Absolute income and life expectancy

Absolute rather than relative income is a better socioeconomic predictor of chronic obstructive pulmonary disease in Swedish adults

BACKGROUND

While psychosocial theory claims that socioeconomic status (SES), acting through social comparisons, has an important influence on susceptibility to disease, materialistic theory says that socioeconomic position (SEP) and related access to material resources matter more. However, the relative role of SEP versus SES in chronic obstructive pulmonary disease (COPD) risk has still not been examined.

METHOD

We investigated the association between SES/SEP and COPD risk among 667 094 older adults, aged 55 to 60, residing in Sweden between 2006 and 2011. Absolute income in five groups by population quintiles depicted SEP and relative income expressed as quintile groups within each absolute income group represented SES. We performed sex-stratified logistic regression models to estimate odds ratios and the area under the receiver operator curve (AUC) to compare the discriminatory accuracy of SES and SEP in relation to COPD.

RESULTS

Even though both absolute (SEP) and relative income (SES) were associated with COPD risk, only absolute income (SEP) presented a clear gradient, so the poorest had a three-fold higher COPD risk than the richest individuals. While the AUC for a model including only age was 0.54 and 0.55 when including relative income (SES), it increased to 0.65 when accounting for absolute income (SEP). SEP rather than SES demonstrated a consistent association with COPD.

CONCLUSIONS

Our study supports the materialistic theory. Access to material resources seems more relevant to COPD risk than the consequences of low relative income.

Anti-Egalitarianism, Legitimizing Myths, Racism, and “Neo-McCarthyism” in Social Epidemiology and Public Health: A Review of Sally Satel's PC, M.D

Sally Satel's PC, M.D.: How Political Correctness Is Corrupting Medicine constitutes an attempt to weaken the influence of egalitarian and antiracist scholarship in contemporary public health. This book has been widely distributed and has received many positive reviews in academia and the general press. Surprisingly, Satel has enlisted the direct or indirect support of prominent public health academics. The authors' critical review of this book indicates that Satel uses a combination of tactics to convince the reader of the danger involved in egalitarian public health efforts. Among them are insults, traditional “red baiting” tactics, “triangulation,” exaggeration, emotionally charged examples, omissions, and a strong appeal to individual responsibility to explain social inequalities in health. PC, M.D. reveals a scientific and ideological conflict over the determinants of health in populations that takes place within and outside the public health discipline. Efforts such as PC, M.D. suggest that social epidemiologists and other egalitarian public health scholars are having some impact in shaping how the public views health disparities.

Does an increase of low income families affect child health inequalities? A Swedish case study

STUDY OBJECTIVE

Reduction of health inequalities is a primary public health target in many countries. A change of proportion of low income families might affect child health inequalities. Yet, the importance of family incomes in high income welfare states is not well established. The aim of this study was to investigate the effect of increased percentage of low income families on child health inequalities during an economic recession in Sweden, 1991-1996.

DESIGN

Health inequalities for six health indicators were assessed during the period 1991-1996 and during adjacent periods. Relative inequality indices were estimated according to Pamuk and Mackenback. Appraisal of a child's socioeconomic situation was based on social data for the child's residency area.

SETTING

The total population of children and adolescents 0-<19 years old living in Stockholm County, Sweden, was studied. Each one year cohort comprised 20 470-25 420 people.

MAIN OUTCOME MEASURES

Mortality; rate of low birth weight; days of hospital care for infections, asthma/allergic disorders, and unintentional injuries; and rate of abortions.

MAIN RESULTS

Mortality decreased annually by 6.9%. The average relative inequality index for mortality before the recession was 1.40 and was lower during the recession, 1.14. The remaining five health indicators, and the relative inequality index for these indicators, did not differ significantly between the recession years (1991-1996) and adjacent periods.

CONCLUSIONS

Relative health inequalities did not change, or decreased, during the recession years. The findings indicate that the connection was weak between child health inequalities and family incomes, within the frame of time and the range of income changes that occurred during the study period.

Social capital, disorganized communities, and the third way: understanding the retreat from structural inequalities in epidemiology and public health

The construct of social capital has recently captured the interest of researchers in social epidemiology and public health. The authors review current hypotheses on the social capital and health link, and examine the empirical evidence and its implications for health policy. The construct of social capital employed in the public health literature lacks depth compared with its uses in social science. It presents itself as an alternative to materialist structural inequalities (class, gender, and race) and invokes a romanticized view of communities without social conflict that favors an idealist psychology over a psychology connected to material resources and social structure. The evidence on social capital as a determinant of better health is scant or ambiguous. Even if confirmed, such hypotheses call for attention to social determinants beyond the proximal realm of individualized sociopsychological infrastructure. Social capital is used in public health as an alternative to both state-centered economic redistribution and party politics, and represents a potential privatization of both economics and politics. Such uses of social capital mirror recent "third way" policies in Germany, the United Kingdom, and United States. If third way policies lose support in Europe, the prominence of social capital there might be short lived. In the United States, where the working class is less likely to influence social policy, interest in social capital could be longer lived or could drift into academic limbo like other psychosocial constructs once heralded as the next big idea.