in last week’s frozen pea friday post – the weekly post about people dealing with cancer, inspired by susan reynolds and my friends who are dealing with cancer – we alluded to the difficulty of paying for the necessary care needed for people living with cancer. this immediately led me to thinking about the connection between health and socio-economic status (SES), or income level. having spent the majority of my career as a counsellor with people living in poverty, particularly people in vancouver’s downtown eastside, canada’s poorest urban area, i am very familiar with the connection between health and income.
says one canadian government web site:
only 47% of canadians in the lowest income level rate their health as excellent or very good, compared to 73% of canadians in the highest income group.
canadians who live in the poorest neighbourhoods are more likely than residents of the richest neighbourhoods to die at an early age.
at each rung up the income ladder, canadians have less sickness, longer life expectancies and improved health.
in the UK, “life expectancy in the wealthiest areas is ten years longer than the poorest areas. the gap appears to be increasing as life expectancy for the prosperous continues to increase while in more deprived communities there is little increase.”
the impact of poverty on health by shelley phipps for the canadian population health initiative and the canadian institute for health information gives further information:
research has found a very robust relationship between an adult individual’s income and that individual’s health. regardless of how health and socio-economic status (ses) are measured and how these measures are combined, there is little doubt that poverty leads to ill health.
- the relationship between individual income and health is non-linear (i.e. low-income individuals suffer larger negative health consequences than high-income individuals reap health benefits, though high-income individuals do reap benefits).
- long-duration poverty has larger (negative) health consequences than occasional episodes of poverty.
- both income level and income changes are significant predictors of health status, but income level is the more important of the two.
further along in the study, there is mention that chronic diseases such as arthritis, rheumatism, diabetes, heart problems, cancer, and hypertension are much more common–often twice as common–for aboriginal persons, who also have generally much lower SES than non-aboriginals.theories on how SES and health are connected include these:
absolute income hypothesis
this hypothesis suggests that health status improves with the level of personal income, but at a decreasing rate. one implication is that:”…if income is redistributed from the rich, whose health is not much affected, to the poor, whose health is more responsive to income, average health will improve. other things being equal, including average income, nations (or other groups) with a more equal distribution of income will have better average group health.”
absolute deprivation hypothesis
this can be regarded as an extreme version of the absolute income hypothesis. it suggests that very low standards of living are bad for health, but that once past some deprivation threshold, additional income is not particularly important for health. the emphasis here is that individuals living with very low incomes will encounter physical conditions that may undermine their health, such as poor nutrition, more limited access to health care, hazards from poor environmental quality, health-limiting behaviours such as smoking and sedentary habits and stress resulting from coping with very low income.
neo-materialist hypothesis
this hypothesis argues that high levels of income inequality are simply one manifestation of underlying historical, cultural, political and economic processes that simultaneously generate inequalities in social infrastructure (such as medical, transportation, educational, housing, parks and recreational systems). from this perspective, inequalities in health derive from inequalities in all of the above aspects of the material environment.
lynch and co-authors employ the metaphor of a long trip on an airplane to explain the difference in interpretation between the psycho-social and the neo-materialist interpretations. on a long trip on an airplane, passengers seated in first class are treated better: they have, for example, more room and receive better food. passengers travelling in economy class are cramped and, these days, receive little–if any–food! lynch et al argue that by the end of many hours of travel, the differences in physical conditions and treatment will reduce the well-being of the passengers in economy class (beyond feeling negative emotions because they know they are being unequally treated).
(image by old shoe woman)