Health disparities: Socioeconomic status
Socioeconomic status is one of the strongest predictors of health. Across many diseases and populations, people with lower socioeconomic status experience worse health outcomes and shorter life expectancy.
Recognizing how socioeconomic status contributes to health disparities highlights opportunities to improve health equity through clinical care, community partnerships, and advocacy.
Socioeconomic status refers to an individual's or group's standing in society based on access to and control over material and social resources.
It has 3 core components income, educational attainment, and occupation. Income influences access to resources such as housing, nutritious food, health care, and medications.
Educational attainment can influence employment opportunities, income, and access to health information. Occupation reflects factors such as job security, working conditions, workplace exposures, and social standing, sometimes called occupational prestige.
For many people, occupation also affects access to health insurance. Although these components are closely related, they are not interchangeable.
Together these factors interact to shape health in different and often cumulative ways. To see how these components influence health, let's compare two patients with the same diagnosis.
Meet Alejandro. He's 45 years old, has a high school diploma, and works as a warehouse packer.
Long shifts and a lack of paid sick leave make it difficult for him to attend healthcare appointments. His household income is near the national poverty line, and he has basic health insurance.
He lives in a neighborhood with limited access to affordable, nutritious food. Miguel is also 45 years old and has a high school diploma, but he works as a marketing manager.
He has a flexible schedule, paid sick leave, and comprehensive health insurance. His household income is well above the national median, and he lives in a neighborhood with several grocery stores nearby.
Both patients are diagnosed with type 2 diabetes, with a hemoglobin A1C of 10%. 12 months later, Alejandro's hemoglobin A1C has increased to 12%, and retinal screening shows early signs of diabetic retinopathy.
As for Miguel, his hemoglobin A1C has improved to 6%, and he has no diabetes-related complications. So what happened?
Over the past year, Alejandro has struggled to prioritize diabetes diagnosis while supporting his family. He has missed appointments because taking time off work means losing income.
High out of pocket costs have made it difficult to take his medications consistently. Limited access to affordable, nutritious food and few opportunities for physical activity have made lifestyle changes more challenging.
On the other hand, Miguel has been able to attend follow-up appointments, take his medications as prescribed, and make dietary and lifestyle changes supported by his work schedule, income, and neighborhood resources.
Although Alejandro and Miguel have similar educational attainment, differences in income and occupation have contributed to very different health outcomes.
Alejandro's lower income limits access to resources, while his occupation creates time and financial constraints that make managing a chronic disease more difficult.
Alejandro's and Miguel's experiences reflect a broader pattern. Socioeconomic status influences health at both the individual and population levels.
Across nearly every disease category, from diabetes and cardiovascular disease to mental illness and maternal and infant mortality, people with lower socioeconomic status experience worse health outcomes.
In the United States, the difference in life expectancy between people with the highest and lowest incomes can exceed a decade.
Countries with greater income inequality often have poorer overall health outcomes, even when their total wealth is similar.
In other words, health is influenced not only by how much wealth a society has, but also how that wealth is distributed.
Now how does socioeconomic status influence health? There are 4 major pathways.
First, lower socioeconomic status may limit access to nutritious food, safe places to be physically active, and healthy living environments while facing greater exposure to tobacco and environmental hazards.
Second, socioeconomic status can influence access to healthcare and the quality of care received through factors such as insurance coverage, transportation barriers, health literacy, and implicit bias.
Third, limited financial resources can make it more difficult to afford stable housing, reliable transportation, or prescribed medications.
These pathways help explain why socioeconomic status is considered both multifaceted and context-dependent. Although income, educational attainment, and occupation are the three core components of socioeconomic status, they do not always move together.
For example, someone may have a high level of educational attainment but a relatively low income early in their career, while another person may have a high income through a skilled trade without completing a college degree.
Socioeconomic status is also context dependent. The same income, level of education or occupation may provide different opportunities depending on factors such as cost of living, accumulated wealth, family responsibilities, neighborhood resources, or access to healthcare.
For this reason, it's important to be specific when discussing socioeconomic status. Rather than describing someone simply as having low socioeconomic status, it's often more helpful to identify which component or combination of components is most relevant.
For example, a person's health may be influenced by limited income, lower educational attainment, occupational exposures, or several of these factors together.
Being specific helps avoid oversimplification in stereotyping while providing a more accurate understanding of the factors that influence health.
The relationship between socioeconomic status and health is also bidirectional. Socioeconomic status influences health, but health can also influence socioeconomic status.
For example, a serious illness or injury may make it difficult to work, reducing income and financial stability. Medical debt can also contribute to financial hardship for individuals and families.
Finally, socioeconomic status also interacts with other factors including race and ethnicity, gender, geography, disability, and early life experiences.
These overlapping influences can compound health disparities, making it important to consider each person's unique circumstances rather than any single characteristic in isolation.
Recognizing the impact of socioeconomic status on health has led to important changes in public health and healthcare policy.
One early milestone was the 1985 Heckler report, which documented persistent racial and socioeconomic health disparities in the United States and led to the creation of the Office of Minority Health.
Later, the Healthy People Initiative established national goals to improve health and reduce disparities, including those related to economic stability.
The Affordable Care Act expanded access to health insurance for millions of people, including many with lower incomes. More recently, healthcare systems have increasingly recognized that addressing social needs such as food insecurity, housing instability, and transportation barriers is an important part of improving health outcomes.
Programs such as the Centers for Medicare and Medicaid Services Accountable Health Communities model have helped integrate health and social care by connecting patients with community resources.
These efforts reflect a broader shift from treating illness alone to addressing the social and economic conditions that influence health.
Healthcare professionals can help address health disparities related to socioeconomic status at the individual, community, and policy levels.
At the individual patient level, healthcare professionals should begin with awareness by screening for health-related social needs using validated tools.
Then they can adjust care plans to account for a patient's circumstances, such as prescribing lower cost medications, or recommending treatment options that fit their work schedule, transportation, or caregiving responsibilities.
Also assistance can be provided by connecting patients with community resources, social services, or care coordinators when appropriate.
Identifying a social need is only the first step. Patients also need support to address it.
At the community level, alignment involves partnering with organizations such as community health workers, food banks, schools, housing services, and public health agencies to better address the social and structural factors that influence health.
The final A, which stands for advocacy, extends beyond individual patient care. Healthcare professionals can support policies that improve access to healthcare, education, housing, and other resources that promote health.
They can also participate in research and data collection that help identify disparities, evaluate interventions, and monitor progression over time.
Professional organizations can amplify individual voices and provide opportunities to advocate for policies that promote health equity.
All right, as a quick recap, socioeconomic status is one of the strongest predictors of health and is shaped by three components income, educational attainment, and occupation.
Because these components are related but distinct, socioeconomic status is multifaceted and context dependent. That's why it's important to be specific when discussing socioeconomic circumstances and to avoid oversimplification or stereotyping.
Lower socioeconomic status is associated with poorer health outcomes through differences in access to resources, healthcare, and opportunities for health.
Addressing these disparities requires action at multiple levels, from caring for individual patients to partnering with communities and advocating for policies that promote health equity.
No notes for this video yet
Try adding a note below