5.3 Impact of Socioeconomic Status on Health & Health Behavior

Impact of Socioeconomic Status on Health & Health Behavior

Building upon the demographic data discussed earlier in this module, this section defines socioeconomic status (SES) and describes how the components of SES (e.g., education, income, employment) act as social determinants influencing individual and community-level health and behavior, and, more specifically, how SES intersects with racial-ethnic minority status.

Review this factsheet from the American Psychological Association to learn more about Socioeconomic Status & Ethnic and Racial Minorities (American Psychological Association, Ethnic and Racial Minorities & Socioeconomic Status. [factsheet], 2017).

What are the social determinants of health? Health is influenced by many factors, which may generally be organized into five broad categories known as determinants of health: genetics, behavior, environmental and physical influences, medical care and social factors. These five categories are interconnected.

The fifth category (social factors as a determinant of health) encompasses economic and social conditions that influence the health of people and communities (Commission on Social Determinants of Health, 2008). These conditions are shaped by socioeconomic position, which is the amount of money, power, and resources that people have, all of which are influenced by socioeconomic and political factors (e.g., policies, culture, and societal values) (Commission on Social Determinants of Health, 2007). An individual’s socioeconomic position can be shaped by various factors such as their education, occupation, or income. All of these factors (social determinants) impact the health and well-being of people and the communities they interact with.

Several factors related to health outcomes are listed below:

• early childhood development
• quality of education
• ability to get and hold a job
• type of work a person is engaged in
• food security
• access to health services
• living conditions such as housing status, public safety, clean water and pollution
• individual and household income
• social norms and attitudes (discrimination, racism and distrust of government)
• residential segregation (physical separation of races/ethnicities into different neighborhoods)
• social support
• language and literacy
• incarceration
• culture (general customs and beliefs of a particular group of people)
• access to mass media and emerging technologies (cell phones, internet, and social media)

All of these factors are influenced by social circumstances. Of course, many of the factors in this list are also influenced by the other four determinants of health.

Addressing social determinants of health is a primary approach to achieving health equity. Health equity can be defined in several ways. One commonly used definition of health equity is an environment in which all people have “the opportunity to ‘attain their full health potential’ and no one is ‘disadvantaged from achieving this potential because of their social position or other socially determined circumstance’” (Braveman, 2003). Health equity has also been defined as “the absence of systematic disparities in health between and within social groups that have different levels of underlying social advantages or disadvantages—that is, different positions in a social hierarchy” (​​Braveman & Gruskin, 2003). Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities.

Social determinants of health such as poverty, unequal access to health care, lack of education, neighborhood disadvantage, stigma, and racism contribute to broad structural health inequities that shape risky behavior patterns including increased prevalence of drug use and dependence as well as participation in the cultivation, manufacture, distribution and sale of illicit drugs.

In addition to clinical approaches and interventions aimed at modifying behavior, where appropriate, a growing body of research highlights the importance of upstream factors that influence health and the need for policy interventions to address those factors (Gnadinger, 2014). Health organizations, research institutes, governmental agencies, and education programs are encouraged to look beyond behavioral factors and address underlying systemic factors related to social determinants of health (Centers for Disease Control, Adapted from: What is health equity?, 2019).