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Objectives. To investigate the effect of social mobility and to assess the use of socioeconomic indicators in monitoring health inequities over time, we examined the association of self-rated health with socioeconomic position over the life course. Methods. Data came from a cross-sectional telephone survey (n=2999) that included life-course socioeconomic indicators and from a chronic disease and risk factor surveillance system (n=26400). Social mobility variables, each with 4 possible intergenerational trajectories, were constructed from family financial situation and housing tenure during childhood and adulthood. Results. Low socioeconomic position during both childhood and adulthood and improved financial situation in adulthood were associated with a reduced prevalence of excellent or very good health. Trends over time indicated that socioeconomic disadvantage in adulthood was associated with poorer self-rated health. Conclusions. Our results support policies aiming to improve family financial situation during childhood and housing tenure across the life course. Inclusion of life-course socioeconomic measures in surveillance systems would enable monitoring of health inequities trends among socially mobile groups. (doi:10.2105/AJPH.2008.141713)

Objectives. We estimated associations between poverty in early, middle, and later childhood and adult body mass index to further elucidate the effects of socioeconomic status on health. Methods. We conducted secondary analyses of data from men and women (N=885) born between 1968 and 1975 who were tracked between their prenatal and birth years and adulthood in the nationally representative Panel Study of Income Dynamics. We used multivariate regression techniques and spline models to estimate the relationship between income in different stages of childhood and adult body mass index, overweight, and obesity. We controlled for other family characteristics, including income in other periods of childhood. Results. Mean annual family income in the prenatal and birth years for children whose annual family incomes averaged less than $25 000 was significantly associated with increased adult body mass index, but mean annual family income between 1 and 5 years of age and between 6 and 15 years of age was not. Conclusions. Our results indicated that economic conditions in the earliest period of life (during the prenatal and birth years) may play an important role in eventual anthropometric measures. (doi: 10.2105/AJPH.2007.130575)

Background. The pathophysiological mechanisms that underlie health disparities by socioeconomic status and race/ ethnicity are poorly understood. Promising new research suggests that the burden of persistent infection may influence adult disease risk and mortality. This article examines how multiple persistent infections cluster within individuals and how this clustering varies by socioeconomic position and race/ethnicity in U.S. adults. Methods. We analyze data from the National Health and Nutrition Examination Survey III (N = 19,275) for adults aged 17-90 years. The clustering of infections within individuals is studied using tetrachoric correlations. Multiple indicator multiple cause models are used to analyze the infection burden construct as measured by seropositivity to Helicobacter pylori, cytomegalovirus, herpes simplex virus-l, and hepatitis B, focusing on the burden's distribution by socioeconomic position and race/ethnicity. The results are corroborated using ordered logistic regression for a commonly used count index of individual infections. Results. Seroprevalence of individual persistent infections is positively correlated, suggesting common factors related to exposure or susceptibility. Education, income, and race/ethnicity are strong and significant independent predictors of infection burden in U.S. adults in all models. Conclusion. The disproportionate burden of persistent infections among disadvantaged groups across all ages may be one biologic pathway by which low socioeconomic position is related to increased rates of morbidity and mortality in the United States. Key Words: Socioeconomic--Race--Ethnic--United states--Adults--Infection--Biomarkers.

Objective: We consider associations between individual, household and area-level characteristics and self-reported health. Method: Data is taken from baseline surveys undertaken in 13 socio-economically disadvantaged neighbourhoods in Victoria (n=3,944). The neighbourhoods are sites undergoing Neighbourhood Renewal (NR), a State government initiative redressing place-based disadvantage. Analysis: This focused on the relationship between area and compositional factors and self-reported health. Area was coded into three categories; LGA, NR residents living in public housing (NRPU) and NR residents who lived in private housing (NRPR). Compositional factors included age, gender, marital status, identifying as a person with a disability, level of education, unemployment and receipt of pensions/benefits. Results: There was a gradient in socioeconomic disadvantage on all measures. People living in NR public housing were more disadvantaged than people living in NR private housing who, in turn, were more disadvantaged than people in the same LGA. NR public housing residents reported the worst health status and LGA residents reported the best. Conclusions: Associations between compositional characteristics of disability, educational achievement and unemployment income and poorer self-reported health were shown. They suggested that area characteristics, with housing policies, may be contributing to differences in self-reported health at the neighbourhood level. Implications: The clustering of socioeconomic disadvantage and health outcomes requires the integration of health and social support interventions that address the circumstances of people and places. Key words: Socio-economic factors, family characteristics, health status, public policy, public housing, residential mobility

Objective: To estimate the contribution of health care to health gain, and to ethnic and socio-economic health inequalities, in New Zealand over the past quarter century. Method: Amenable and all-cause mortality rates by ethnicity and equivalised household income tertile from 1981-84 to 2001-04 were estimated from linked census-mortality datasets (the New Zealand Census-Mortality Study). Amenable mortality (deaths under age 75 from conditions responsive to health care) was defined using a classification recently developed for use in Australia and New Zealand. The contribution of health care to the observed improvement in population health status was estimated by the ratio of the difference in amenable to the difference in all-cause mortality over the observation period. Results: Trends in amenable causes of death were estimated to account for approximately one-third of the fall in mortality over the past quarter century, for the population as a whole and for all income and ethnic groups except Pacific peoples, for whom there was no reduction in amenable mortality. In 2001-04, amenable causes accounted for approximately one quarter of the mortality gap between all ethnic groups compared to the European/Other reference. Discussion: Our finding provides one indicator of the social impact of health care over this period. More importantly, that Pacific peoples seem to have benefited less than other ethnic groups calls for urgent explanation. Also, our finding that amenable causes account for about one quarter of current mortality disparities, clearly indicates that improvement in access to and quality of health care for disadvantaged groups could substantively reduce health inequalities. Key words: amenable mortality, trends, New Zealand

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2008.12.010 Byline: Jennifer Beam Dowd (a), Anna Zajacova (b), Allison Aiello (b) Abstract: Recent work in biodemography has suggested that lifetime exposure to infection and inflammation may be an important determinant of later-life morbidity and mortality. Early exposure to infections during critical periods can predispose individuals to chronic disease, in part through the reallocation of energy away from development needed for immune and inflammatory responses. Furthermore, markers of inflammation are known to vary by socioeconomic status in adults and may contribute to overall socioeconomic health inequalities, but little is known about how the sources of this inflammation differ over the life course. This paper uses novel biomarker data from the Third National Health and Nutrition Examination Survey (NHANES III) to test the association of the burden of common chronic infections (Helicobacter pylori (H. pylori), cytomegalovirus (CMV), herpes simplex virus-1 (HSV-1), hepatitis A and hepatitis B) with height-for-age and asthma/chronic respiratory conditions in U.S. children ages 6 and older, and the association of these chronic infections to children's socioeconomic status. A higher burden of infection is found to be associated with lower height-for-age as well as an increased likelihood of asthma net of race/ethnicity, family income, and parental education. Children with lower family income, lower parental education, and non-white race/ethnicity have a higher likelihood of infection with several individual pathogens as well as the overall burden of infection. Differential exposure and/or susceptibility to infections may be one mechanism through which early social factors get embodied and shape later-life health outcomes. Author Affiliation: (a) Hunter College, School of Health Sciences, and CUNY Institute for Demographic Research, 425 E. 25th St., New York, NY 10010, USA (b) University of Michigan, Ann Arbor, MI, USA

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0140-6736(08)61775-4 Byline: David P Fidler (a), Nick Drager (b), Kelley Lee (c) Abstract: This article forms part of a six-part Series on trade and health, and sets the stage for this Series by analysing key aspects of the relationship between trade and health. The Series takes stock of this relation and provides timely analysis of the key challenges facing efforts to achieve an appropriate balance between trade and health across a diverse range of issues. This introductory article reviews how trade and health have risen and expanded on global policy agendas in the past decade in unprecedented ways, describes how trade and health issues are respectively governed in international relations, examines the ongoing search for policy coherence between the two policy spheres, and highlights the topics of the remaining articles in the Series. Author Affiliation: (a) Center on American and Global Security, Indiana University School of Law, Bloomington IN, USA (b) Department of Ethics, Equity, Trade and Human Rights, World Health Organization, Geneva, Switzerland (c) Centre on Global Change and Health, London School of Hygiene and Tropical Medicine, London, UK

Self-rated health (SRH) predicts future mortality, Individuals in different social classes with similar physical health status may have different reference levels and criteria against which they judge their health, therefore the SRH-mortality relationship may vary according to social class, We examine the relationship between SRH and mortality by occupational social class in a prospective study of 22,457 men and women aged 39-79 years, without prevalent disease, living in the general community in Norfolk, United Kingdom, recruited using general practice age-sex registers in 1993-1997 and followed up for an average of 10 years. As expected, SRH was related to subsequent mortality. The age and sex adjusted hazard ratio for mortality for those with poor compared to those with excellent SRH was 4.35 (95% confidence interval 3.38-5.59, P < 0,001). The prevalence of poor or moderate SRH was higher in manual than in non-manual classes. However, SRH was similarly related to mortality in manual and non-manual classes: when non-manual classes are compared with manual classes for each category of SRH, the 95% confidence intervals for the mortality hazard ratios overlap. There was no evidence of an interaction between social class and SRH in either men or women. Thus in this population, SRH appears to predict mortality in a similar manner in non-manual and manual classes. Keywords: Self-rated health Social class Health inequalities Mortality Risk factor UK

Background. To determine socioeconomic status (SES) gradients in the different dimensions of health among elderly Costa Ricans. Hypothesis: SES disparities in adult health are minimal in Costa Rican society. Methods. Data from the Costa Rican Study on Longevity and Healthy Aging study: 8,000 elderly Costa Ricans to determine mortality in the period 2000-2007 and a subsample of 3,000 to determine prevalence of several health conditions and biomarkers from anthropometry and blood and urine specimens. Results. The ultimate health indicator, mortality, as well as the metabolic syndrome, reveals that better educated and wealthier individuals are worse off. In contrast, quality of life-related measures such as functional and cognitive disabilities, physical frailty, and depression all clearly worsen with lower SES. Overall self-reported health (SRH) also shows a strong positive SES gradient. Traditional cardiovascular risk factors such as diabetes and cholesterol are not significantly related to SES, but hypertension and obesity are worse among high-SES individuals. Reflecting mixed SES gradients in behaviors, smoking and lack of exercise are more common among low SES, but high calorie diets are more common among high SES. Conclusions. Negative modern behaviors among high-SES groups may be reversing cardiovascular risks across SES groups, hence reversing mortality risks. But negative SES gradients in healthy years of life persist. Key Words: Aging--Biological markers--Costa Rica--Health--Mortality--Socioeconomic status.

The disparities in the burden of ill health caused by environmental risks should be an important consideration beyond their aggregate population effects. We used comparative risk assessment methods to calculate the mortality effects of unsafe water and sanitation, indoor air pollution from household solid fuel use, and ambient urban particulate matter pollution in Mexico. We also estimated the disparities in mortality caused by each risk factor, across municipios (counties) of residence and by municipio socioeconomic status (SES). Data sources for the analysis were the national census, population-representative health surveys, and air quality monitoring for risk factor exposure; systematic reviews and meta-analyses of epidemiological studies for risk factor effects; and vital statistics for disease-specific mortality. During 2001-2005, unsafe water and sanitation, household solid fuel use, and urban particulate matter pollution were responsible for 3,000, 3,600, and 7,600 annual deaths, respectively. Annual child mortality rates would decrease by 0.2, 0.1, and 0.1 per 1,000 children, and life expectancy would increase by 1.0, 1.2, and 2.4 months, respectively, in the absence of these environmental exposures. Together, these risk factors caused 10.6% of child deaths in the Iowest-SES communities (0.9 deaths per 1,000 children), but only 4.0% in communities in the highest-SES ones (0.1 per 1,000). In the 50 most-affected municipios, these 3 exposures were responsible for 3.2 deaths per 1,000 children and a 10-month loss of life expectancy. The large disparities in the mortality effects of these 3 environmental risks should form the basis of interventions and environmental monitoring programs. environmental health | environmental justice | global health | population health | risk assessment

Objectives. We sought to quantify the extent of health selection (i.e., the degree to which potential immigrants migrate, or fail to migrate, on the basis of their health status) among contemporary US immigrant groups and evaluate the degree that selection explains variation in self-rated health among US legal permanent residents. Methods. Data came from the New Immigrant Survey 2003 cohort. We estimated the extent of positive and negative health selection through a unique series of questions asking immigrants in the United States to evaluate their health and compare it to that of citizens in their country of origin. Results. The extent of positive health selection differed significantly across immigrant groups and was related to compositional differences in the socioeconomic profiles of immigrant streams. Conclusions. The salience of socioeconomic status and English-language ability in explaining health differentials across immigrant groups reinforces the importance of further research on the role of these factors in contributing to the health of immigrants above and beyond the need for additional attention to the health selection process.

Objectives. We assessed whether markers of acculturation (birthplace and number of US generations) and socioeconomic status (SES) are associated with markers of subclinical cardiovascular disease--carotid artery plaque, internal carotid intima-media thickness, and albuminuria--in 4 racial/ethnic groups. Methods. With data from the Multi-Ethnic Study of Atherosclerosis (n = 6716 participants aged 45-84 years) and race-specific binomial regression models, we computed prevalence ratios adjusted for demographics and traditional cardiovascular risk factors. Results. The adjusted US-to foreign-born prevalence ratio for carotid plaque was 1.20 (99% confidence interval [CI]=0.97, 1.39) among Whites, 1.91 (99% C1=0.94, 2.94) among Chinese, 1.62 (99% CI=1.28, 2.06) among Blacks, and 1.23 (99% CI=1.15, 1.31) among Hispanics. Greater carotid plaque prevalence was found among Whites, Blacks, and Hispanics with a greater number of generations with US residence (P< .001) and among Whites with less education and among Blacks with lower incomes. Similar associations were observed with intima-media thickness. There was also evidence of an inverse association between albuminuria and SES among Whites and Hispanics. Conclusions. Greater US acculturation and lower SES were associated with a higher prevalence of carotid plaque and greater intima-media thickness but not with albuminuria. Maintenance of healthful habits among recent immigrants should be encouraged.

Studies have provided contradictory findings about the influence of race and ethnicity on mental health. Using data from the National Longitudinal Survey of Youth (1979 to 1992), this study examines the extent to which multiple dimensions of past and present socioeconomic status explain the influence of race and ethnicity on depression in young adulthood. Results indicate that Blacks and Hispanics have significantly higher levels of depressive symptoms than Whites, which supports social stress theory. These racial and ethnic differences are partially explained by family background and wealth, and substantially explained by the duration of poverty across 13 years of the transition to adulthood. Moreover, the robust depressive effect of past poverty duration is independent of present socioeconomic status and family background. Overall, this study was inspired by the life-course perspective and highlights the importance of wealth and histories of poverty for understanding racial and ethnic mental health disparities among young adults in the United States. Keywords: race and ethnicity; wealth; poverty duration; depression; young adulthood

Background. Interest in the determinants of 'successful aging' is growing. Nonetheless, successful aging remains ill defined, and its appropriate measurement is hotly contested. Most studies have focused on the absence of disability or deficits in physical performance as outcomes. The present study extends this research by using the Health Utilities Index Mark 3 (HUI3), a multidimensional measure of health status, to examine the maintenance of exceptionally good health among older participants in the Canadian National Population Health Survey (1994-2004). Methods. The maintenance of exceptionally good health in old age was examined prospectively among 2432 individuals (65-85 years old at baseline) who met the inclusion criteria. The participants were classified into one of four health trajectories: thrivers (who maintained exceptional health with no or only mild disability), nonthrivers (who experienced a moderate or severe disability), the deceased, and the institutionalized. Results. In 10 years of follow-up, 190 (8%) were thrivers (HUI3 score [greater than or equal to] 0.89 at all interviews), 1076 (47%) were nonthrivers, 893 (36%) died, and 273 (9%) were institutionalized. The maintenance of exceptionally good health among the elderly participants was related to younger age at baseline, socioeconomic status (higher income), psychosocial factors (including lower psychological distress), and behavioral factors (never smoked and moderate alcohol use). Conclusions. The maintenance of exceptionally good health in old age is related, at least in part, to modifiable lifestyle factors. However, elevated socioeconomic status also distinguishes those who are able to maintain exceptionally good health. Key Words: Aging--Epidemiology--Longitudinal--Population health.

Despite the substantial and prolonged sociological interest in health disparities, much remains unknown about the processes that initiate them. To investigate this topic, we focus on the case study of cocaine use, for which a socioeconomic disparity emerged across all age groups in a short period of time around 1990. We examine whether the newly-formed disparity represents a selective remnant of previous users or, instead, a selective recruitment of new users. To evaluate these two potential processes we use latent class regression on a nationally representative cohort with repeated measures of past-year cocaine use before and after 1990. Results support the 'remnant' hypothesis and show that the newly-formed disparity resulted primarily because people in the lower social strata were less likely to have a trajectory of cocaine use with a sharp drop in use after 1990. These results point to the 'remnant' concept as a way to bring together disparity analysis of very different and diverse health outcomes.

Medicare research has shown that there are substantial disparities by race and socioeconomic status in use of services. In this article, I review past research and discuss how findings apply specifically to vulnerable men aged 65 years or older. Six lessons from this review are Identified and Illustrated here. Disparities in certain measures of health are growing; to reverse this trend, substantial efforts are needed, including dissemination of information about disparities as well as testing of hypotheses regarding underlying causes.

I have summarized in this article data on the magnitude of health challenges faced by men in the United States. Across a broad range of indicators, men report poorer health than women. Although men in all socioeconomic groups are doing poorly in terms of health, some especially high-risk groups include men of low socioeconomic status (SES) of all racial/ethnic backgrounds, Iow-SES minority men, and middle-class Black men. Multiple factors contribute to the elevated health risks of men. These include economic marginality, adverse working conditions, and gendered coping responses to stress, each of which can lead to high levels of substance use, other health-damaging behaviors, and an aversion to health-protective behaviors. The forces that adversely affect men's health are interrelated, unfold over the life course, and are amenable to change.

Health services at the community level are organized and financed in such a way that men need access but encounter barriers to care such as poor service design, lack of insurance, and the absence of health literacy. Community health delivery systems may not be appropriate, effective, fit, or able to meet the needs they are charged to fill. Community-based health services, including health departments, are underfunded, understaffed, and unable to carry out their mission in a way that protects the health of the community. The current design for funding and delivering health care services excludes poor men, particularly men of color. Improving the health of men requires modifications in the way health care is financed, delivered, and managed.

Objectives. We assessed the prevalences of periodontitis by education and income levels among US adults with data from the third National Health and Nutrition Examination Survey. Methods. The study was limited to non-Hispanic Blacks, Mexican Americans, and non-Hispanic Whites 50 years of age or older with a complete periodontal assessment during the dental examination. Results. Blacks with higher education and income levels had a significantly higher prevalence of periodontitis than their White and Mexican-American counterparts. The relationship between income level and periodontitis was modified by race/ethnicity. High-income Blacks exhibited a higher prevalence of periodontitis than did low-income Blacks and high-income Whites. Conclusions. Our findings call attention to the importance of recognizing socioeconomic status-related health differences across racial/ethnic groups within the social, political, and historical context.

Objectives. Profound and growing disparities exist in oral health among certain US populations. We sought here to determine the prevalence of oral health complaints among Harlem adults by measures of social class, as well as their access to oral health care. Methods. A population-based survey of adults in Central Harlem was conducted from 1992 to 1994. Two questions on oral health were included: whether participants had experienced problems with their teeth or gums during the past 12 months and, if so, whether they had seen a dentist. Results. Of 50 health conditions queried about, problems with teeth or gums were the chief complaint among participants (30%).Those more likely to report oral health problems than other participants had annual household incomes of less than $9000 (36%), were unemployed (34%), and lacked health insurance (34%).The privately insured were almost twice as likely to have seen a dentist for oral health problems (87%) than were the uninsured (48%). Conclusions. There is an urgent need to provide oral health services for adults in Harlem. Integrating oral health into comprehensive primary care is one promising mechanism.

BACKGROUND: Previous research demonstrated increased risk of breast cancer associated with higher socioeconomic status (SES) measured at both the individual and community levels. However, little attention has been paid to [...]

Vitamin B-12 is related to neurocognitive function in school-age children, yet sociodemographic and dietary correlates of vitamin B-12 status in this age group are not well characterized. The prevalences of vitamin B-12 or folate deficiencies in Colombia are unknown. We conducted a cross-sectional study in a representative sample of 2800 low- and middle-income children aged 5-12 y from Bogota's public schools. Plasma vitamin B-12 and erythrocyte folate concentrations (mean [+ or -] SD) were 327 [+ or -] 106 pmol/L and 858 [+ or -] 256 nmol/L, respectively. The prevalence of vitamin B-12 deficiency (

The current study estimated the contribution of job characteristics to socioeconomic inequalities in incidence of myocardial infarction (MI) during a 12-year follow-up period. Data were from the working population (aged 25-64 years) in the Netherlands longitudinal GLOBE study (N = 5757). Self-reported information was available from baseline measurement (in 1991) for education, occupation, job demand, job control, fear of becoming unemployed, adverse physical working conditions, and smoking and alcohol use. Information on hospital admissions for MI among study participants was available until 2003, and was linked to baseline data via record linkage. Cox regression analyses were performed to estimate the hazard of MI in different socioeconomic groups before and after adjustment for job characteristics and health-related behaviours. Lower educated and manual workers had a higher risk of Ml during follow-up, after adjusting for age, sex and marital status than higher educated and non-manual workers, respectively. After adjustment for occupation, the lowest educated still had an elevated risk of MI. After adjustment for education, no significant association of occupation with MI was observed. Job control and adverse physical working conditions were not significantly associated with MI after adjustment for socioeconomic position. These results suggest that the reduction of the socioeconomic position--MI association after adjustment for the two specific job characteristics reflect the effect of other unobserved factors closely related to both socioeconomic position and job characteristics. The results of this study point toward education as being the stronger predictor of hospital admitted MI, compared to occupational position and job characteristics, in the Dutch working population. Keywords: The Netherlands; Social inequalities; Socioeconomic position; Job characteristics; Cardiovascular disease; Myocardial infarction

Traditional cardiac risk factors only partially explain the biological mechanisms by which persons of lower socioeconomic status (SES) have higher cardiovascular risk. Dietary factors, resulting in lower circulating levels of (n-3) fatty acids, may also contribute to the increased risk of cardiovascular disease (CVD) in patients with low SES. We tested whether low SES is associated with RBC levels of (n-3) fatty acids in patients with coronary heart disease. We performed a cross-sectional analysis of 987 adults with stable coronary artery disease (CAD) recruited from San Francisco area outpatient clinics. Four SES measures (household income, education, occupation, and housing status) were assessed by self-report. RBC fatty acid levels of 2 (n-3) fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), were measured in venous blood samples from fasting subjects. Participants with lower household income, education, occupation, and housing status had lower RBC levels of (n-3) fatty acids (P < 0.001 for all 4 measures). In multivariable models, household income, education, and occupation remained strongly associated with DHA and EPA levels after adjustment for demographic factors, BMI, physical activity, statin use, and kidney function (P < 0.001 for all 3 measures). Housing status was not associated with DHA or EPA after multivariable adjustment. Among patients with CAD, 3 indicators of low SES, household income, education, and occupation, were strongly associated with lower RBC levels of (n-3) fatty acids. Our results raise the possibility that (n-3) fatty acids may be an important mediating factor in the association between low SES and CVD.

There is substantial evidence from developed countries that lower socioeconomic status (SES) is associated with increased occurrence of mental illness, and growing interest in the role of social support and social capital in mental health. However, there are few data on social determinants of mental health from low- and middle-income nations. We examined the association between psychological distress and SES, social support and bonding social capital in a nationally-representative sample of South African adults. As part of a national survey of mental health, a probability sample of 4351 individuals was interviewed between 2002 and 2004. Non-specific psychological distress was measured using the Kessler K-10 scale. SES was assessed from an aggregate of household income, individual educational and employment status, and household material and financial resources. Social support, bonding social capital and traumatic life events were measured using multi-item scales. The mean age in the sample was 37 years and 76% of participants were black African. Measures of SES and social capital were inversely associated (p < 0.001). Both recent and traumatic life events were more common among individuals with low levels of SES and social support. After adjusting for participant demographic characteristics and life events, high levels of psychological distress were most common among individuals with lower levels of SES and social capital. There was no independent association between levels of social support and psychological distress. The occurrence of recent life events appeared to partially mediate the association between SES and psychological distress (p = 0.035) but not the association involving social capital (p = 0.40). These data demonstrate persistent associations between levels of SES, social capital and psychological distress in South Africa. The increased frequency of recent life events appears to only partially explain higher levels of psychological distress among individuals of lower SES. Additional research is required to understand the temporality of this association as well as mechanisms through which SES and social capital influence mental health in low- and middle-income settings where high levels of poverty and trauma may contribute to excess burden of mental illness. Keywords: Psychological distress; Mental health; Socioeconomic status (SES); Social support; Social capital; South Africa

Although the overall population in the United States has experienced a dramatic increase in obesity in the past 25 years, ethnic/racial minorities, and socio-economically disadvantaged populations have a greater prevalence of obesity, as compared to white, and/or economically advantaged populations. Disparities in obesity are unlikely to be predominantly due to individual psychosocial or biological differences, and they may reflect differences in the built or social environment. The retail food environment is a critical aspect of the built environment that can contribute to observed disparities. This paper reviews the literature on retail food environments in the United States and proposes interrelated hypotheses that geographic, racial, ethnic, and socioeconomic disparities in obesity within the United States are the result of disparities in the retail food environment. The findings of this literature review suggest that poor-quality retail food environments in disadvantaged areas, in conjunction with limited individual economic resources, contribute to increased risk of obesity within racial and ethnic minorities and socioeconomically disadvantaged populations.

Socioeconomic inequalities in adolescent health have been little studied until recently, partly due to the lack of appropriate and agreed upon measures for this age group. The difficulties of measuring adolescent socioeconomics status (SES) are both conceptual and methodological. Conceptually, it is unclear whether parental SES should be used as a proxy, and if so, which aspect of SES is most relevant. Methodologically, parental SES information is difficult to obtain from adolescents resulting in high levels of missing data. These issues led to the development of a new measure, the Family Affluence Scale (FAS), in the context of an international study on adolescent health, the Health Behaviour in School-Aged Children (HBSC) Study. The paper reviews the evolution of the measure over the past 10 years and its utility in examining and explaining health related inequalities at national and cross-national level in over 30 countries in Europe and North America. We present an overview of HBSC papers published to date that examine FAS-related socioeconomic inequalities in health and health behaviour, using data from the HBSC study. Findings suggest consistent inequalities in self-reported health, psychosomatic symptoms, physical activity and aspects of eating habits at both the individual and country level. FAS has recently been adopted, and in some cases adapted, by other reseach and policy related studies and this work is also reviewed. Finally, ongoing FAS validation work is described together with ideas for future development of the measure. Keywords: Health inequalities; Adolescents; Family affluence; Health behaviours; Health indicators; Health Behaviour in School-Aged Children (HBSC); Comparative

Characteristics associated with disadvantaged social position, such as low socioeconomic status (SES) and female gender, may play a significant role in the development of internalizing symptoms among adolescents. Indeed, theories of 'double jeopardy' suggest that these disadvantaged status characteristics interact to produce particularly harmful mental health outcomes. We tested the hypothesis that lower SES places adolescent females at greater risk for internalizing symptoms than males. We used data from the Project on Human Development in Chicago Neighborhoods collected from a 15-year-old adolescent cohort (n = 640) at baseline and at two-year follow-up. Female gender predicted internalizing symptoms cross-sectionally and prospectively, whereas household income and caretaker education generally were not associated with internalizing symptoms. Findings overall did not indicate interactive effects between gender and SES indicators. However, subgroups of females at the lowest levels of caretaker education and household income displayed increased risk for specific outcomes, including higher internalizing symptom levels at follow-up and maintenance of severe symptom levels from baseline to follow-up. Keywords: Gender; Adolescence; Internalizing; Double jeopardy; Socioeconomic status (SES); USA; Gender; Mental health

The aims of this study were to examine the association between maternal working conditions and birth outcomes, and to determine the extent to which these contributed to class inequalities in six birth outcomes. We used an existing job exposure matrix developed from survey data collected in 1977 and 1979 to apply occupational-level information on working conditions to the national Swedish Registry, including approximately 280,000 mothers and 360,000 births during the period 1980-1985. Data were analysed using multivariate logistic regressions. Low levels of job control, high levels of physical demands and job hazards were more common in manual compared to non-manual classes. The self-employed had intermediate levels of such exposures. Job exposures, particularly low levels of job control, were generally and significantly associated with higher risks for low birthweight, very low birthweight, small for gestational age, all preterm, very preterm and extremely preterm births, but not with mortality. Compared to middle non-manuals (the reference group), lower non-manual and manual classes had higher risks for all birth outcomes, and these risks were nearly all significant. The highest odds ratios were found for skilled and unskilled manual workers in the manufacturing sector, with ratios between 1.35 and 2.66 (all significant). Job control explained a considerable proportion of inequalities in all birth outcomes. Job hazards contributed particularly to very low birthweight and extremely preterm birth, and physical demands to low birthweight and all preterm births. In conclusion, class differences in maternal working conditions clearly contributed to class differences in low birthweight (explained fraction 14-38%), all preterm births (20-46%), very (14-46%) and extremely (12-100%) preterm births. For very low birthweight and small for gestational age, there was a similar contribution in the manufacturing sector only. For all birth outcomes, class differences could still be detected after working conditions were taken into consideration. Keywords: Working conditions; Birth outcome; Socio-economic inequalities; Sweden

Objectives. Objectives were to study the effects of socioeconomic factors on transitions in living arrangements and mortality for men and women. Methods. We used a sample of Finns aged 65 years and older living alone or with a partner at the end of 1997 (N = 250,787) drawn from population registers, and followed them up for transitions in living arrangements (with partner, alone, with others, institutionalized) and death at the end of 2002. Results. Health conditions associated with functional difficulties were major determinants of institutionalization and death and were associated with transitions between private households. Low income among men and in particular not owning a home were independently associated with institutionalization and death among those living alone or with a partner at baseline. Among those living with a partner, the transition to living alone was associated with all socioeconomic factors but most strongly with a low income and not owning a home. Transitions to living with others were associated in particular with low occupational social class and education. Discussion. Variations in the associations of different socioeconomic indicators with living arrangement transitions imply different social pathways. However, material socioeconomic indicators dominated other measures of socioeconomic status in determining such transitions, and their effects were only partly mediated by chronic conditions. Key Words: Living arrangements--Socioeconomic status--Finland.

Despite improvements in the status of Blacks and women over the past 30 years, racial and gender disparities in mortality and morbidity persist. Using General Social Survey (GSS) data from 1974 to 2004, the authors explore the extent to which race, gender, and socioeconomic status converge to produce differences in self-assessed health. The intersectionality paradigm is used to guide this work on health disparities. The authors find that the gender gap in self-assessed health has narrowed significantly over this 30-year time period. This decreased gap is especially pronounced because of the marked improvement over time in Black women's reports of their health. However, Black women continue to report the lowest levels of self-assessed health even in 2004. In fact, Black women who hold a college degree report worse health than White men, White women, and Black men with a high school diploma. Keywords: health; disparity; race; gender; intersectionality

In this study, the authors use longitudinal data from the Panel Study of Income Dynamics and growth curve models to examine the utility of the concept of cumulative disadvantage as an explanation for race differences in life-course health (sell-rated) in the United States. The authors ask whether socioeconomic resources equally benefit the health of Blacks and Whites, or if Whites receive higher rates of return to resources across the life course. The authors find that the relationship differs depending on the indicator of socioeconomic status that is examined. Education does not offer the same advantages for the health of Blacks as it does for Whites, particularly at higher levels of education, and this is compounded with age. In contrast, returns to income and wealth are similar for Blacks and Whites, and these resources remain equally important to protecting the health of Blacks and Whites across the life course. Over time, Blacks are at an increasing health disadvantage relative to Whites, a result that is not attenuated by educational attainment. Keywords: life-course health; race differences in health: socioeconomic status and health: education and health

Background: Socio-economic factors may affect diet quality, perhaps differentially across gender and ethnicity. The mechanism of this association is still largely unknown. Objectives: We examined the independent effects of socio-economic [...]

The associations between neighborhood context and various indicators of health are receiving growing empirical attention, but much of this research is regionally circumscribed or assumes similar effects across the life course. This study utilizes a U.S. national sample to investigate the association between urban neighborhood socioeconomic disadvantage and health specifically among older adults. Data are from 3442 participants aged 70 years and older in the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, and the 1990 U.S. Census. Our approach underscores the importance of multiple dimensions of health (selfreported physician-diagnosed cardiovascular disease [CVD], functional status, and self-rated health) as well as multiple dimensions of neighborhood disadvantage, which are conceptualized as environmental hazards that may lead to a physiologically consequential stress response. We find that individual-level factors attenuate the association between neighborhood disadvantage and both CVD and functional status, but not self-rated health. Net of covariates, high neighborhood socioeconomic disadvantage is significantly associated with reporting poor health. In late life, neighborhood socioeconomic disadvantage is more consequential to subjective appraisals of health than diagnosed CVD or functional limitations. Keywords: U.S.A.; Health status; Residence characteristics; Socioeconomic factors; Multilevel modelling; Elderly

Aims: To describe the socio-economic background and physical health status of young offenders in custody in New South Wales (Australia). Design: Cross-sectional survey of all young offenders held at nine juvenile detention centres across New South Wales (NSW) (eight male and one female) between January and March 2003. Methods: Demographic and health information was collected by nurse interviewers and psychologists using a face-to-face interview. Blood and urine samples were collected to screen for blood-borne viruses and sexually transmissible infections. Results: The final sample comprised 242 young people (223 males and 19 females). Overall, 90% of those assessed rated their general health as 'excellent', 'very good' or 'good'. Sixty-nine (30%) young offenders reported that they had been previously diagnosed with asthma. Two young women reported a past diagnosis of diabetes with the results of the random blood glucose testing indicating that a further six young people required testing for possible diabetes. None of those tested were positive for HIV, 9% tested positive for hepatitis C antibody, and 11% tested positive for hepatitis B core-antibody. Conclusions: Our findings indicate that young offenders in New South Wales have backgrounds characterised by extreme disadvantage (poor educational attainment, unemployment, and care placements) and poor physical health. Parental incarceration was common to 43% of the sample. Our findings reinforce the concept that for marginalised groups, contact with the criminal justice system represents an important opportunity to detect illness, initiate treatment, and promote contact with health services. Keywords: Adolescent; prisoners; bloodborne pathogens; health status; Australia. doi:10.1111/j.1753-6405.2008.00169.x

The imperfect risk adjustment of prospective payment for hospitals may have dramatic consequences on equity. If the hospital is able to distinguish subgroups of patients with different expected costs within a group for which the risk-adjusted payment per admission is the same, it is likely to select the most profitable cases and deny care to the others. Meanwhile, hospitals refusing to practice patients' selection may experience solvency problems. In the long term, either those hospitals fail and access to care is at risk, or they decrease the quality of treatments and access to quality is at risk. In Belgium, since 1995, a prospective payment per case has replaced the traditional per diem payments for non-medical expenditures. A fixed number of days are paid to each admission, based on the patient's characteristics, namely diagnosis, age and geriatric profile. In this paper, we examine the imperfect risk adjustment related to the non-inclusion of socioeconomic factors in the hospital financing formula. Using data from 61 Belgian hospitals from 1995, we observe that socio-economic status, which is currently not accounted for as risk adjuster, has a significant impact on length of stay (LOS). We estimate that patients in the upper-income categories, patients with a self-employed status and patients with an employee status are beneficial for hospitals' financial results, due to their shorter stays. On the contrary, the non-active, the low-income patients and patients benefiting from an insurance preferential regime represent, on average, a financial loss for hospitals. Finally, we find that financial results under the current financing scheme are biased due to the non-inclusion of SES risk-adjustors. Hospitals with the most beneficial social case-mix are shown to experience a shift from a positive to a negative financial outcome when SES risk adjustors are included, while the reverse is observed for hospitals with the worst social case-mix. Keywords: Risk-adjustment; Hospital financing; Socio-economic status; Length of stay; Patient's selection; Belgium

The cumulative advantage hypothesis suggests diverging socioeconomic status (SES) based gaps in health with age. However, previous studies yield inconsistent findings regarding the association between SES and health across the adult life span. Dealing with the issue of mortality selection bias, this study utilizes latent growth-curve modeling to comprehensively examine age trajectories of both physical and mental health by SES using panel data based on a national probability sample of 3617 US adults. We find that education-and income-based gaps in physical impairment and the education-based gap in depression diverge over time for all adult age groups, supporting the hypothesis of cumulative advantage. In contrast, we find that the income-based gap in depression converges in older age, supporting the hypothesis of age-as-leveler. Mortality selection bias is unlikely to be a major part of the explanation for the convergence. These results indicate that age-related patterns in health trajectories may differ by various dimensions of SES and health. Finally, we take into account persistence or change in income over time to examine the relationship between trajectories of income and health across adulthood, highlighting the importance of considering the temporal patterns of income in understanding age trajectories of health. Keywords: USA; Socioeconomic status (SES); Health disparities; Latent growth-curve modeling; Cumulative advantage; Mortality selection

Objectives. We investigated whether racial disparities in the prevalence of type 2 diabetes exist beyond what may be attributable to differences in socioeconomic status (SES) and other modifiable risk factors. Methods. We analyzed data from 34331 African American and 9491 White adults aged 40 to 79 years recruited into the ongoing Southern Community Cohort Study. Participants were enrolled at community health centers and had similar socioeconomic circumstances and risk factor profiles. We used logistic regression to estimate the association between race and prevalence of self-reported diabetes after taking into account age, SES, health insurance coverage, body mass index, physical activity, and hypertension. Results. Multivariate analyses accounting for several diabetes risk factors did not provide strong support for higher diabetes prevalence rates among African Americans than among Whites (men: odds ratio [OR] = 1.07; 95% confidence interval [CI] = 0.95, 1.20); women: OR = 1.13, 95% CI = 1.04, 1.22). Conclusions. Our findings suggest that major differences in diabetes prevalence between African Americans and Whites may simply reflect differences in established risk factors for the disease, such as SES, that typically vary according to race.

Objective This study tested the hypothesis that neighborhood deprivation will be associated with lower levels of serum carotenoids in comparison with wealthy residential areas. Design Cross-sectional, nationally representative survey data were used to assess the relationship between neighborhood level socioeconomic status and serum carotenoids. Subjects Seventeen thousand two participants aged 17 years and older from the Third National Health and Nutrition Examination Survey were linked with 1990 census data. Main outcome measures Serum levels of lycopene, [beta]-carotene, [alpha]-carotene, lutein/zeaxanthin, and [beta]-cryptoxanthin. Statistical analysis Multivariate linear regression was used to model the association of serum carotenoids and neighborhood deprivation, which is a summary index of 11 indicators for tract level socioeconomic status. Adjustments are made for individual level age, sex, years of education, household income, employment, race/ethnicity, body mass index, serum cotinine, alcohol use, physical activity, and serum cholesterol. Results Multivariate analysis revealed a negative and statistically significant association between high levels of neighborhood deprivation and [beta]-carotene ([beta]=-2.98 [micro]g/dL [-0.06 [micro]mol/L], P=0.00), [alpha]-carotene ([beta]=-1.28 [micro]g/dL [-0.02 [micro]mol/L], P=<0.0001), lutein/zeaxanthin (-1.69 [micro]g/dL [-0.03 [micro]mol/L], P=0.00, [beta]-cryptoxanthin ([beta]=-1.34 [micro]g/dL [-0.02 [micro]mol/L], P<0.0001), and total carotenoids ([beta]=- 8.20 [micro]g/dL, P= <0.0001). Lycopene was not related to neighborhood deprivation. Adjusted mean levels of carotenoids for high deprivation neighborhoods were lower than neighborhoods with low deprivation: [beta]-carotene=8.72 [micro]g/dL [0.16 [micro]mol/L] vs 20.64 [micro]g/dL [0.38 [micro]mol/L], [alpha]-carotene=0.44 [micro]g/dL [0.008 [micro]mol/L] vs 5.56 [micro]g/dL [0.10 [micro]mol]L], lutein/zeaxanthin = 13.79 [micro]g/dL [0.24 [micro]mol]L] vs 20.55 [micro]g/dL [0.36 [micro]mol/L], [beta]-cryptoxanthin=4.57 [micro]g/dL [0.08 [micro]mol/L] vs 9.93 [micro]g/dL [0.18 [micro]mol/L], lycopene=22.07 [micro]g/dL [0.41 [micro]mol/L] vs 25.63 [micro]g/dL [0.48 [micro]mol/L], and total=49.56 [micro]g]dL vs 82.36 [micro]g/dL. Conclusions Neighborhood deprivation was associated with lower serum levels of carotenoids. There was a substantial disparity between low deprivation and high deprivation residential areas with respect to fruit and vegetable intake.

The inverse graded relationship of education and risk factors of coronary heart disease (CHD) has been reported from Western populations. To examine whether risk factors of CHD are predicted by level of education and influenced by the level of urbanization in Indian industrial populations, a cross-sectional survey (n = 19,973; response rate, 87.6%) was carried out among employees and their family members in 10 medium-to-large industries in highly urban, urban, and periurban regions of India. Information on behavioral, clinical, and biochemical risk factors of CHD was obtained through standardized instruments, and educational status was assessed in terms of the highest educational level attained. Data from 19,969 individuals were used for analysis. Tobacco use and hypertension were significantly more prevalent in the low-(56.6% and 33.8%, respectively) compared with the high-education group (12.5% and 22.7%, respectively; P < 0.001). However, dyslipidemia prevalence was significantly higher in the high-education group (27.1% as compared with 16.9% in the lowest-education group; P < 0.01). When stratified by the level of urbanization, industrial populations located in highly urbanized centers were observed to have an inverse graded relationship (i.e., higher-education groups had lower prevalence) for tobacco use, hypertension, diabetes, and overweight, whereas in less-urbanized locations, we found such a relationship only for tobacco use and hypertension. This study indicates the growing vulnerability of lower socioeconomic groups to CHD. Preventive strategies to reduce major CHD risk factors should focus on effectively addressing these social disparities. coronary heart disease | socioeconomic status

Although the relationship between socioeconomic status (SES) and health is well-established in Western industrialized countries, few studies have examined this association in developing countries, particularly among older cohorts. We use the Mexican Health and Aging Study (MHAS), a nationally representative survey of Mexicans age 50 and older, to investigate the linkages between three indicators of SES (education, income, and wealth) and a set of health outcomes and behaviors in more and less urban areas of Mexico. We consider three measures of current health (self-rated health and two measures of physical functioning) and three behavioral indicators (obesity, smoking, and alcohol consumption). In urban areas, we find patterns similar to those in industrialized countries: higher SES individuals are more likely to report better health than their lower SES counterparts, regardless of the SES measure considered. In contrast, we find few significant SES-health associations in less urban areas. The results for health behaviors are generally similar between the two areas of residence. One exception is the education obesity relationship. Our results suggest that education is a protective factor for obesity in urban areas and a risk factor in less urban areas. Contrary to patterns in the industrialized world, income is associated with higher rates of obesity, smoking, and excessive alcohol consumption. We also evaluate age and sex differences in the SES health relationship among older Mexicans. The results suggest that further economic development in Mexico may lead to a widening of socioeconomic inequalities in health. The study also provides insight into why socioeconomic gradients in health are weak among Mexican-Americans and underscores the importance of understanding health inequalities in Latin America for research on Hispanic health patterns in the US. Keywords: Mexico: Socioeconomic status; Health: Health inequalities: Older adults; Area

Objective To measure socioeconomic inequalities and differential risk in infant mortality on national and regional levels in Chile from 1990 to 2005, and propose new policy targets. Methods The study analysed Chilean vital events registries from 1990 to 2005 for infant mortality by maternal education, head of household occupational status, cause, age and location of death. Annual infant mortality rates and relative risk were calculated by maternal education and head of household occupational status for each cause and age of death. Socioeconomic inequalities were then mapped to 29 regional health services. Findings Reductions in the national infant mortality rate were driven by reductions among highly educated mothers, while recent stagnation in the national rate is caused by high levels of infant mortality among uneducated mothers. These vulnerable households are particularly prone to infant mortality risk due to infectious disease and trauma. We also identify clustering of high socioeconomic inequalities in infant mortality throughout the poorer north, indigenous south and densely populated metropolitan centre of Santiago. Finally, we report large inequities in vital statistics coverage, with infant deaths among vulnerable households much more likely to be inadequately defined than in the remaining population. Conclusion These results indicate that the socioeconomically disadvantaged in Chile are at a significantly higher risk for infant mortality by infectious diseases and trauma during the first month of life. Efforts to reduce national infant mortality in Chile and other countries must involve policies that target child survival for at-risk populations for specific diseases, ages and locations. Resume Baisse de la mortalite infantile au Chili : a qui beneficie ce progres? Inegalites socioeconomiques et geographiques en matiere de mortalite infantile de 1990 a 2005 Objectif Mesurer les inegalites socioeconomiques et les variations du risque de mortalite infantile aux niveaux national et regional au Chili entre 1990 et 2005 et proposer de nouveaux objectifs pour les politiques sanitaires. Methodes L&apos;etude a analyse les registres d&apos;etat civil chiliens entre 1990 et 2005 pour determiner la mortalite infantile par niveau d&apos;education de la mere, statut professionnel du chef de famille, cause, age et lieu du deces. Pour chaque cause et age de deces, les taux annuels de mortalite infantile et les risques relatifs ont ete calcules par niveau d&apos;education maternelle et par statut professionnel du chef de familles. On a ensuite dresse la carte des inegalites socioeconomiques en fonction des 29 services de sante regionaux. Resultats Les baisses du taux de mortalite infantile national etaient liees a des baisses du taux de mortalite infantile chez les femmes beneficiant d&apos;un niveau d&apos;education eleve, tandis que la stagnation recente du taux national etait imputable a de forts niveaux de mortalite infantile chez les femmes non eduquees. Les foyers vulnerables concernes etaient plus exposes au risque de mortalite infantile par maladie infectieuse ou traumatisme. Nous avons aussi releve une concentration de fortes inegalites socioeconomiques en matiere de mortalite infantile dans le nord du pays plus pauvre, dans la partie sud du pays peuplee d&apos;indigenes et dans la conurbation a forte densite de population de Santiago. Enfin, nous signalons d&apos;importantes inegalites dans la couverture par les registres d&apos;etat-civil, le nombre de deces infantiles parmi les foyers vulnerables ayant une probabilite nettement plus forte detre mal defini que dans le reste de la population. Conclusion Ces resultats indiquent que les habitants socioeconomiquement desavantages du Chili sont exposes un risque significativement plus eleve de mortalite par maladie infectieuse ou par traumatisme pendant leur premier mois de vie. Les efforts pour reduire la mortalite infantile nationale dans des pays comme le Chili doivent comprendre des politiques visant la survie des enfants parmi les populations a risque exposees des maladies et appartenant a des classes d&apos;age et a des lieux specifiques. Resumen Disminucion de la mortalidad infantil en Chile: ?quienes se benefician? Desigualdades socioeconomicas y geograficas en mortalidad infantil, 1990-2005 Objetivo Medir las desigualdades socioeconomicas y el riesgo diferencial en mortalidad infantil a nivel nacional y regional en Chile entre 1990 y 2005 y proponer nuevas metas de politica. Metodos A partir de registros de eventos vitales del pais correspondientes al periodo de 1990 a 2005, se analizo la mortalidad infantil en funcion de la educacion de la madre, la situacion laboral del cabeza de familia, la causa, la edad y el lugar de la defuncion. Se calcularon las tasas anuales y el riesgo relativo de mortalidad infantil en funcion de la educacion de la madre y de la situacion laboral para cada causa y edad de fallecimiento. Sobre esa base, se mapearon las desigualdades socioeconomicas en 29 servicios regionales de salud. Resultados Las reducciones de la tasa nacional de mortalidad infantil se debieron a la disminucion conseguida entre las madres con alto nivel de estudios, mientras que el estancamiento reciente de esa tasa se debe al elevado nivel de mortalidad infantil registrado entre las madres sin estudios. En estos hogares vulnerables se observa un riesgo especialmente elevado de mortalidad infantil por enfermedades infecciosas y traumatismos. Detectamos ademas agrupamientos de gran desigualdad socioeconomica en las zonas mas pobres del norte, las comunidades indigenas del sur y el centro metropolitano densamente poblado de Santiago. Por ultimo, informamos de importantes inequidades en la cobertura de las estadisticas vitales, toda vez que las defunciones de lactantes que se producen en los hogares vulnerables suelen estar descritas con menos precision que en el resto de la poblacion. Conclusion Los resultados indican que las clases desfavorecidas de Chile estan expuestas a un riesgo significativamente mayor de mortalidad infantil por enfermedades infecciosas y traumatismos durante el primer mes de vida. Los esfuerzos orientados a reducir la mortalidad infantil en Chile y en otros paises deben incluir politicas focalizadas en la supervivencia infantil en poblaciones de riesgo caracterizadas por enfermedades especificas, por la edad y por el lugar geografico., Introduction Latin America remains one of the most extraordinarily unequal regions in the world. Despite its recent economic growth and development, Chile is plagued by the same profound disparities in [...]

Research has established that those with higher social status have better health. Less is known about whether this relationship differs cross-nationally and whether it operates similarly across different institutional arrangements. To examine the relationship between stratification and health, two Western, industrialized societies at opposite ends of an equal/unequal continuum are compared: the United States and Iceland. Using data from the 1998 General Social Survey and the 1998 Health and Living Standards of Adult Icelanders survey, I draw from two theoretical perspectives. First, I explore the notion of fundamental causes of disease by examining whether stratification has similar effects on health. Second, I examine whether the organization of welfare states affects this relationship. The results show that education, employment, and relative poverty have similar effects on health in both nations, thus supporting the notion of a fundamental cause. However, in Iceland relative affluence has a weaker relationship with health. Further, being a parent, regardless of marital status, has a stronger positive relationship with good health in Iceland. Welfare state intervention may be most successful in equalizing health outcomes by supporting families and by removing advantages traditionally accumulated by the wealthy in capitalist societies.

This article seeks to elucidate the relationship between socioeconomic position and health by showing how different facets of socioeconomic position (education and income) affect different stages (onset vs. progression) of health problems. The biomedical literature has generally treated socioeconomic position as a unitary construct. Likewise, the social science literature has tended to treat health as a unitary construct. To advance our understanding of the relationship between socioeconomic position and health, and ultimately to foster appropriate policies and practices to improve population health, a more nuanced approach is required--one that differentiates theoretically and empirically among dimensions of both socioeconomic position and health. Using data from the Americans' Changing Lives Study (1986 through 2001/2002), we show that education is more predictive than income of the onset of both functional limitations and chronic conditions, while income is more strongly associated than education with the progression of both.