But those who are food-insecure or low-income also face unique challenges in adopting and maintaining healthful behaviors, as described below. Limited resources and lack of access to healthy, affordable foods. Instead, residents — especially those without reliable transportation — may be limited to shopping at small neighborhood convenience and corner stores, where fresh produce and low-fat items are limited, if available at all. Comprehensive literature reviews examining neighborhood disparities in food access find that neighborhood residents with better access to supermarkets and limited access to convenience stores tend to have healthier diets and reduced risk for obesity Larson et al.
In addition, a growing body of research has documented associations between social and cultural factors and health Berkman and Kawachi, ; Marmot and Wilkinson, For some types of social variables, such as socioeconomic status SES or poverty, robust evidence of their links to health has existed since the beginning of official record keeping.
For other kinds of variables—such as social networks and social support or job stress—evidence of their links to health has accumulated over the past 30 years.
The purpose of this chapter is to provide an overview of the social variables that have been researched as inputs to health the so-called social determinants of healthas well as to describe approaches to their measurement and the empirical evidence linking each variable to health outcomes.
It should be emphasized at the outset that the social determinants of health can be conceptualized as influencing health at multiple levels throughout the life course.
Thus, for example, poverty can be conceptualized as an exposure influencing the health of individuals at different levels of organization—within families or within the neighborhoods in which individuals reside. Moreover, these different levels of influence may co-occur and interact with one another to produce health.
For example, the detrimental health impact of growing up in a poor family may be potentiated if that family also happens to reside in a disadvantaged community where other families are poor rather than in a middle-class community.
Furthermore, poverty may differentially and independently affect the health of an individual at different stages of the life course e. In short, the influence of social and cultural variables on health involves dimensions of both time critical stages in the life course and the effects of cumulative exposure as well as place multiple levels of exposure.
The contexts in which social and cultural variables operate to influence health outcomes are called, generically, the social and cultural environment. Comprehensive surveys of current areas of research in the social determinants of health can be found in existing textbooks Marmot and Wilkinson, ; Berkman and Kawachi, These variables are highlighted because of their robust associations with health status and their well-documented and reliable methods of measuring these variables, and because there are good reasons to believe that these variables interact with both behavioral as well as inherited characteristics to influence health.
Socioeconomic differences in health are large, persistent, and widespread across different societies and for a diverse range of health outcomes. In the social sciences, SES has been measured by three different indicators, taken either separately or in combination: Although these measures are moderately correlated, each captures distinctive aspects of social position, and each potentially is related to health and health behaviors through distinct mechanisms.
Educational Attainment Education is usually assessed by the use of two standard questions that ask about the number of years of schooling completed and the educational credentials gained.
The quality of education also may be relevant to health, but it is more difficult to assess accurately. An extensive literature has linked education to health outcomes, including mortality, morbidity, health behaviors, and functional limitations.
The relationship between lower educational attainment and worse health outcomes occurs throughout the life course. For example, infants born to Caucasian mothers with fewer than 12 years of schooling are 2.
An association between education and health in observational data does not necessarily imply causation. Alternatively, the association between education and health may partly reflect confounding by a third variable, such as ability, which is a prior common cause of both educational attainment and health status.
The totality of the evidence suggests, nonetheless, that education is a causal variable in improving health. Natural policy experiments—such as the passage of compulsory schooling legislation at different times in different localities within the United States—suggest that higher levels of education are associated with better health lower mortality Lleras-Muney, It is therefore likely that the association between schooling and health reflects both a causal effect of education on health, as well as an interaction between the level of schooling and inherited characteristics.
Several causal pathways have been hypothesized through which higher levels of schooling can improve health outcomes. They include the acquisition of knowledge and skills that promote health e.
Although it is not established which of these pathways matter more for health, they each are likely to contribute to the overall pattern of higher years of schooling being associated with better health status.
Moreover, the evidence points to the importance of improving access to preschool education as a means of enhancing the health prospects of disadvantaged children Acheson, Income The measurement of income is more complex than assessing educational attainment.
Survey-based questions inquiring about income must minimally specify the following components: In addition to the higher rate of measurement error for income as compared to educational attainmentthis variable also is associated with higher refusal rates in surveys that are administered to the general population.
As with education, an extensive literature has documented the association between income and health. For example, even after controlling for educational attainment and occupational status, post-tax family income was associated with a 3. That is, the excess risks of poor health are not confined simply to individuals below the official poverty threshold of income.
That is, the relationship between the two variables is acknowledged to be dynamic and reciprocal. Ill health is a potent cause of job loss and reduction in income. Indeed, income as an indicator of SES is more susceptible to reverse causation than education, which tends to be completed in early adult life prior to the onset of major causes of morbidity and functional limitations.4 Social and community influences.
Here the role of social and community influences on health are considered. The concept of social capital has become very popular within public health in recent years, although, like many similar concepts, it been used in different ways by different people.
Yet understanding how and why people in poverty are statistically at greater risk for disease is more complex.
Diet and exercise play a big role in determining a person’s health status; however, research shows that health behaviors like these are largely driven by the context of where people live.
The Influence Of Income On Health: Views Of An Epidemiologist In Marmot was awarded a knighthood “for services to epidemiology and understanding health inequalities.” Poverty and.
With stressed-filled homes, shaky nutrition, toxic environments and health-care gaps of every kind, kids in very low-income families may never catch up when it comes to their health. Below, experts spell out the strong link between poverty and illness and discuss efforts to lift people to better health.
Understanding Poverty Global data and statistics, research and publications, and topics in poverty and development We face big challenges to help the world’s poorest people and ensure that everyone sees benefits from economic growth. Poor Health.
Globally, millions suffer from poverty-related health conditions as infectious diseases ravage the lives of an estimated 14 million people a year and are of the top effects of poverty. These diseases are contracted through sources like contaminated water, the absence of water and sanitation, and lack of access to proper healthcare.