Social inequalities in health: the mediating role of material deprivation and psychological resources
Abstract
The article deals with the problem of socio-structural inequalities in health. Numerous studies confirm the social structuring of health — its deterioration with the decline of socio-economic status, i.e. level of education, income, and professional status. The main theoretical approaches to the explanation of structural inequalities in health are associated with materialistic, psychosocial and behavioral interpretations. This review presents the current state of research in which these approaches have been tested. It is empirically established that the poor health of low status individuals is linked not only to an increased prevalence of risky behavior patterns, such as smoking and alcohol abuse, but is also generated to a large extent by their unfavorable material circumstances. Psychosocial explanations have also been convincingly confirmed in empirical studies devoted to the study of the mediation effects associated with stressful influences and a person’s psychological resources. Recently, these findings have been questioned, due to the fact that when taking into account the joint mediating influence of material, psychosocial and behavioral factors, the severity of individual mediations turned out to be less distinct — the psychosocial and behavioral effects were not so clearly manifested as in separate analysis, being much weaker than material mediation. But this conclusion also requires clarification, given that the mediation effects may depend on the public macro-context. It is possible that material and psychological mediators will be less pronounced in countries with a strong economy and social guarantees, as people from vulnerable strata can count on protection from the state and maintain their self-efficacy, with optimism looking to the future.
In less developed countries, not capable of providing social guarantees at a high level, not only material deprivation will serve as a mediator of structural inequalities, but also psychological resources which people with low social standing lose due to life’s hardships.
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Adler N.E., Boyce T., Chesney M.A., et al. (1994). Socioeconomic status and health: The challenge of the gradient. American Psychologist, 49(1), 15–24. doi:10.1037/0003-066X.49.1.15
Adler N.E., Snibbe A.C. (2003). The role of psychosocial processes in explaining the gradient between socioeconomic status and health. Current Directions in Psychological Science, 12(4), 119–123. doi:10.1111/1467-8721.01245
Adler N. E., Stewart J. (2010). Health disparities across the lifespan: Meaning, methods, and mechanisms. Annals of the New York Academy of Sciences, 1186(1), 5–23. doi:10.1111/j.1749-6632.2009.05337.x
Aldabe B., Anderson R., Lyly-Yrjänäinen M., et al. (2011). Contribution of material, occupational, and psychosocial factors in the explanation of social inequalities in health in 28 countries in Europe. Journal of Epidemiology and Community Health, 65(12), 1123–1131. doi:10.l136/jech.2009.102517
Bleich S.N., Jarlenski M.P., Bell C.N., LaVeist T.A. (2012). Health inequalities: Trends, Progress, and Policy Annual Review of Public Health, 33, 7–40. doi: 10.1146/annurev-publhealth-031811-124658
Bobak M., Pikhart H., Rose R., Hertzman C., Marmot M. (2000). Socioeconomic factors, material inequalities, and perceived control in self-rated health: cross-sectional data from seven post-communist countries. Social Science & Medicine, 51(9), 1343-1350. doi: 10.1016/S0277-9536(00)00096-4
Boehm J.K., Chen Y., Williams D.R., et al. (2015). Unequally distributed psychological assets: Are there social disparities in optimism, life satisfaction, and positive affect? PLoS ONE, 10(2), e0118066. doi:10.1371/journal.pone.0118066
Boehm J.K., Peterson C., Kivimaki M., Kubzansky L.A. (2011). Prospective Study of Positive Psychological Well-Being and Coronary Heart Disease. Health Psychology, 30(3), 259–267. doi: 10.1037/a0023124
Boeing H. (1991). Epidemiological research in stomach cancer: progress over the last ten years. Journal of Cancer Research and Clinical Oncology, 117(2), 133–143. doi: 10.1007/BF01613137
Bosma H., Schrijvers C., Mackenbach J.P. (1999). Socioeconomic inequalities in mortality and importance of perceived control: Cohort study. British Medical Journal, 319(7223), 1469–1470. doi: 10.1136/bmj.319.7223.1469
Brunello G., Fort M., Schneeweis N., Winter-Ebmer R. (2016). The causal effect of education on health: what is the role of health behaviors? Health Economics, 25(3), 314–336. doi: 10.1002/hec.3141
Cohen S., Janicki-Deverts D., Miller G.E. (2007). Psychological stress and disease. Journal of the American Medical Association, 298(14), 1685–1687. doi: 10.1001/jama.298.14.1685
Daoud N., Soskolne V., Manor O. (2009). Examining cultural, psychosocial, community and behavioural factors in relationship to socioeconomic inequalities in limiting longstanding illness among the Arab minority in Israel. Journal of Epidemiology and Community Health, 63(5). 351–358. doi: 10.1136/jech.2008.080465
Ellaway A., Macdonald L., Keams A. (2016). Are housing tenure and car access still associated with health? A repeat cross-sectional study of UK adults over a 13-year period. British Medical Journal Open, 6(11), e012268. doi: 10.1136/bmjopen-2016-012268
Elgar F., Pförtner T-K., Moor I., et al. (2015). Socioeconomic inequalities in adolescent health 2002-2010: a time-series analysis of 34 countries participating in the Health Behaviour in School-aged Children study. Lancet, 385(9982), 2088-2095. doi: 10.1016/S0140-6736(14)61460-4
Festin K, Thomas K., Ekberg J., Kristenson M. (2017). Choice of measure matters: A study of the relationship between socioeconomic status and psychosocial resources in a middle-aged normal population. PLoS ONE, 12(8), e0178929. doi:10.1371/journal.pone.0178929
Fritzell J., Rehnberg J., Hertzman J.B., Blomgren J. (2015). Absolute or relative? A comparative analysis of the relationship between poverty and mortality. International Journal of Public Health, 60(1), 101–110. doi: 10.1007/s00038-014-0614-2
Fusco A., Guio A-C., Marlier E. (2013). Building a material deprivation index in a multinational context: lessons from the EU experience. In V. Bérenger, F. Bresson (Eds.), Poverty and social exclusion around the Mediterranean Sea (pp. 43–71). New York: Springer. doi: 10.1007/978-1-4614-5263-8_2
Gallo L.C, Matthews K.A. (2003). Understanding the association between socioeconomic status and physical health: Do negative emotions play a role? Psychological Bulletin, 129(1), 10-51. doi: 10.1037/0033-2909.129.1.10
Goldman N. (2001). Social inequalities in health: Disentangling the underlying mechanisms. Annals of the New York Academy of Sciences, 954(1), 118–139. doi: 10.1111/j.1749–6632.2001.tb02750.x
Granström F., Molarius A., Garvin P., et al. (2015). Exploring trends in and determinants of educational inequalities in self-rated health. Scandinavian Journal of Public Health, 43(7), 677–686. doi: 10.1177/1403494815592271
Groffen D.A.I., Bosma H., Tan F.E.S., et al. (2011). Material vs. psychosocial explanations of old-age educational differences in physical and mental functioning. European Journal of Public Health, 22(4), 587–592. doi: 10.1093/eurpub/ckr063
Guio A-C., Gordon D., Marlier E. (2012). Measuring material deprivation in the EU: indicators for the whole population and child-specific indicators. Luxembourg: Publications Office of the European Union. doi: 10.2785/33598
Hatch S.L., Dohrenwend B.P. (2007). Distribution of traumatic and other stressful life events by race/ethnicity, gender, SES and age: a review of the research. American Journal of Community Psychology, 40(3–4), 313–332. doi: 10.1007/s10464-007-9134-z
Infurna F.J., Gerstorf D., Zarit S.H. (2011). Examining dynamic links between perceived control and health: Longitudinal evidence for differential effects in midlife and old age. Developmental Psychology, 47(1), 9-18. doi: 10.1037/a0021022
Kan Ch., Kawakami N., Karasawa M., et al. (2014). Psychological resources as mediators of the association between social class and health: Comparative findings from Japan and the USA. International Journal of Behavioral Medicine, 21(1), 53–65.
doi: 10.1007/s12529-012-9249-y
Katikireddi S.V., Higgins M., Smith K.E., Williams G. (2013). Health inequalities: the need to move beyond bad behaviours. Journal of Epidemiology and Community Health, 67(9), 715–716. doi: 10.1136/jech-2012-202064
Kawachi I., Subramanian S.V., Almeida-Filho N. (2002). A glossary for health inequalities. Journal of Epidemiology and Community Health, 56(9), 647–652. doi: 10.1136/jech.56.9.647
Laaksonen M., Roos E., Rahkonen O., et al. (2005). Influence of material and behavioural factors on occupational class differences in health. Journal of Epidemiology and Community Health, 59(2), 163–169. doi: 10.1136/jech.2003.019323
Lynch J.W., Smith G.D., Kaplan G.A., House J.S. (2000). Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. British Medical Journal, 320(7243), 1200–1204. doi: 10.1136/bmj.320.7243.1200
Mackenbach J., de Jong J.P. (2018). Health Inequalities: an Interdisciplinary Exploration of Socioeconomic Position, Health and Causality. Amsterdam: FEAM/ALLEA Committee on Health Inequalities.
Mackenbach J.P., Kulhánová I., Artnik B., et al. (2016). Changes in mortality inequalities over two decades: register based study of European countries. British Medical Journal, 353(8053), i1732. doi: 10.1136/bmj.i1732
Mackenbach J.P., Kulhánová I., Menvielle G., et al. (2015). Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries. Journal of Epidemiology and Community Health, 69(3), 207–217. doi: 10.1136/jech-2014-204319
Mackenbach J.P., Stirbu I., Roskam A.J., et al. (2008). Socioeconomic inequalities in health in 22 European countries. New England Journal of Medicine, 358(23), 2468–2481. doi: 10.1056/NEJMsa0707519
Marmot M.G. (2004). The status syndrome. How social standing affects our health and longevity. New York: Henry Holt & Company.
Marmot M.G., Fuhrer R., Ettner S.L., et al. (1998). Contribution of Psychosocial Factors to Socioeconomic Differences in Health. Milbank Quarterly, 76(3), 403-448. doi: 10.1111/1468-0009.00097
Marmot M., Wilkinson R.G. (2001). Psychosocial and material pathways in the relation between income and health: a response to Lynch et al. British Medical Journal, 322(7296), 1233–1236. doi: 10.1136/bmj.322.7296.1233
Matthews K.A., Gallo L.C. (2011). Psychological perspectives on pathways linking socioeconomic status and physical health. Matthews K.A., Gallo L.C. (2011). Psychological perspectives on pathways linking socioeconomic status and physical health. Annual Review of Psychology, 62, 501–530. doi: 10.1146/annurev.psych.031809.130711
Matthews K.A., Gallo L.C., Taylor S.E. (2010). Are psychosocial factors mediators of socioeconomic status and health connections? A progress report and blueprint for the future. Annals of the New York Academy of Sciences, 1186(1), 146–173. doi: 10.1111/j.1749-6632.2009.05332.x
McDonough P., Berglund P. (2003). Histories of poverty and self-rated health trajectories. Journal of Health and Social Behavior, 44(2), 198–214. doi: 10.2307/1519808
McLeod J.D., Kessler R.C. (1990). Socioeconomic status differences in vulnerability to undesirable life events. Journal of Health and Social Behavior, 31(2), 162–172. doi: 10.2307/2137170
Moor I., Günther S., Knöchelmann A., et al. (2018). Educational inequalities in subjective health in Germany from 1994 to 2014: a trend analysis using the German Socio-Economic Panel study (GSOEP). British Medical Journal Open, 8(6), e019755. doi: 10.1136/bmjopen-2017-019755
Moor I., Rathmann K., Stronks K., et al. (2014). Psychosocial and behavioural factors in the explanation of socioeconomic inequalities in adolescent health: a multilevel analysis in 28 European and North American countries. Journal of Epidemiology and Community Health, 68(10), 912–921. doi: 10.1136/jech-2014-203933
Moor I., Richter M., Ravens-Sieberer U., et al. (2015). Trends in social inequalities in adolescent health complaints from 1994 to 2010 in Europe, North America and Israel: The HBSC study. European Journal of Public Health, 25(Suppl.2), 57–60. doi: 10.1093/eurpub/ckv028
Moor I., Spallek J., Richter M. (2017). Explaining socioeconomic inequalities in self-rated health: a systematic review of the relative contribution of material, psychosocial and behavioural factors. Journal of Epidemiology and Community Health, 71(6), 565–575. doi: 10.1136/jech-2016-207589
Pampel F.C., Krueger P.M., Denney J.T. (2010). Socioeconomic disparities in health behaviors. Annual Review of Sociology, 36, 349-370. doi: 10.1146/annurev.soc.012809.102529
Pförtner T-K., Elgar F.J. (2016). Widening inequalities in self-rated health by material deprivation? A trend analysis between 2001 and 2011 in Germany. Journal of Epidemiology and Community Health, 70(1), 82–89. doi: 10.1136/jech-2015-205948
Ploubidis G.B., DeStavola B.L., Grundy E. (2011). Health differentials in the older population of England: an empirical comparison of the materialist, lifestyle and psychosocial hypotheses. BMC Public Health, 11(1), 390. doi: 10.1186/1471-2458-11-390
Pogosova N. V., Boitsov S. A., Oganov R. G., et al. (2018). Psychosocial risk factors in ambulatory patients with arterial hypertension and ischemic heart disease of 30 cities in Russia: Data from the КОМЕТА (Сomet) Study. Kardiologiia, 58(11), 5–16. (In Russ.). doi: 10.18087/cardio.2018.11.10193
Pogosova N.V., Oganov R.G., Boytsov S.A., et al. (2017). Psychosocial factors and life quality in coronary heart disease patients: results of the Russian part of International multicenter study EUROASPIRE IV. Cardiovascular Therapy and Prevention, 16(5), 20-26. (In Russ.). doi: 10.15829/1728-8800-2017-5-20-26
Rasmussen H.N., Scheier M.F., Greenhouse J.B. (2009). Optimism and physical health: A meta-analytic review. Annals of Behavioral Medicine, 37(3), 239–256. doi: 10.1007/s12160-009-9111-x
Richter M., Moor I., van Lenthe F.J. (2012). Explaining socioeconomic differences in adolescent self-rated health: the contribution of material, psychosocial and behavioural factors. Journal of Epidemiology and Community Health, 66(8), 691–697. doi: 10.1136/jech.2010.125500
Roepke S.K., Grant I. (2011). Toward a more complete understanding of the effects of personal mastery on cardiometabolic health. Health Psychology, 30(5), 615-632. doi: 10.1037/a0023480
Rusinova N.L. Safronov V.V. (2018). The psychological mediators of social inequalities in health: Self-efficacy in Europe and Russia. Sociological Journal, 24(4), 30–53. (In Russ.). doi: 10.19181/socjour.2018.24.4.6096
Rusinova N.L. Safronov V.V. (2019). Psihologicheskie resursy, materialnye lisheniya i zdorove v Evrope: Pryamoe vliyanie i mediaciya neravenstv po obrazovaniyu. (Psychological resources, material deprivation and health in Europe: direct influence and mediation of educational inequalities). Journal of Economic Sociology, forthcoming.
Sacker A., Bartley M., Firth D., Fitzpatrick R. (2001). Dimensions of social inequality in the health of women in England: occupational, material and behavioural pathways. Social Science and Medicine, 52(5), 763–781. doi: 10.1016/S0277-9536(00)00176-3
Schmitz A.L., Pförtner T-K. (2017). Health inequalities in old age: the relative contribution of material, behavioral and psychosocial factors in a German sample. Journal of Public Health, 40(3), e235–e243. doi: 10.1093/pubmed/fdx180
Schönfeld P., Brailovskaia J., Bieda A., et al. (2016). The effects of daily stress on positive and negative mental health: Mediation through self-efficacy. International Journal of Clinical and Health Psychology, 16(1), 1-10. doi: 10.1016/j.ijchp.2015.08.005
Schrijvers C.T., Stronks K., van de Mheen H.D., Mackenbach J.P. (1999). Explaining educational differences in mortality: the role of behavioral and material factors. American Journal of Public Health, 89(4), 535–540. doi: 10.2105/AJPH.89.4.535
Seeman M., Lewis S. (1995). Powerlessness, health and mortality: a longitudinal study of older men and mature women. Social Science and Medicine, 4l(4), 5l7-525. doi: 10.1016/0277-9536(94)00362-W
Skalická V., van Lenthe F., Bambra C., et al. (2009). Material, psychosocial, behavioural and biomedical factors in the explanation of relative socio-economic inequalities in mortality: evidence from the HUNT study. International Journal of Epidemiology, 38(5), 1272–1284. doi: 10.1093/ije/dyp262
Stronks K., van de Mheen H.D., Looman C.W.N., Mackenbach J.P. (1996). Behavioural and structural factors in the explanation of socio-economic inequalities in health: an empirical analysis. Sociology of Health & Illness, 18(5), 653–674. doi: 10.1111/1467-9566.ep10934524
Surtees P.G., Wainwright N.W.J., Luben R., et al. (2010). Mastery is associated with cardiovascular disease mortality in men and women at apparently low risk. Health Psychology, 29(4), 412–420. doi: 10.1037/a0019432
Takakura M., Sakihara S. (2001). Psychosocial correlates of depressive symptoms among Japanese high school students. Journal of Adolescent Health, 28(1), 82–89. doi: 10.1016/S1054-139X(00)00144-0
Tøge A.G., Bell R. (2016). Material deprivation and health: a longitudinal study. BMC Public Health, 16, 747. doi: 10.1186/s12889-016-3327-z
Townsend P. (1979). Poverty in the United Kingdom: a survey of household resources and standards of living. Berkeley: University of California Press.
Townsend P., Davidson N. (1982). Inequalities in Health: the Black Report. London: Penguin.
Twenge J.M., Campbell W.K. (2002). Self-esteem and socioeconomic status: A meta-analytic review. Personality and Social Psychology Review, 6(1), 59-71. doi: 10.1207/S15327957PSPR0601_3
Van Lenthe F.J., Gevers E., Joung I.M., et al. (2002). Material and behavioral factors in the explanation of educational differences in incidence of acute myocardial infarction: the Globe study. Annals of Epidemiology, 12(8), 535–542. doi: 10.1016/S1047-2797(01)00279-4
Van Oort F.V., van Lenthe F.J., Mackenbach J.P. (2005). Material, psychosocial, and behavioural factors in the explanation of educational inequalities in mortality in The Netherlands. Journal of Epidemiology and Community Health, 59(3), 214–220. doi: 10.1136/jech.2003.016493
