Social Factors Health
Individuals with lower socioeconomic status (SES)—those who have less education and income—have an earlier onset of illness, more illness overall, and earlier deaths than those with higher SES. Social stratification early in the life course affects the trajectory an individual is likely to follow. Being born with economic advantages is likely to lead to educational success, which is linked to occupational advantage and later financial security. Data from the National Longitudinal Survey of Labor Market Experience: Mature Men, 1966–1990 was used to examine the impact of educational and occupational experiences on premature death. Length of education, type of first job, type of job in middle age, and family wealth in middle age each were found to contribute independently to the risk of a premature death. Data from other countries replicate this importance of social class over the life course for timing of death. When individuals were categorized according to the number of points in their life when they were living with a father who held a manual labor job or they themselves held a manual job, those who never engaged in manual labor had better health than those who did so at all points. While social status in childhood influences later social status through educational advancement, social position at each stage of life has also been found to exert an independent influence on later health.
A large dataset of noninstitutionalized adults in the United States found that in the six years before death, the health status of older respondents varied based on their level of education. In the years before death, those with less education were likely to be more limited in activity, to have multiple chronic health conditions, and to have spent more days in bed and in the hospital. This suggests that those with higher socioeconomic status are likely to live more of their life in good health than those with lower SES.
What is it about lower levels of education and income that leads to declines in health? House, et al. (1994) found that people with lower socioeconomic status are more likely to be exposed to risk factors. Compared with those with more money and education, those with less are at a disadvantage, in terms of drinking, marital status, informal social integration, and chronic financial stress, across all age groups. For other risk factors, including smoking, being overweight, formal social integration, perceived social support, and self-esteem and self-mastery, the disadvantage of those with lower SES increases through middle age and then diminishes later in life. This suggests that early disadvantage based on these risk factors may cause less healthy individuals with lower socioeconomic status to die at earlier ages.
Overall, the health status of older adults is positively related to their social status. Being married, having high levels of social support, attending religious services, and having a high socioeconomic status offers health benefits that the widowed, elderly persons with little social support, those who do not attend religious services, and those of low socioeconomic status do not enjoy. The social position that each older individual occupies, which exerts such strong influence on health, is the result of lifelong processes, and may itself be influenced by earlier health status.
ELLEN L. IDLER JULIE MCLAUGHLIN
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