IDEAS home Printed from https://ideas.repec.org/p/ifs/ifsewp/07-04.html
   My bibliography  Save this paper

The SES health gradient on both sides of the Atlantic

Author

Listed:
  • James Banks

    (Institute for Fiscal Studies and University of Manchester)

  • Michael Marmot

    (Institute for Fiscal Studies and UCL Research Department of Epidemiology and Public Health)

  • Zoe Oldfield

    (Institute for Fiscal Studies and Institute for Fiscal Studies)

  • James Smith

    (Institute for Fiscal Studies and RAND Corporation)

Abstract

In this paper we investigate the size of health differences that exist among men in England and the United States and how those differences vary by Socio-Economic Status (SES) in both countries. Three SES measures are emphasized - education, household income, and household wealth - and the health outcomes investigated span multiple dimensions as well. International comparisons have played a central part of the recent debate involving the 'SES health gradient' with some authors citing cross-country differences in levels of income equality and mortality as among the most compelling evidence that unequal societies have negative impacts on individual health outcomes. In spite of the analytical advantages of making such international comparisons, until recently good micro data measuring both SES and health in comparable ways have not been available for both countries. Fortunately, that problem has been remedied with the fielding of two surveys - the Health and Retirement Survey (HRS) and the English Longitudinal Survey of Aging (ELSA). In order to facilitate the type of research represented in this paper, both the health and SES measures in ELSA and HRS were purposely constructed to be as directly comparable as possible. Our analysis presents data on some of the most salient issues regarding the social health gradient in health and the manner in which this health gradient differs for men across the two countries in question. There are a several key findings. First, looking across a wide variety of diagnosed diseases, average health status among mature men is much worse in America compared to England, confirming non-gender specific findings we reported in earlier research. Second, there exists a steep negative health gradient for men in both countries where men at the bottom of the economic hierarchy are in much worse health than those at the top. This social health gradient exists whether education, income, or financial wealth is used as the marker of SES. While the negative social gradient in male health characterizes men in both countries, it appears to be steeper in the United States. These central conclusions are maintained even after controlling for a standard set of behavioral risk factors such as smoking, drinking, and obesity and are equally true using either biological measures of disease or individual self-reports. In contrast to these disease based measures of health, the health of American men appears to be superior to the health of English men when self-reported subjective general health status is used as the measure of health status. This apparent contradiction does not result from differences in co-morbidity, emotional health, or ability to function all of which still point to mature American men being less healthy than their English counterparts. The contradiction most likely stems instead from different thresholds used by Americans and English when evaluation their health status on subjective scales. For the same 'objective' health status, Americans are much more likely to say that their health is good than are the English. Finally, we present preliminary data that indicates that feedbacks from new health events to household income are also one of the reasons that underlie the strength of the income gradient with health in England. Previous research has demonstrated its importance as one of the underlying causes in the United States and these results suggest that that conclusion should most likely be extended to England as well although further research is required on this topic.

Suggested Citation

  • James Banks & Michael Marmot & Zoe Oldfield & James Smith, 2007. "The SES health gradient on both sides of the Atlantic," IFS Working Papers W07/04, Institute for Fiscal Studies.
  • Handle: RePEc:ifs:ifsewp:07/04
    as

    Download full text from publisher

    File URL: http://www.ifs.org.uk/wps/wp0704.pdf
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. James Banks & Richard Blundell & James P. Smith, 2003. "Understanding Differences in Household Financial Wealth between the United States and Great Britain," Journal of Human Resources, University of Wisconsin Press, vol. 38(2).
    2. James Smith, 2004. "Unravelling the SES health connection," IFS Working Papers W04/02, Institute for Fiscal Studies.
    3. Arie Kapteyn & James P. Smith & Arthur Van Soest, 2004. "Self-reported Work Disability in the US and The Netherlands," Working Papers WR-206, RAND Corporation.
    4. Michael Hurd & F. Thomas Juster & James P. Smith, 2003. "Enhancing the Quality of Data on Income: Recent Innovations from the HRS," Journal of Human Resources, University of Wisconsin Press, vol. 38(3).
    5. Arie Kapteyn & James P. Smith & Arthur Van Soest, 2004. "Self-reported Work Disability in the US and The Netherlands," Working Papers 206, RAND Corporation.
    6. Peter Adams & Michael D. Hurd & Daniel L. McFadden & Angela Merrill & Tiago Ribeiro, 2004. "Healthy, Wealthy, and Wise? Tests for Direct Causal Paths between Health and Socioeconomic Status," NBER Chapters, in: Perspectives on the Economics of Aging, pages 415-526, National Bureau of Economic Research, Inc.
    Full references (including those not matched with items on IDEAS)

    Citations

    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Science, ego and power
      by chris dillow in Stumbling and Mumbling on 2011-11-02 18:49:36
    2. Recessions kill
      by chris dillow in Stumbling and Mumbling on 2008-08-13 18:43:11

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. David M. Cutler & Adriana Lleras-Muney & Tom Vogl, 2008. "Socioeconomic Status and Health: Dimensions and Mechanisms," NBER Working Papers 14333, National Bureau of Economic Research, Inc.
    2. Michael Lokshin & Martin Ravallion, 2008. "Testing for an economic gradient in health status using subjective data," Health Economics, John Wiley & Sons, Ltd., vol. 17(11), pages 1237-1259.
    3. Rambotti, Simone, 2015. "Recalibrating the spirit level: An analysis of the interaction of income inequality and poverty and its effect on health," Social Science & Medicine, Elsevier, vol. 139(C), pages 123-131.
    4. McDonough, Peggy & Worts, Diana & Sacker, Amanda, 2010. "Socioeconomic inequalities in health dynamics: A comparison of Britain and the United States," Social Science & Medicine, Elsevier, vol. 70(2), pages 251-260, January.
    5. Oswald, Andrew J & Powdthavee, Nattavudh, 2007. "Obesity, Unhappiness, and The Challenge of Affluence : Theory and Evidence," The Warwick Economics Research Paper Series (TWERPS) 793, University of Warwick, Department of Economics.
    6. Emma Tominey, 2007. "Maternal Smoking During Pregnancy and Early Child Outcomes," CEP Discussion Papers dp0828, Centre for Economic Performance, LSE.
    7. ZHONG, Hai, 2015. "An over time analysis on the mechanisms behind the education–health gradients in China," China Economic Review, Elsevier, vol. 34(C), pages 135-149.
    8. David G. Blanchflower & Andrew J. Oswald & Bert Van Landeghem, 2009. "Imitative Obesity and Relative Utility," Journal of the European Economic Association, MIT Press, vol. 7(2-3), pages 528-538, 04-05.
    9. Ana María Iregui-Bohórquez & Ligia Alba Melo-Becerra & María Teresa Ramírez-Giraldo, 2015. "Risky Health Behaviors: Evidence for an Emerging Economy," Borradores de Economia 891, Banco de la Republica de Colombia.
    10. Martin Siegel & Karl Mosler, 2014. "Semiparametric Modeling Of Age‐Specific Variations In Income Related Health Inequalities," Health Economics, John Wiley & Sons, Ltd., vol. 23(7), pages 870-878, July.
    11. Mikael Svensson, 2010. "Economic upturns are good for your heart but watch out for accidents: a study on Swedish regional data 1976-2005," Applied Economics, Taylor & Francis Journals, vol. 42(5), pages 615-625.
    12. Kajal Lahiri & Zulkarnain Pulungan, 2006. "Health Inequality and Its Determinants in New York," Discussion Papers 06-03, University at Albany, SUNY, Department of Economics.
    13. Datta Gupta, Nabanita & Kleinjans, Kristin J. & Larsen, Mona, 2011. "The Effect of an Acute Health Shock on Work Behavior: Evidence from Different Health Care Regimes," IZA Discussion Papers 5843, Institute of Labor Economics (IZA).
    14. Majo, M.C., 2010. "A microeconometric analysis of health care utilization in Europe," Other publications TiSEM 1cf5fd2f-8146-4ef8-8eb5-e, Tilburg University, School of Economics and Management.
    15. Michael Lokshin & Martin Ravallion, 2008. "Testing for an economic gradient in health status using subjective data," Health Economics, John Wiley & Sons, Ltd., vol. 17(11), pages 1237-1259, November.
    16. van Kippersluis, Hans & O'Donnell, Owen & van Doorslaer, Eddy & Van Ourti, Tom, 2010. "Socioeconomic differences in health over the life cycle in an Egalitarian country," Social Science & Medicine, Elsevier, vol. 70(3), pages 428-438, February.
    17. Cormac O'Dea & Ian Preston, 2012. "The distributional impact of public spending in the UK," IFS Working Papers W12/06, Institute for Fiscal Studies.
    18. Ciro Avitabile & Tullio Jappelli & Mario Padula, 2008. "Screening Tests, Information, and the Health-Education Gradient," CSEF Working Papers 187, Centre for Studies in Economics and Finance (CSEF), University of Naples, Italy, revised 28 Apr 2008.
    19. Martin Siegel & Markus Luengen & Stephanie Stock, 2013. "On age-specific variations in income-related inequalities in diabetes, hypertension and obesity," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 58(1), pages 33-41, February.
    20. Majo, Maria Cristina & van Soest, Arthur, 2012. "Income and health care utilization among the 50+ in Europe and the US," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 28(4), pages 3-22.
    21. Damon Clark & Heather Royer, 2010. "The Effect of Education on Adult Health and Mortality: Evidence from Britain," NBER Working Papers 16013, National Bureau of Economic Research, Inc.
    22. Kapteyn, Arie & Wah, Saw Htay, 2016. "Challenges to small and medium-size businesses in Myanmar: What are they and how do we know?," Journal of Asian Economics, Elsevier, vol. 47(C), pages 1-22.
    23. Stefan Hupfeld, 2011. "Non-monotonicity in the longevity–income relationship," Journal of Population Economics, Springer;European Society for Population Economics, vol. 24(1), pages 191-211, January.
    24. Lahiri, Kajal & Pulungan, Zulkarnain, 2007. "Income-related health disparity and its determinants in New York state: racial/ethnic and geographical comparisons," MPRA Paper 21694, University Library of Munich, Germany.
    25. Datta Gupta, Nabanita & Kleinjans, Kristin J. & Larsen, Mona, 2015. "The effect of a severe health shock on work behavior: Evidence from different health care regimes," Social Science & Medicine, Elsevier, vol. 136, pages 44-51.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Teresa Bago d'Uva & Eddy Van Doorslaer & Maarten Lindeboom & Owen O'Donnell, 2008. "Does reporting heterogeneity bias the measurement of health disparities?," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 351-375, March.
    2. Hernández-Quevedo, Cristina & Jones, Andrew M. & Rice, Nigel, 2008. "Persistence in health limitations: A European comparative analysis," Journal of Health Economics, Elsevier, vol. 27(6), pages 1472-1488, December.
    3. Florian Heiss & Axel Börsch-Supan & Michael Hurd & David A. Wise, 2009. "Pathways to Disability: Predicting Health Trajectories," NBER Chapters, in: Health at Older Ages: The Causes and Consequences of Declining Disability among the Elderly, pages 105-150, National Bureau of Economic Research, Inc.
    4. Börsch-Supan, Axel, 2007. "Work Disability, Health, and Incentive Effects," MEA discussion paper series 07135, Munich Center for the Economics of Aging (MEA) at the Max Planck Institute for Social Law and Social Policy.
    5. van Kippersluis, Hans & O'Donnell, Owen & van Doorslaer, Eddy & Van Ourti, Tom, 2010. "Socioeconomic differences in health over the life cycle in an Egalitarian country," Social Science & Medicine, Elsevier, vol. 70(3), pages 428-438, February.
    6. Hans-Martin von Gaudecker & Rembrandt D. Scholz, 2006. "Lifetime earnings and life expectancy," MPIDR Working Papers WP-2006-008, Max Planck Institute for Demographic Research, Rostock, Germany.
    7. Johnston, David W. & Propper, Carol & Shields, Michael A., 2009. "Comparing subjective and objective measures of health: Evidence from hypertension for the income/health gradient," Journal of Health Economics, Elsevier, vol. 28(3), pages 540-552, May.
    8. Javier Alvarez-Galvez & Maria Luisa Rodero-Cosano & Emma Motrico & Jose A. Salinas-Perez & Carlos Garcia-Alonso & Luis Salvador-Carulla, 2013. "The Impact of Socio-Economic Status on Self-Rated Health: Study of 29 Countries Using European Social Surveys (2002–2008)," IJERPH, MDPI, vol. 10(3), pages 1-15, February.
    9. Owen O'Donnell & Eddy Van Doorslaer & Tom Van Ourti, 2013. "Health and Inequality," Tinbergen Institute Discussion Papers 13-170/V, Tinbergen Institute.
    10. James Banks & Arie Kapteyn & James P. Smith & Arthur van Soest, 2009. "Work Disability is a Pain in the ****, Especially in England, the Netherlands, and the United States," NBER Chapters, in: Health at Older Ages: The Causes and Consequences of Declining Disability among the Elderly, pages 251-293, National Bureau of Economic Research, Inc.
    11. James Smith, 2005. "Consequences and Predictors of New Health Events," NBER Chapters, in: Analyses in the Economics of Aging, pages 213-240, National Bureau of Economic Research, Inc.
    12. Beomsoo Kim & Christopher J. Ruhm, 2012. "Inheritances, health and death," Health Economics, John Wiley & Sons, Ltd., vol. 21(2), pages 127-144, February.
    13. Hernández-Quevedo, Cristina & Jones, Andrew M. & López-Nicolás, Angel & Rice, Nigel, 2006. "Socioeconomic inequalities in health: A comparative longitudinal analysis using the European Community Household Panel," Social Science & Medicine, Elsevier, vol. 63(5), pages 1246-1261, September.
    14. Hernández-Quevedo, Cristina & Jiménez-Rubio, Dolores, 2009. "A comparison of the health status and health care utilization patterns between foreigners and the national population in Spain: New evidence from the Spanish National Health Survey," Social Science & Medicine, Elsevier, vol. 69(3), pages 370-378, August.
    15. Kim, Hoolda & Mitra, Sophie, 2022. "Dynamics of health and labor income in Korea," The Journal of the Economics of Ageing, Elsevier, vol. 21(C).
    16. Stefan Angel, 2016. "The Effect of Over-Indebtedness on Health: Comparative Analyses for Europe," Kyklos, Wiley Blackwell, vol. 69(2), pages 208-227, May.
    17. Rablen, Matthew D. & Oswald, Andrew J., 2007. "Mortality and Immortality," The Warwick Economics Research Paper Series (TWERPS) 785, University of Warwick, Department of Economics.
    18. James M. Poterba & Steven F. Venti & David A. Wise, 2011. "Were They Prepared for Retirement? Financial Status at Advanced Ages in the HRS and AHEAD Cohorts," NBER Chapters, in: Investigations in the Economics of Aging, pages 21-69, National Bureau of Economic Research, Inc.
    19. John Gathergood & Eleonora Fichera, 2012. "House Prices, Home Equity and Health," Discussion Papers 12/07, University of Nottingham, School of Economics.
    20. Andrew M. Jones & Eddy Van Doorslaer & Teresa Bago D’Uva & Silvia Balia & Lynn Gambin & Cristina Hernández Quevedo & Xander Koolman & Nigel Rice, 2006. "Health and Wealth: Empirical Findings and Political Consequences," Perspektiven der Wirtschaftspolitik, Verein für Socialpolitik, vol. 7(s1), pages 93-112, May.

    More about this item

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:ifs:ifsewp:07/04. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Emma Hyman (email available below). General contact details of provider: https://edirc.repec.org/data/ifsssuk.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.