Socioeconomic Disparities In Health: Pathways And Policies

Harvard University, Cambridge, Massachusetts, United States
Health Affairs (Impact Factor: 4.97). 03/2002; 21(2):60-76. DOI: 10.1377/hlthaff.21.2.60
Source: PubMed


Socioeconomic status (SES) underlies three major determinants of health: health care, environmental exposure, and health behavior. In addition, chronic stress associated with lower SES may also increase morbidity and mortality. Reducing SES disparities in health will require policy initiatives addressing the components of socioeconomic status (income, education, and occupation) as well as the pathways by which these affect health. Lessons for U.S. policy approaches are taken from the Acheson Commission in England, which was charged with reducing health disparities in that country.

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    • "For example, full-time employed women in Canada earn on average 19% less than men (Organisation for Economic Co-operation and Development [OECD], 2014). Lower socioeconomic status, in turn, is a well-known predictor of poorer health status (Adler & Newman, 2002; Marmot et al., 1991), with its associated implications for higher health care needs. Women are also more likely to work part time (OECD, 2014) and consequently less likely to be eligible for full employment benefits, including health services benefits such as prescription drug insurance. "
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    ABSTRACT: Introduction: Existing literature is inconclusive as to whether disparities in access to health care between men and women are mainly driven by socioeconomic or gender inequalities. The aim of this study was to assess whether gender was independently associated with perceived unmet health care needs among a representative sample of British Columbia adults. Methods: Using data from the 2011/2012 Canadian Community Health Survey, logistic regression analyses were conducted to investigate the independent effect of gender on perceived unmet health care needs adjusting for potential individual and contextual confounders. Results: Among 12,252 British Columbia adults (51.9% female), the prevalence of perceived unmet health care needs was 12.0%, with a significantly greater percentage among women compared with men (13.7% vs. 10.1%; p < .001). After adjusting for multiple confounders, women had independently increased odds of perceived unmet health care needs (adjusted odds ratio, 1.37; 95% CI, 1.11-1.68). Discussion: The current study found that, among a representative sample of British Columbia adults and adjusting for various individual and contextual factors, female gender was associated independently with an increased odds of perceived unmet health care needs. Conclusion: These findings suggest that within Canada's universal health system, gender further explains differences in health care access, over and above socioeconomic inequalities. Interventions within and outside the health sector are required to achieve equitable access to health care for all residents in British Columbia.
    Women s Health Issues 09/2015; DOI:10.1016/j.whi.2015.08.001 · 1.61 Impact Factor
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    • "Being a member of a racial minority ( Cook, McGuire, & Miranda, 2007; Larson et al., 2008; Smedley, Stith, & Nelson, 2003; Williams & Jackson, 2005) and having a lower socioeconomic status (SES) ( Adler & Newman, 2002; Braveman et al., 2011) are associated with physical health problems ( Adler & Newman, 2002; Larson et al., 2008) such as cancer, heart disease, and diabetes ( Smedley et al., 2003). Health disparities are characterized by having limited or no access to health insurance and having more exposure to factors that are linked to poorer health outcomes (Dubay & Lebrun, 2012; Williams & Jackson, 2005). "
    Health & social work 08/2015; DOI:10.1093/hsw/hlv058 · 0.94 Impact Factor
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    • "conditions , and social networks ( Adler and Newman , 2002). Given the long follow - up of participants in this study , it is possible that education - al attainment may have also influenced their diabetes risk in such indi - rect ways . "
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    ABSTRACT: Educational attainment is inversely associated with type 2 diabetes risk, but it is unknown whether education impacts individuals' diabetes prevention efforts. We examined the comparative efficacy of intensive lifestyle intervention and metformin by educational attainment among participants in the Diabetes Prevention Program (DPP), an ongoing U.S. multi-site trial beginning in 1996. We studied 2,910 DPP participants randomized to receive lifestyle intervention, metformin, or placebo. Stratifying by educational attainment, diabetes incidence and relative risk reductions by treatment assignment were estimated using Cox proportional hazards regression. 47% of participants had completed college and 53% had not. Compared to placebo, lifestyle participants who had completed college demonstrated a 68% reduction in diabetes incidence (95% CI=56, 77), whereas those with less education experienced a 47% risk reduction (95% CI=29, 61). For metformin participants, college graduates experienced a 49% relative risk reduction (95% CI=33, 62), compared to 23% (95% CI=1, 41) among those with lower educational attainment. There was a statistically significant education-by-treatment interaction with incident diabetes (p=0.03). Intensive lifestyle intervention and metformin have greater efficacy among highly educated individuals. Future efforts to deliver these treatments and study their dissemination may be more effective if tailored to individuals' educational background. Copyright © 2015. Published by Elsevier Inc.
    Preventive Medicine 05/2015; 77. DOI:10.1016/j.ypmed.2015.05.017 · 3.09 Impact Factor
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