Addressing the substantial disparity in health between low and high socioeconomic status (SES) groups requires a detailed understanding of the complex interaction between dimensions of SES (such as, education, income and wealth) and those of health (including disability and mortality). Progress has been made in recent years in characterizing the relationships between the various dimensions of SES and health over the lifecycle and in understanding the relative importance and directions of causal pathways. Yet, despite these advances in knowledge little is known about many of the mechanisms that produce the observed causal relations. Progress is hampered by the lack of a comprehensive theoretical framework to interpret empirical facts. It is no surprise then that recent reviews of the literature point to the absence of such a unifying theory and emphasize the importance of developing one. We have recently made substantial efforts toward the development of a unified theoretical framework for analyzing health and socioeconomic status trajectories over the lifecycle. Our theoretical framework aims to understand the SES-health gradient as the outcome of rational (but constrained) individual behavior. The structural model contains many potential mechanisms that could explain disparities in health by SES. Of particular importance appear to be lifestyle factors (preventive care, healthy and unhealthy consumption), work conditions (job-related health stress)1, curative care and the constraining effect of health on work. Empirical testing is needed to distinguish important from less important mechanisms. The objectives of this research are (i) to derive new, testable predictions from this framework;(ii) to test these predictions using existing panel data from the US and European countries.
The aim of these tests is not only to establish plausible causality but to evaluate the underlying mechanisms that produce the causal relationships;and (iii) to couple the estimated models with international variation in institutions to inform policy and decision makers about the relative effectiveness of alternative public policies to reduce disparities in health.
The specific aims of the proposed research are to: 1) improve our understanding of mechanisms responsible for socioeconomic disparities in health using a structural model of lifestyle and work;2) use the structural model to empirically assess the importance of lifestyle and job-related health stress with the richest panel data available to date;3) evaluate the contribution of health-induced labor-force withdrawal to health disparities;and 4) assess the effects of institutions and public policies on creating/moderating health disparities. 1 The concept of job-related health stress can be interpreted broadly and can range from physical working conditions (e.g., hard labor) to psychosocial aspects of work (e.g., low status, limited control, repetitive work, etc). The notion here is that it can include any aspect of work that is detrimental to health and as such is associated with a wage premium (relative to an imaginary situation where there would not be a detrimental affect on health).

Public Health Relevance

Without a detailed understanding of the causes of the substantial disparities in health between low and high socioeconomic status groups, policies aimed at reducing such disparities are likely to be ineffective. We have recently made substantial efforts toward the development of a structural model that allows for many potential mechanisms that could explain disparities in health by SES over the lifecycle. The objectives of this research are (i) to derive new, testable predictions from this framework, (ii) to test these predictions using existing panel data from the US and European countries, and (iii) to use the estimated models and international variation to inform policy and decision makers about the relative effectiveness of alternative public policies to reduce disparities in health.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG037398-05
Application #
8733116
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Phillips, John
Project Start
2010-07-01
Project End
2015-06-30
Budget Start
2014-07-01
Budget End
2015-06-30
Support Year
5
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of Southern California
Department
Miscellaneous
Type
Schools of Arts and Sciences
DUNS #
City
Los Angeles
State
CA
Country
United States
Zip Code
90089
Adjaye-Gbewonyo, Kafui; Avendano, Mauricio; Subramanian, S V et al. (2016) Income inequality and depressive symptoms in South Africa: A longitudinal analysis of the National Income Dynamics Study. Health Place 42:37-46
Aguila, Emma; Angrisani, Marco; Blanco, Luisa R (2016) Ownership of a bank account and health of older Hispanics. Econ Lett 144:41-44
Lopez-Arana, Sandra; Avendano, Mauricio; Forde, Ian et al. (2016) Conditional cash transfers and the double burden of malnutrition among children in Colombia: a quasi-experimental study. Br J Nutr 115:1780-9
Coveney, Max; García-Gómez, Pilar; Van Doorslaer, Eddy et al. (2016) Health Disparities by Income in Spain Before and After the Economic Crisis. Health Econ 25 Suppl 2:141-158
O'Donnell, Owen; O'Neill, Stephen; Van Ourti, Tom et al. (2016) conindex: Estimation of concentration indices. Stata J 16:112-138
Hessel, Philipp; Avendano, Mauricio (2016) Economic downturns during the life-course and late-life health: an analysis of 11 European countries. Eur J Public Health 26:766-771
Bijwaard, Govert E; Van Kippersluis, Hans (2016) Efficiency of Health Investment: Education or Intelligence? Health Econ 25:1056-72
de Vries, Esther; Arroyave, Ivan; Pardo, Constanza et al. (2015) Trends in inequalities in premature cancer mortality by educational level in Colombia, 1998-2007. J Epidemiol Community Health 69:408-15
Noelke, Clemens; Avendano, Mauricio (2015) Who suffers during recessions? Economic downturns, job loss, and cardiovascular disease in older Americans. Am J Epidemiol 182:873-82
Avendano, Mauricio; Berkman, Lisa F; Brugiavini, Agar et al. (2015) The long-run effect of maternity leave benefits on mental health: evidence from European countries. Soc Sci Med 132:45-53

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