self-Rated Health: A Multilevel Study of Italian Elderly

We adopted a multilevel approach in order to provide a comprehensive overview of the main social and economic differences associated with inequalities in self-rated health, according to the territorial context of residence. We focused on the Italian population aged 65 and over, availing of the most recent data on health conditions in Italy. This study proves the persistence in Italy, a modern welfare state that has one of the best overall healthcare systems in the world, of significant, if not enormous, socioeconomic differences in self-perceived health among the elderly. We found that each component of the socioeconomic status is autonomously correlated with individual perceptions of health, highlighting the importance of considering all of the facets of the individual socioeconomic status in measuring the extent of health inequalities. The lack of a network of relationships was also found to be strongly associated with a poor health status for elderly Italians. Our study also documented the presence of a contextual effect. The proposed multilevel modeling proved to be useful in shedding light on relevant aspects in the field of perceived health and for avoiding misleading results.     

Skewed Sex Ratios and Criminal Victimization in India

Although substantial research has explored the causes of India’s excessively masculine population sex ratio, few studies have examined the consequences of this surplus of males. We merge individual-level data from the 2004–2005 India Human Development Survey with data from the 2001 India population census to examine the association between the district-level male-to-female sex ratio at ages 15 to 39 and self-reports of victimization by theft, breaking and entering, and assault. Multilevel logistic regression analyses reveal positive and statistically significant albeit substantively modest effects of the district-level sex ratio on all three victimization risks. We also find that higher male-to-female sex ratios are associated with the perception that young unmarried women in the local community are frequently harassed. Household-level indicators of family structure, socioeconomic status, and caste, as well as areal indicators of women’s empowerment and collective efficacy, also emerge as significant predictors of self-reported criminal victimization and the perceived harassment of young women. The implications of these findings for India’s growing sex ratio imbalance are discussed.     

The Income and Health Effects of Tribal Casino Gaming on American Indians

The legalization of American Indian casino gaming in the late 1980s allows examination of the relationship between income and health in a quasi-experimental way. Revenue from gaming accrues to individual tribes and has been used both to supplement tribe members’ income and to finance tribal infrastructure. We assembled annual data from 1988–2003 on tribal gaming, health care access (from the Area Resource File), and individual health and socioeconomic characteristics data (from the Behavioral Risk Factors Surveillance System). We use this information within a structural, difference-in-differences framework to study the effect of casino gaming on tribal members’ income, health status, access to health care, and health-related behaviors. Our difference-in-differences framework relies on before-after comparisons among American Indians whose tribe has at some time operated a casino and with-without comparisons between American Indians whose tribe has and those whose tribe has not initiated gaming. Our results provide identified estimates of the positive effect of gaming on American Indian income and on several indicators of American Indian health, health-related behaviors, and access to health care.     

Intergenerational Profiles of Socioeconomic (Dis)advantage and Obesity During the Transition to Adulthood

Investigations of socioeconomic status (SES) and health during the transition to adulthood in the United States are complicated by the later and more varied transitions in residence, employment, schooling, and social roles compared with previous generations. Parental SES is an important influence during adolescence but cannot sufficiently capture the SES of the independent young adult. Typical, single SES indicators based on income or education likely misclassify the SES of young adults who have not yet completed their education or other training, or who have entered the labor force early with ultimately lower status attainment. We use a latent class analysis (LCA) framework to characterize five intergenerational SES groups, combining multidimensional SES information from two time points—that is, adolescent (parental) and young adult (self) SES data. Associations of these groups with obesity, a high-risk health outcome in young adults, revealed nuanced relationships not seen using traditional intergenerational SES measures. In males, for example, a middle-class upbringing in adolescence and continued material advantage into adulthood was associated with nearly as high obesity as a working poor upbringing and early, detrimental transitions. This intergenerational typology of early SES exposure facilitates understanding of SES and health during young adulthood.     

Measuring and Analysing the Wellbeing of Australia’s Indigenous Population

According to most standard socioeconomic indicators (for example employment, income and education), Indigenous Australians tend to have worse outcomes than their non-Indigenous counterparts. Most objective health indicators including life expectancy also tend to be worse. Traditionally, these two domains and associated objective indicators have been the focus of research, government policy and evaluation. There has been less research, however, on differences between Indigenous and non-Indigenous Australians in subjective measures of wellbeing. In this paper, I attempt to answer three related research questions on Indigenous wellbeing—What is the average level of emotional wellbeing and satisfaction with life for the Indigenous and non-Indigenous population of Australia? How do the differences between the two populations change once other characteristics have been controlled for? What are the factors associated with emotional wellbeing within the Indigenous population? With regards to the first two questions, Indigenous Australians are less likely to report frequent periods of happiness and more likely to report periods of extreme sadness than the non-Indigenous population. Surprisingly, given these results for emotional wellbeing, a major finding from the analysis was that Indigenous Australians were significantly more likely to report above-average satisfaction with their life. The main finding with regards to the third question is that using retrospective measures, those in remote areas report higher levels of happiness than those in non-remote areas. This is different to the results for socioeconomic status and objective measures of health found elsewhere and has important implications for government policy in Australia.     

我国人口流动中的健康选择机制研究

利用2008年中国流动与健康调查数据,对农村留守人口、农村外出返乡人口、乡城流动人口以及城镇居民等不同流动特征群体之间的健康差异进行比较,并系统检验了我国人口流动过程中的两种健康选择机制——"健康移民"(healthy migrant)效应和"三文鱼偏误"(salmon bias)效应。模型分析结果表明,我国人口流动存在着较为明显的"健康移民"和"三文鱼偏误"选择效应。在控制被访者的年龄、性别、主要社会经济特征以及相关健康行为后,流动人口自评一般健康、慢性病状况、经常性身体不适和肺活量等健康指标显著优于农村留守人口,乡城流动人口患有慢性病和出现经常性身体不适的可能性也显著低于农村返乡人口。在控制相关变量后,乡城流动人口与城镇居民的健康状况(除慢性病和心率过高症状外)不存在显著差别。     

Preliminary Development and Validation of the Social and Emotional Health Survey for Secondary School Students

This study reports on the preliminary development and validation of the Social and Emotional Health Survey (SEHS) with a sample of 4,189 (51 % female) California students in Grades 8, 10, and 12. The SEHS was designed to measure the psychological building blocks of adolescents’ positive mental health and is operationalized in the present study by a theoretical model comprised of 12 measured indicators that form four first-order domains (belief-in-self, belief-in-others, emotional competence, and engaged living) that, in turn, contribute to one underlying, second-order meta-construct called covitality. This study was the first to investigate the validity and utility of the adolescent covitality construct, which is conceptualized as the synergistic effect of positive mental health resulting from the interplay among multiple positive-psychological building blocks. Findings from confirmatory factor analyses, invariance analysis, and latent means testing all supported the theoretical model underlying the SEHS, indicating that the second-order covitality model was the best fit for both males and females. Results from a path-modeling analysis indicated that covitality was a strong predictor of students’ subjective well-being (operationalized as a composite of life satisfaction, positive affect, and negative affect), and findings from additional concurrent validity analyses indicated that adolescents’ covitality level was significantly associated with self-reported academic achievement, perceptions of school safety, substance use, and experiences of depressive symptoms. Implications for theory, practice, and future research are discussed.     

Walking the Dog: The Effect of Pet Ownership on Human Health and Health Behaviors

This analysis explores whether pet owners have better physical health outcomes, and if so, whether the positive physical health benefits are explained by better health behaviors that result from having to take care of the pet’s physical needs. Data come from the National Health and Nutrition Examination Survey, a representative sample of the non-institutionalized United States population. Analyses were limited to persons living alone (n = 2,474) in order to isolate primary pet caretakers from those merely living in a pet household. Results showed that pet owners, particularly dog and cat owners, had more positive physical health outcomes when compared to non pet owners or those owning other types of pets. Surprisingly, the effect of pet ownership was not mediated by health behaviors such as recreational walking. However, the health benefits of pet ownership were largely reduced once sociodemographic variables such as age, socioeconomic status, and residential location were controlled. The positive health effects of pet ownership appear to be primarily the result of selection, not increased physical activity associated with the active caretaking of pets.     

农民工健康状况影响因素分析

农民工的健康状况对其个人生活、就业状况和整个中国的经济增长都有重要意义。本文利用2008年6—7月对江苏和浙江农民工的调查数据,采用自评健康水平来测度农民工的健康状况,并对影响农民工健康状况的因素进行了深入分析。结果显示：男性的自评健康水平好于女性,初中、高中组的健康状况好于大专及以上组,家庭负担系数越大、日工作时间越长的农民工健康状况越差,一线工人的健康状况比技术人员要差,不同城市的农民工健康状况存在差异。     

Assessing the Use of the Family Affluence Scale as Socioeconomic Indicators for Researching Health Inequalities in Taiwan Adolescents

This study examined the reliability and validity of the Family Affluence Scale (FAS) and explored the relationship between FAS and health in a general adolescent population of Taiwan. Our data was obtained from a 2009 school-based survey. In total, 3,368 students (1,741 boys, 1,627 girls) in grades 6–10 in Kinmen County, Taiwan completed a modified WHO Health Behaviour in School-Aged Children (HBSC) questionnaire. Indicators of the family’s social position were their parents’ occupation and education. Indicators of material affluence were number of cars, number of holiday travel, whether the participant had his or her own room and number of computers (FAS items). A higher proportion of the participants completed the four family affluence items than their parents’ occupation and education items (≧98% vs. 90% and 88%; respectively). Analysis of the FAS showed a moderate internal reliability (Cronbach’s alpha = 0.35). The associations between the FAS scores and parental occupation and education were moderate (P < .001). Consistent gradients were found for the association between FAS and positive health and health promoting behaviours. In conclusion, the Taiwan version of the FAS had a high completion rate and moderate internal reliability and external validity. The clear associations between the FAS and health indicators confirm the findings of previous studies and suggest that the FAS can be used as an additional measure of socioeconomic status among Taiwan adolescents.