Skip to main content
SpringerLink
Log in

The socioeconomic gradient in health: how important is material deprivation?

  • Published:
The Journal of Economic Inequality Aims and scope Submit manuscript

Abstract

In this paper we use the Spanish Living Conditions Survey (2005–2008) to investigate the existence of a socioeconomic gradient in health when alternative measures of socioeconomic status, apart from income, are considered. In particular we construct a material deprivation index that reflects minimum standards of quality of life and that incorporates comparison effects with societal peers and we estimate health equations with probit adapted least squares, fixed effects and instrumental variables. Our results reveal that the relationship between health and income operates through comparison information with respect to societal peers. In contrast, material deprivation in terms of financial difficulties, basic necessities and housing conditions exerts a direct effect on individual health. Mixed evidence is found with respect to gender.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Adams, P., Hurd, M.D., McFadden, D., Merrill, A., Ribiero, T.: Healthy, wealthy and wise? Tests for direct causal paths between health and socioeconomic status. J. Econ. 112, 3–5 (2003)

    Article  Google Scholar 

  2. Adamson, J.A., Ebrahim, S., Hunt, K.: The psychosocial versus material hypothesis to explain observed inequality in disability among older adults: data from the West of Scotland Twenty-07 Study. J. Epidemiol. Community Health 60(11), 974–80 (2006)

    Article  Google Scholar 

  3. Adda, J., Chandola, T., Marmot, M.: Socio-economic status and health: causality and pathways. J. Econ. 112(1), 57–63 (2003)

    Article  Google Scholar 

  4. Anderson, M., Marmot M.: The effects of promotions on heart disease: evidence from Whitehall. Econ. J. 122, 555–589 (2012)

    Article  Google Scholar 

  5. Arendt, J.N.: Does education cause better health? A panel data analysis using school reforms for identification. Econ. Educ. Rev. 24, 149–160 (2005)

    Article  Google Scholar 

  6. Atkinson, A.B., Cantillon, B., Marlier, E., Nolan, B.: Social Indicators: The EU and Social Inclusion. Oxford University Press, Oxford (2002)

    Book  Google Scholar 

  7. Baker, M., Stabile, M., Deri, C.: What do self-reported objective measures of health measure? J. Human Resour. 39, 1067–1093 (2004)

    Article  Google Scholar 

  8. Bellani, L., D’Ambrosio C.: Deprivation, social exclusion and subjective well-being. Soc. Indic. Res. 104, 67–86, (2010)

    Article  Google Scholar 

  9. Bender, K.A., Theodossiou, I.: Controlling for endogeneity in the health-socioeconomic status relationship of the near retired. J. Socio-Econ. 38(6), 977–987 (2009)

    Article  Google Scholar 

  10. Benzeval, M., Judge, K., Solomon, M.: The health status of Londoners: a comparative perspective. King’s Fund London Initiative Working Paper 1, King’s Fund, London (1992)

  11. Benzeval, M., Green, M.J., Leyland, A.H.: Do social inequalities in health widen or converge with age? Longitudinal evidence from three cohorts in the West of Scotland. BMC Public Health 11, 947 (2011)

    Google Scholar 

  12. Bertrand, M., Mullainathan, S.: Do people mean what they say? Implications for subjective survey data. Am. Econ. Rev. 91(2), 67–72 (2001)

    Article  Google Scholar 

  13. Blanchflower, D.G., Oswald, A.J.: Well-being over time in Britain and the USA. NBER Working Paper Series No. 7487 (2004)

  14. Blaxter, M.: Health and Lifestyles. Tavistock/Routledge, London (1990)

    Book  Google Scholar 

  15. Blázquez, M., Cottini, E., Herrarte A.: Socioeconomic gradient in health: how important is material deprivation? GINI Discussion Paper 39 (2012)

  16. Bossert, W., D’Ambrosio C., Peragine V.: Deprivation and social exclusion. Economica 74, 777–803 (2007)

    Article  Google Scholar 

  17. Bound, J.: Self-reported versus objective measures of health in retirement models. J. Human Resour. 26(1), 106–138 (1991)

    Article  Google Scholar 

  18. Bound, J., Schoenbaum, M., Stinebrickner, T.R., Waidmann, T.: The dynamic effects of health on the labour force transitions of older workers. Labour Econ. 6, 179–202 (1999)

    Article  Google Scholar 

  19. Brown, G., Gardner J., Oswald A.: Does wage rank affect employees’ well-being? Ind. Relat. 47, 355–389 (2008)

    Article  Google Scholar 

  20. Chakravarty, S.R., D’Ambrosio, C.: The measurement of social exclusion. Rev. Income Wealth 9(3), 377–398 (2006)

    Article  Google Scholar 

  21. Chandola, T., Bartley, M., Sacker, A., Jenkinson, C., Marmot, M.: Health selection in the Whitehall II Study, UK. Soc. Sci. Med. 56(10), 2059–2072 (2003)

    Article  Google Scholar 

  22. Contoyannis, P., Rice, N.: The impact of health on wages: evidence from the British Household Panel Survey. Empir. Econ. 26(4), 599–622 (2001)

    Article  Google Scholar 

  23. Contoyannis, P., M. Jones, A., Rice, N.: The dynamics of health in the British Household Panel Survey. J. Appl. Econ. 19, 473–503 (2004)

    Article  Google Scholar 

  24. Cutler, D.M., Lleras-Muney, A.: Education and health: evaluating theories and evidence. In: House, J.S., Schoeni, R.F., Kaplan, G.A., Pollack, H. (eds.) The Health Effects of Social and Economic Policy Russell Sage Foundation. New York (2007)

  25. Deaton, A, Paxson, C.: Mortality, education, income, and inequality among American cohorts. NBER Working Paper 7140 (1999)

  26. Deaton, A.: Health, inequality and economic development. J. Econ. Lit. 41, 113–158 (2003)

    Article  Google Scholar 

  27. Disney, R., Emmerson, C., Wakefield, M.: Ill health and retirement in Britain: a panel data-based Analysis. J. Health Econ. 25(4), 621–649 (2006)

    Article  Google Scholar 

  28. Economou, A., Theodossiou, I.: Poor and sick: estimating the relationship between household income and health. Rev. Income Wealth 57(3), 395–411 (2011)

    Article  Google Scholar 

  29. Eibner, C., Sturm, R., Gresenz, C.: Does relative deprivation predict the need for mental health services. J. Ment. Health Policy Econ. 7(4), 167–175 (2004)

    Google Scholar 

  30. Eibner, C., Evans, W.: Relative deprivation, poor health habits and Mortality. J. Human Resour. 40(3), 591–620 (2005)

    Google Scholar 

  31. Ettner, S.: New evidence on the relationship between income and health. J. Health Econ. 15, 67–85 (1996)

    Article  Google Scholar 

  32. Eurostat: European Social Statistics. Income, Poverty and Social Exclusion, THEME 3, Population and Social Conditions, Luxembourg (2000)

  33. Ferrer-i-Carbonell, A.: Income and well-being: an empirical analysis of the comparison income effect. J. Public Econ. 89, 997–1019 (2005)

    Article  Google Scholar 

  34. Ferrer-i-Carbonell, A., Gërxhani, K.: Financial satisfaction and (in)formal sector in a transition country. Social Indicators Research (2010)

  35. Ferrer-i-Carbonell, A., Frijters, P.: How important is methodology for the estimates of the determinants of happiness? Econ. J. 114, 641–659 (2004)

    Article  Google Scholar 

  36. Frijters, P., Haisken-DeNew, J.P. Shields, M.A.: Estimating the causal effect of income on health: evidence from post reunification East Germany. Centre for Economic Policy. Discussion Paper 465, Australian National University (2003)

  37. Frijters, P., Hatton T., Sheilds, M.R.: The causal effects of income on health: evidence from Germany reunification. J. Health Econ. 24, 997–1–17 (2005)

    Article  Google Scholar 

  38. Fuchs, V.R.: Reflections on the socio-economic correlates of health. J. Health Econ. 23, 653–661 (2004)

    Article  Google Scholar 

  39. Gailly, B., Hausman, P.: Désavantages relatifs à une measure objective de la pauvreté. In: Sarpellon, G. (eds.) Understanding Poverty. Franco Angeli, Milano (1984)

  40. Gambin, L.: The impact of health on wages in Europe—does gender matter? HEDG Working Paper 05/03 (2005)

  41. Graham, H.: Unequal Lives: Health and Socioeconomic Inequalities. Open University Press, New York (2007)

    Google Scholar 

  42. Gravelle, H., Sutton, M.: Income, relative income, and self-reported health in Britain 1979–2000. Health Econ. 18(2), 125–145 (2009)

    Article  Google Scholar 

  43. Grossman, M.: On the concept of health capital and the demand for health. J. Polit. Econ. 80(2), 223–255 (1972)

    Article  Google Scholar 

  44. Grossman, M.: The human capital model. In: Culyer, A.J., Newhouse, J.P. (eds.) Handbook of Health Economics, vol. 1A (2000)

  45. Gunasekara, F.I., Carter, K., Blakely, T.: Change in income and change in self-rated health: systematic review of studies using repeated measures to control for confounding bias. Soc. Sci. Med. 72(2), 193–201 (2011)

    Article  Google Scholar 

  46. Gupta, S., McDade, T., Adam, E.: Objective versus subjective measures of health: systematic differences and determinants (Preliminary version) (2010)

  47. Hahn, J., Hausman, J.: Notes on bias in estimators for simultaneous equation models. Econ. Lett. 75(2), 237–241 (2002)

    Article  Google Scholar 

  48. Horwitz, A., Davies, L.: Are emotional distress and alcohol problems differential outcomes to stress? An exploratory test. Soc. Sci. Q. 75(3), 607–621 (1994)

    Google Scholar 

  49. House, J.S., Lantz, P.M., Herd, P.: Continuity and change in the social stratification of aging and health over the life course: evidence from a nationally representative longitudinal study from 1986 to 2001/2002. J. Gerontol. Ser. B. 60, 15–26 (2005)

    Article  Google Scholar 

  50. Idler, E.L., Kasl, S.V.: Self-ratings of health: do they also predict change in functional ability. J. Gerontol. 50(6), 344–353 (1995)

    Article  Google Scholar 

  51. Idler, E.L., Benyammi, Y.: Self-rated health and mortality: a review of twenty-seven community studies. J. Health Soc. Behav. 38, 21–37 (1997)

    Article  Google Scholar 

  52. Jäckle, R., Himmler, O.: Health and wages: panel data estimates considering selection and endogeneity. J. Human Resour. 45, 364–406 (2010)

    Article  Google Scholar 

  53. Jensen, R., Richter K.: The health implications of social security failure: evidence from the russian pension crisis. J. Public Econ. 88, 209–236 (2004)

    Article  Google Scholar 

  54. Jones, A., Wildman, J.: Health, income and relative deprivation: evidence from the BHPS. J. Health Econ. 27, 308–324 (2008)

    Article  Google Scholar 

  55. Jones, A.M., Koolman, X., Rice, N.: Health-related non-response in the British Household Panel Survey and European Community Household Panel: using inverse-probability-weighted estimators in non-linear models. J. R. Stat. Soc. Ser. A 169, 543–569 (2006)

    Article  Google Scholar 

  56. Kawachi, l., Adler, N. E., Dow, W. H.: Money, schooling, and health: mechanisms and causal evidence. Ann. N. Y. Acad. Sci. 1186(1), 56–68 (2010)

    Article  Google Scholar 

  57. Kiuila, O., Mieszkowski, P.: The effects of income, education and age on health. Health Econ. 16, 781–798 (2007)

    Article  Google Scholar 

  58. Kondo, N., Kawachi, I., Hirai, H.: Relative deprivation and incident functional disability among older Japanese women and men: prospective cohort study. J. Epidemiol. Community Health 63, 461–467 (2008)

    Article  Google Scholar 

  59. Lahelma, E.: Health and social stratification. In: Cockerham, W.C., Malden, M.A. (eds.) The Blackwell Companion to Medical Sociology, pp. 64–93. Blackwell Publishers Inc. (2001)

  60. Lhila, A., Simon, K.I.: Relative deprivation and child health in the USA. Soc. Sci. Med. 71, 777–785 (2010)

    Article  Google Scholar 

  61. Lindahl, M.: Estimating the effect of income on health and mortality using lottery prizes as an exogenous source of variation in income. J. Human Resour. 40, 144–68 (2005)

    Google Scholar 

  62. Lleras-Muney, A.: The relationship between education and adult mortality in the United States. Rev. Econ. Stud. 72, 189–221 (2005)

    Article  Google Scholar 

  63. Lorgelly, P.K., Lindley, J.: What is the relationship between income inequality and health? Evidence from the BHPS. Health Econ. 17(2), 249–265 (2008)

    Article  Google Scholar 

  64. Luttmer, E.: Neighbors as negatives: relative earnings and well-being. Q. J. Econ. 120(3), 963–1002 (2005)

    Google Scholar 

  65. Lynch, J., Kaplan G., Shema S.: Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning. N. Engl. J. Med. 337, 1889–1895 (1997)

    Article  Google Scholar 

  66. Lynch, J.W., Davey-Smith, G., Kaplan, G.A., House, J.: Income inequality and mortality: importance to health of individual incomes, psychosocial environment, or material conditions. Br. Med. J. 320, 1200–1204 (2000)

    Article  Google Scholar 

  67. Lynch, J., Davey Smith, G., Harper, S., Hillemeier, M., Ross, N., Kaplan, G., Wolfson, M.: Is income inequality a determinant of population health? Milbank Q. 82, 5–99 (2004)

    Article  Google Scholar 

  68. Mangyo, E., Park, A.: Relative deprivation and health: which reference groups matter. J. Human Resour. 46(3), 459–481 (2010)

    Article  Google Scholar 

  69. Marmot, M.G., Wilkinson, R.G.: Social Determinants of Health. Oxford Univ. Press, Oxford (1999)

    Google Scholar 

  70. Marmot, M.: Understanding social inequalities in health. Perspect. Biol. Med. 46(3), S9–S23 (2003)

    Article  Google Scholar 

  71. Marmot, M., Wilkinson, R.: Psychosocial and material pathways in the relation between income and health: a response to Lynch et al. Br. Med. J. 322, 1233–1236 (2001)

    Article  Google Scholar 

  72. McBride, M.: Relative-income effects on subjective well-being in the cross-section. J. Econ. Behav. Organ. 45, 251–278 (2001)

    Article  Google Scholar 

  73. Meer, J., Millar, D., Rosen, H.: Exploring the health–wealth nexus. J. Health Econ. 22, 713–730 (2003)

    Article  Google Scholar 

  74. Nolan, B., Whelan C.: Poverty and Deprivation in Europe. Oxford University Press, Oxford (2011)

    Book  Google Scholar 

  75. Papadopoulos, F., Tsakloglou, P.: Identifying population groups at high risk of social exclusion: evidence from the ECHP. In: Muffels, R., Tsakloglou, P., Mayes, D. (eds.) Social Exclusion in European Welfare States, pp. 135–169. Edward Elgar, Cheltenham (2002)

    Google Scholar 

  76. Persky, J., Tam, M.: Local status and national social welfare. J. Reg. Sci. 30(2), 229–238 (1990)

    Article  Google Scholar 

  77. Ploubidis, G., DeStavola, B., Grundy, E.: Health differentials in the older population of England: an empirical comparison of the materialist, lifestyle and psychosocial hypotheses. BMC Public Health 11, 390 (2011)

    Article  Google Scholar 

  78. Runciman, W.G.: Relative Deprivation and Social Justice. Routledge, London (1966)

    Google Scholar 

  79. Salas, C.: On the empirical association between poor health and low socioeconomic status at old age. Health Econ. 11(3), 207–220 (2002)

    Article  Google Scholar 

  80. Senik, C.: Direct evidence on income comparisons and their welfare effects. J. Econ. Behav. Organ. 72, 408–424 (2009)

    Article  Google Scholar 

  81. Smith, J.: Healthy bodies and thick wallets: the dual relation between health and economic status. J. Econ. Perspect. 13, 145–166 (1999)

    Article  Google Scholar 

  82. Stock, J.H., Yogo, M.: Testing for weak instruments in linear IV regression. NBER Technical Working Papers 0284, National Bureau of Economic Research, Inc. (2005)

  83. Stronks, K., van de Miheen, D., Mackenbach, J.: A higher prevalence of health problems in low income groups: does it reflect relative deprivation? J. Epidemiol. Community Health 52, 548–557 (1998)

    Article  Google Scholar 

  84. Subramanian, S.V., Kawachi, I.: Being well and doing well: on the importance of income for health. Int. J. Soc. Welf. 15(1), 13–22 (2006)

    Article  Google Scholar 

  85. Subramanian, S.V., Subramanyam, M., Kawachi, I., Berkman, L.: Relative deprivation in income and self-rated health in the United States. Soc. Sci. Med. 69, 327–334 (2009)

    Article  Google Scholar 

  86. Stern, S.: Measuring the effect of disability on labor force participation. J. Human Resour. 24, 361–395 (1989)

    Article  Google Scholar 

  87. Theodossiou, I., Zangelidis, A.: The social gradient in health: the effect of absolute income and subjective social status assessment on the individual’s health in Europe. Econ. Human Biol. 7, 229–237 (2009)

    Article  Google Scholar 

  88. Townsend, P.: Poverty in the United Kingdom. Allen Lane and Penguin Books, London (1979)

    Google Scholar 

  89. Townsend, P.: Deprivation. J. Soc. Policy 16, 125–246 (1987)

    Article  Google Scholar 

  90. van Praag, B.M.S., Ferrer-i-Carbonell, A.: Happiness Quantified: A Satisfaction Calculus Approach. Oxford University Press, Revised edition (2008)

  91. van Doorslaer, Koolman, X.: Explaining the differences in income-related health inequalities across European countries. Health Econ. 13, 609–628 (2004)

    Article  Google Scholar 

  92. Whelan, C., Maître B.: New and old social risks: life cycle and social class perspectives on social exclusion in Ireland. Econ. Soc. Rev. 39, 131–156 (2008)

    Google Scholar 

  93. Wilkinson, R., Pickett, K.: Income inequality and population health: a review and explanation of the evidence. Soc. Sci. Med. 62, 1768–1784 (2006)

    Article  Google Scholar 

  94. Wilkinson, R.G.: Health inequalities: relative or absolute material standards? Br. Med. J. 314, 591–595 (1997)

    Article  Google Scholar 

  95. Wilkinson, R.: Why is inequality bad for health? In: Auerbach, J.A., Krimgold, B.K. (eds.) Income, Socioeconomic Status and Health: Exploring the Relationships. National Policy Association, Washington, DC (2001)

    Google Scholar 

  96. Winkelmann, L., Winkelmann, R.: Why are the unemployed so unhappy? Evidence from panel data. Economica 65, 1–15 (1998)

    Article  Google Scholar 

  97. Wooldridge, J.M.: Econometric Analysis of Cross Section and Panel Data. The MIT Press (2010)

  98. Yitzhaki, S.: Relative deprivation and the Gini coefficient. Q. J. Econ. 93, 321–324 (1979)

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Economics, Universidad Autónoma de Madrid, Cantoblanco, 28049, Madrid, Spain

    Maite Blázquez & Ainhoa Herrarte

  2. Università Bocconi, Milan, Italy

    Elena Cottini

Authors
  1. Maite Blázquez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elena Cottini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ainhoa Herrarte
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maite Blázquez.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Blázquez, M., Cottini, E. & Herrarte, A. The socioeconomic gradient in health: how important is material deprivation?. J Econ Inequal 12, 239–264 (2014). https://doi.org/10.1007/s10888-013-9248-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10888-013-9248-5

Keywords

JEL Classification

Search

Navigation