The health impact of social factors also is supported by the strong and widely observed associations between a wide range of health indicators and measures of individuals' socioeconomic resources or social position, typically income, educational attainment, or rank in an occupational hierarchy.
This stepwise gradient pattern was first noted in the United Kingdom. Minkler and colleagues found dramatic socioeconomic gradients in functional limitations among people aged 65—74 years. This finding is particularly remarkable because income gradients generally tend to flatten in old age. Health, United States Life expectancy at age 25, by sex and education level [cited Nov 29].
Braveman P, Egerter S. Overcoming obstacles to health in and beyond: Robert Wood Johnson Foundation; Natl Vital Stat Rep ; National Survey of Children's Health. Overcoming obstacles to health: How do widespread and persistent socioeconomic gradients in health add to evidence that social factors are important influences on health? Strong links between poverty and health have been observed for centuries. Although the effects of abject poverty on health are rarely disputed, not everyone concurs about the effects of income and education on health across the socioeconomic spectrum.
Some have argued that income-health or education-health relationships reflect reverse causation i. The aforementioned evidence reflects associations that by themselves do not establish causation. However, the observational examples cited as illustrations are backed up by extensive literature employing a range of techniques e.
Accumulated knowledge also reveals, however, that the effects of any given social including socioeconomic factor are often contingent on a host of other factors.
Despite countless unanswered questions, knowledge of the pathways and biological mechanisms connecting social factors with health has increased exponentially during the past 25 years. Mounting evidence supports causal relationships between many social—including socioeconomic—factors and many health outcomes, not only through direct relationships but also through more complex pathways often involving biopsychosocial processes.
Some aspects of socioeconomic factors are connected to health via responses to relatively direct and rapid-acting exposures. For instance, lead ingestion in substandard housing contributes to low cognitive function and stunted physical development in exposed children; 78 , 79 pollution and allergens, also more common in disadvantaged neighborhoods, can exacerbate asthma. Factors affecting the social acceptability of risky health behaviors are a case in point.
For instance, exposure to violence can increase the likelihood that young people will perpetrate gun violence; 82 and the availability of alcohol in disadvantaged neighborhoods can influence its use among young people, affecting rates of alcohol-related traumatic injury.
In addition to these relatively rapid health impacts, the effects of socioeconomic and other social factors on health-related behaviors can influence disease outcomes that only manifest much later in life. Neighborhood socioeconomic disadvantage and higher concentration of convenience stores have been linked to tobacco use, even after adjusting for several individual-level characteristics, such as educational attainment and household income.
The strong and pervasive relationships between socioeconomic factors and physical health outcomes can reflect even more complex and long causal pathways, which may or may not involve health behaviors as key mediators or moderators.
Evans and Schamberg showed that the association between duration of childhood poverty and adult cognitive function appears to be explained not only by poverty-related material deficits, but also partly by chronic childhood stress.
Adjusting for depression, anxiety, and other negative emotional states, however, has not completely explained the effects of social factors on health. Examples include observations that stress can induce pro-inflammatory responses, including production of IL-6 and C-reactive protein, and that lower income and educational achievement contribute to higher blood pressure and unfavorable cholesterol profiles.
Another area of rapidly evolving knowledge involves the role of socioeconomic and other social factors in epigenetic processes that regulate whether genes are expressed or suppressed.
Telomere shortening is considered a marker of cellular aging that is controlled by both genetic and epigenetic factors. Multiple biological mechanisms appear to be involved in causal pathways from social factors to health outcomes. For example, an allostatic load index combining information on multiple biomarkers of health risk appears to explain more of the impact of education on mortality than any single biological indicator alone.
The physiologic effects of chronic stress is an area of active biological, psychological, and social research that seeks to explain the impact of many social factors on health outcomes. Despite considerable evidence indicating important effects of social factors on health, however, not every individual exposed to socioeconomic or other adversity develops disease.
Protective social factors, such as social support, self-esteem, and self-efficacy, may mitigate the deleterious effects of adverse social conditions. Income may have less health impact where there is less social stigma associated with having limited economic means. Genetics also may play a role in an individual's vulnerability or resilience to socioeconomic adversity: They also may reflect the impact of subjective social status i.
Evidence has clearly demonstrated that relationships between socioeconomic factors and health are complex, dynamic, and interactive; that they may involve multiple mechanisms including epigenetic processes that alter gene expression; and that, at times, they may only manifest decades after exposure. While great advances in documenting and understanding the social, including socioeconomic, determinants of health have been made, unanswered questions about the mechanisms underlying their effects on health are at least as plentiful as the answers we have to date.
All rigorous research is challenging, but research on the upstream social determinants of health SDH faces particular challenges, based in part on the complexity of the causal pathways and the long time periods during which they often play out.
Figure 6 presents very simply three general pathways through which education can influence many health outcomes, reflecting links that have been described in the literature. While there is not necessarily a consensus about each step depicted here, all are plausible in light of current knowledge, including biological knowledge.
The second pathway also is biologically plausible. However, while its left-sided branches i. The third pathway depicts health effects of education through psychobiological processes such as control beliefs, subjective social status, and social networks, again based on existing literature.
Education matters for health. Exploring the social determinants of health: Another barrier to understanding the effects of social factors on health is the difficulty of obtaining information across multiple sectors e.
Access to cross-sectoral information could improve our understanding 54 and ability to intervene effectively. However, cross-sectoral collaborations face multiple barriers, including differing priorities, funding streams, and timelines across agencies; overcoming these barriers will require a major shift in financial and political incentives.
For example, the U. Department of Housing and Urban Development has developed a health council to incorporate health considerations into federal housing policy. Despite challenges, controversies, and unanswered questions, the tremendous advances in knowledge that have occurred in the past 25 years leave little room for doubt that social factors are powerful determinants of health. The consistency and reproducibility of strong associations between social including socioeconomic factors and a multitude of health outcomes in diverse settings and populations have been well documented, and the biological plausibility of the influence of social factors on health has been established.
It is not surprising that exceptional examples of health indicators, settings, and subgroups in which health does not necessarily improve with greater social advantage can be found. There may be thresholds above which a higher degree of a given social factor e.
Exceptions would also be expected as the effects of any given factor are contingent upon the presence of myriad other factors—social, economic, psychological, environmental, genetic, and epigenetic. Considering the long, complex causal pathways leading from social factors—particularly upstream ones such as income and education—to health, with opportunities for countless interactions at each step, it is indeed remarkable that there are so few exceptions to the general rule.
The relative importance of social vs. The emerging awareness of gene-environment interactions, however, has drastically altered nature-vs. Social and genetic causes of disease can no longer be seen as mutually exclusive.
Despite gaps in current knowledge, the case for needing to address upstream socioeconomic factors is strong, and enough is known to inform interventions, which must be rigorously evaluated. Many public health practitioners have little experience in sectors outside public health-care delivery. Medical care providers, including nurses, physicians, and others, undergo intensive training in medicine, not in social work, and we believe in the power of medical care to heal, alleviate suffering, and save lives.
Nevertheless, the knowledge indicating a crucial role for socioeconomic and related social factors in shaping health has become so compelling that it cannot be ignored insofar as public health and health-care personnel are committed to health. Current knowledge suggests ways to collaborate with others to improve health outcomes for socially disadvantaged populations. Finally, clinicians and public health practitioners can be key resources for local, state, and national policy makers on the crucial issue of health equity for all Americans, including those facing the greatest social obstacles.
The authors thank Kaitlin Arena and Rabia Aslam for their outstanding research assistance. National Center for Biotechnology Information , U. Journal List Public Health Rep v. This article has been cited by other articles in PMC.
Abstract During the past two decades, the public health community's attention has been drawn increasingly to the social determinants of health SDH —the factors apart from medical care that can be influenced by social policies and shape health in powerful ways.
Open in a separate window. Life expectancy in the U. Infant mortality rate in the U. Complex, multifactorial causal pathways do not lend themselves to testing with randomized experiments. This diagram is greatly oversimplified: Despite the -oversimplification, it illustrates how upstream socioeconomic determinants such as income, wealth, and education could exert their effects over complicated multifactorial pathways.
A glance at this diagram should make it clear that this intricate series of causal relationships does not lend itself to testing with randomized controlled trials.
Nevertheless, it may be possible to study small pieces of the causal web with randomized experiments, making incremental contributions to understanding the overall pathways.
There are long time lags for health effects to manifest. The links between social factors and health often play out over decades or generations; for example, chronic disease often takes multiple decades to develop. Although we may be able to use intermediate biomarkers such as C-reactive protein or IL-6 or certain behaviors as proxies for health outcomes, it could be two decades or more after the relevant exposures e.
Few studies are able to follow participants for more than a few years. The long time lag between independent and dependent variables represents both a scientific and a political challenge. Funders and politicians want results within timeframes for which they can take credit. The Office of Management and Budget generally requires a five-year-or-less time window for assessing policy impact. Pathways through which education can affect health a.
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Improvements in prenatal insurance coverage and utilization of care in California: A person's social class has a significant impact on their physical health, their ability to receive adequate medical care and nutrition and their life expectancy.
Lower-class people experience a wide array of health problems as a result of their economic status. Lower-class families have higher rates of infant mortality , cancer , cardiovascular disease and disabling physical injuries. Additionally, poor people tend to work in much more hazardous conditions, yet generally have much less if any health insurance provided for them, as compared to middle- and upper-class workers.
The conditions at a person's job vary greatly depending on class. Those in the upper-middle class and middle class enjoy greater freedoms in their occupations. They are usually more respected, enjoy more diversity and are able to exhibit some authority. The physical conditions of the workplace differ greatly between classes.
While middle-class workers may "suffer alienating conditions" or "lack of job satisfaction", blue-collar workers are more apt to suffer alienating, often routine, work with obvious physical health hazards, injury and even death. A recent United Kingdom government study has suggested that a "glass floor" exists in British society which prevents those who are less able, but whom come from wealthier backgrounds, from slipping down the social ladder.
This is due to the fact that those from wealthier backgrounds have more opportunities available to them. Class conflict, frequently referred to as "class warfare" or "class struggle", is the tension or antagonism which exists in society due to competing socioeconomic interests and desires between people of different classes. For Marx, the history of class society was a history of class conflict.
He pointed to the successful rise of the bourgeoisie and the necessity of revolutionary violence—a heightened form of class conflict—in securing the bourgeoisie rights that supported the capitalist economy. Marx believed that the exploitation and poverty inherent in capitalism were a pre-existing form of class conflict.
Marx believed that wage labourers would need to revolt to bring about a more equitable distribution of wealth and political power. Distinctions of wealth , income , education , culture or social network might arise and would only be determined by individual experience and achievement in such a society.
Race and other large-scale groupings can also influence class standing. The association of particular ethnic groups with class statuses is common in many societies. As a result of conquest or internal ethnic differentiation, a ruling class is often ethnically homogenous and particular races or ethnic groups in some societies are legally or customarily restricted to occupying particular class positions.
Which ethnicities are considered as belonging to high or low classes varies from society to society. In modern societies, strict legal links between ethnicity and class have been drawn, such as in apartheid , the caste system in Africa , the position of the Burakumin in Japanese society and the casta system in Latin America. From Wikipedia, the free encyclopedia. For the role-playing game concept, see Character class. From top-left to bottom-right or from top to bottom mobile: This section needs expansion.
You can help by adding to it. Class in Marxist theory. Three-component theory of stratification. Great British Class Survey. Elite , Aristocracy , Oligarchy , and Ruling class.
Middle class , Upper middle class , Lower middle class , and Bourgeoisie. Working class and Proletariat. Social determinants of health. Routledge Encyclopedia of International Political Economy: Subjective self-definition as a missing measure of social class and socioeconomic status in higher education research".
Concise Encyclopedia of Pragmatics. The social science encyclopedia. In Parrillo, Vincent N. Encyclopedia of social problems, Volume 1. The American Class Structure. Great British Class Survey". Retrieved April 4, Sociologists are interested in the idea that class is about your cultural tastes and activities as well as the type and number of people you know".
Their results identify a new model of class with seven classes ranging from the Elite at the top to a 'Precariat' at the bottom". The New York Times. In Smith, Jessie C.
Encyclopedia of social history. Class, race, and family life. Univ of California Press. Stories of Students from the Working Class". Social Background and College Orientation". A Pound of Flesh: Monetary Sanctions as Punishment for the Poor. International Review for the Sociology of Sport. Uses authors parameter link CS1 maint: The Way Class Works: Readings on School, Family, and the Economy. Tearing down the gates: University of California Press. Health disparities in the United States: Access to health care.
Rethinking the health consequences of social class and social mobility. Social Class and Classism in the Helping Professions: Research, Theory, and Practice. Social Stratification and Inequality. Encyclopedia of social work, Volume 1. The Concise Encyclopedia of Sociology. Uses editors parameter link. This article's further reading may not follow Wikipedia's content policies or guidelines.
Please improve this article by removing less relevant or redundant publications with the same point of view ; or by incorporating the relevant publications into the body of the article through appropriate citations. September Learn how and when to remove this template message. Archer, Louise et al. Higher Education and Social Class: The Class of the New paperback ed.
Beckert, Sven, and Julia B. Distinction and Identity in the Nineteenth Century Palgrave Macmillan; pages; Scholarly studies on the habits, manners, networks, institutions, and public roles of the American middle class with a focus on cities in the North. Classes - Transformational Class Analysis Amsterdam: London - A useful analysis of class generally and nature of working class more specifically.
Archived from the original on 10 December Historical analysis of the working out of class in the United States.
Croix, Geoffrey July—August Good study of Marx's concept. William , Who Rules America? Fotopoulos, Takis , Class Divisions Today: Essays in Honour of Ilya Neustadt Cambridge: Cambridge University Press, Theories and Studies of Class Structure Hymowitz, Kay; Marriage and Caste in America: Acta Sociologica , vol.
Mahalingam, Ramaswami; "Essentialism, Culture, and Power: Voter Alignments and U. Party Coalitions Oxford University Press, New Deal" Annual Review of Sociology , pp. Dealignment, Realignment, or Trendless Fluctuation? Annual Review of Sociology. Marmot, Michael; The Status Syndrome: The key statement of class conflict as the driver of historical change. Open University Press,
In spite of all its weaknesses, wealth and income are an important determinant of social class, partly because of the way of life it permits or enforces (a social class is basically a way of life), and partly because it suggests about one’s family life and way of life.
Social classes in China were determined by their father's heredity. The heridity started out a long time ago, granting social classes to people by their worthiness and who the y .
Determinants of Social Class Sociology Homework & Assignment Help, Determinants of Social Class What places· one in a particular social class?' Is it birth, money, education, occupation, or WEALTH AND INCOME. Money is necessary for upper-class position; yet one's class position is not directly proportional to one's income. Determinants of class position This photo of two men on a street in New Orleans uses visual appearance to contrast the social class of two people: a man in casual, possibly work-soiled clothes (note hardhat), and a man with a briefcase in a suit and tie.
The 57th Boyer Lecture Series, exploring the social determinants of health, starts tonight. Over four lectures and four weeks, the World Medical Association president, professor Sir Michael Marmot. Definitions of terms used to describe health equity and social determinants of health. which are linked to both childhood and adult social class position. Resource-based measures refer to material and social resources and assets, including income, wealth, and educational credentials.