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The SES health gradient on both sides of the Atlantic

Author

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  • 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)

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
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    File URL: http://www.ifs.org.uk/wps/wp0704.pdf
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    References listed on IDEAS

    as
    1. 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.
    2. 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.
    3. 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).
    4. James Smith, 2004. "Unravelling the SES health connection," IFS Working Papers W04/02, Institute for Fiscal Studies.
    5. 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).
    6. Arie Kapteyn & James P. Smith & Arthur Van Soest, 2004. "Self-reported Work Disability in the US and The Netherlands," Working Papers 206, RAND Corporation.
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    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Recessions kill
      by chris dillow in Stumbling and Mumbling on 2008-08-13 18:43:11

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    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. 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.
    3. 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.
    4. Kajal Lahiri & Zulkarnain Pulungan, 2006. "Health Inequality and Its Determinants in New York," Discussion Papers 06-03, University at Albany, SUNY, Department of Economics.
    5. 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.
    6. Ana María Iregui-Bohórquez & Ligia Alba Melo-Becerra & María Teresa Ramírez-Giraldo, 2015. "Risky Health Behaviors: Evidence for an Emerging Economy," BORRADORES DE ECONOMIA 013040, BANCO DE LA REPÚBLICA.
    7. 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.
    8. Tominey, Emma, 2007. "Maternal smoking during pregnancy and early child outcomes," LSE Research Online Documents on Economics 19675, London School of Economics and Political Science, LSE Library.
    9. Majo, Maria Cristina & van Soest, Arthur, 2012. "Income and health care utilization among the 50+ in Europe and the US," Applied Econometrics, Publishing House "SINERGIA PRESS", vol. 28(4), pages 3-22.
    10. 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.
    11. 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.
    12. 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.
    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 for the Study of Labor (IZA).
    14. 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.
    15. 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.
    16. 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.
    17. 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.
    18. 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.
    19. 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.
    20. 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.

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    JEL classification:

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

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