Inequality

According to the World Health Organization, health is broadly defined as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity" (World Health Organization, 2000). This definition suggests that many measures of health must be explored to fully understand health and inequality. Older persons are more likely than younger persons to experience chronic health problems, functional impairments, and death. This being said, it is inaccurate to assume that all, or even most, older people are sick to the point that they have trouble functioning. Although the majority (85 percent) of adults age sixty-five or older have one or more chronic illness, only about 20 percent of older adults have trouble providing their own personal care or living independently as a result of functional impairment. Nonetheless, among the older population, health does vary on the basis of age, with those over the age of eighty-five having significantly poorer health than those between the ages of sixty-five and eighty-five.

In general, research suggests that rates of clinical mental disorder are higher among younger than among older adults (Krause, 1999). On the other hand, rates of cognitive impairment and suicide are higher among older than among younger adults (Krause, 1999). Unlike these findings from the psychiatric perspective, sociological research on mental health tends to focus on depressive symptomatology rather than clinical assessments of mental disorder. This research, although still inconclusive, suggests that the relationship between age and depressive symptomatology is nonlinear, decreasing from young to middle adulthood and then increasing at age 60 and thereafter (Krause, 1999).

Gender significantly influences health in later life. On average, women live seven to eight years longer than men. However, older women experience more chronic illnesses and functional impairments, report more depressive symptoms, experience higher levels of psychological distress, and have higher rates of prescription drug use than do older men. Notably, while there is a higher prevalence of depressive disorders among women at all ages when compared to men, this gap decreases with increasing age.

Beyond these age and gender differences, there is further diversity in physical health among older adults on the basis of class and race. One well-known and consistent finding is the relationship between socioeconomic status (SES) and health. Research on physical health generally shows that individuals from lower socioeconomic strata have worse health than do those from higher socioeconomic strata. In general, however, class differences in health are smaller in older age than they are in younger age. Indeed, when education and income are used as measures of SES, the inverse relationship between SES and health is not always supported among samples of older adults. Yet, if occupation is the SES measure used, class differences in health in later life are usually found. For instance, older persons who were previously employed in skilled, white-collar work have fewer health problems and lower rates of mortality than those who were employed in unskilled, blue-collar work (Pampel, 1998).

Regarding mental health, older persons with lower levels of education and income tend to report more depressive symptoms than do those with higher levels of education and income. In contrast, relationships between either education or income and depressive disorder in later life appear to be weak.

Such a strong and consistent relationship between SES and health exists because people with lower levels of income, lower levels of education, and bad jobs are more likely to experience malnutrition, to disproportionately lack knowledge of health care practices, and because they are more often exposed to dangerous working and living environments. All of these things negatively affect health status. Furthermore, research has shown that SES is associated with access to health care services. In particular, older people with higher incomes and who have private health insurance go to the doctor more often and spend more nights in the hospital than do older people who have lower incomes or who do not have private health insurance, regardless of their overall health (Mutchler & Burr, 1991).

The relationship between race and health in later life is complex. For the most part, research suggests that, compared to older white Americans, older black Americans report more chronic health problems, have higher levels of functional decline, and have higher rates of mortality. Yet, even though physical and mental health are often correlated, older black Americans and older white Americans tend to have similar levels of mental health.

The physical health gap between white Americans and black Americans does not increase in later life, but instead remains consistent or declines. In fact, there appears to be a crossover in health after the age of eighty-five, whereby older black persons gain a slight health advantage.

The most reliable data for this crossover effect come from mortality statistics. The ratio of black men and women to white men and women who die in each ten-year age group declines steadily from age twenty-five onward. American data from 1992 show that the black to white mortality ratio for twenty-five-year-old to thirty-five-year-old males is 2.39, and for females it is 2.72. These ratios decline for each successive age group until a crossover occurs in the eighty-five and older age group. In this age group the ratio is .99 for women and .95 for men, suggesting that among the oldest old, black men and women have a slight advantage over white men and women regarding mortality.

Selectivity in survival is the most common explanation given for the age-based decline in the racial health gap and the crossover effect in mortality ratios. This selectivity explanation suggests that the reason the gap in health status between older white and black adults remains the same or declines in later life has to do with the fact that black Americans are at greater risk of dying than are white Americans at each life-course stage. Hence, only the healthiest black persons live into old age, thereby reducing the health distinction between white and black Americans in later life.