Mental health articles

Socioeconomic Status and Health
Most known societies are heterogeneous in socioeconomic
terms; different parts of the population live
under different socioeconomic conditions, have different
levels of education, etc. Such differences often provide
the basis for social stratification, e. g. in social
classes. Socioeconomic status or social class is in general
associated with health status. Frequently, a pronounced
gradient is visible: The socially most advantaged
groups have the best health status while the
socially most disadvantaged groups tend to have the
poorest health status. The pathways through which this association
operates are complex; they include macroeconomic,
social, environmental, and behavioral factors.
These factors, together with genetic background and
life course factors, act on the health status of an individual.
Being migrant increases the probability of living in
socially deprived conditions or of being a member of
the lower social classes. Such class membership is
usually associated with a disadvantaged health situation.
However, migrants differ from indigenous populations
in many other aspects that are also relevant to
health. The differences range from genetic background
to lifestyle and nutrition ( migrant health). Thus, not
all health differences of migrants are the result of social
inequalities. It follows therefore that a disparity in risk
is not necessarily an indication of inequity; equal risks,
on the other hand, do not necessarily imply equity in
health ( migrant mortality, healthy migrant effect).
In addition, migrants often face disadvantages in access
to health care ( migrants, access to health care). To some extent, this limited access may be explained by the social deprivation of migrants, although socially deprived non-migrants also encounter barriers to
access. Deprived population groups, whether with or
without a migration background, tend to have fewer
health-related resources, e. g. a lower health literacy. In
consequence, both groups have lower participation rates
in prevention programs. There are, however, additional
factors affecting access that are specific to the circumstances
of migrants: discrimination, racism, language
barriers, etc. Thus the question arises as to the degree
to which inequalities in health risk among migrants are
an expression of social inequalities, or of inequity in
health care. Identifying and quantifying the contributing
factors in a particular setting could help to develop
appropriate strategies towards improving the health
of migrants – as well as that of other disadvantaged groups.
Unfortunately, differences or similarities in the risk of
specific diseases do not lend themselves as an adequate
measure of equity. In a hypothetical example, similar
mortality rates from cardiovascular disease (CVD)
could be the result of rather different conditions that
are not necessarily all a result of inequity. Consider the following scenarios:
• Migrants and indigenous populations have the same
mortality from CVD and equal access to prevention
and health care resources. This would obviously be an equitable situation.
• Migrants have a lower mortality from CVD (due to
nature or nurture factors), but the potential benefit in
risk is reduced by lower access to health care. This
would be an inequitable situation, because the relative
increase in risk among migrants would be avoided
if migrants had equal access to health care, thus it would be unnecessary and unfair.
• Migrants have a naturally lower mortality from
CVD, but the migration process increases their risk.
Due to changes in their lifestyle or living conditions,
rather than lower access to health care, migrants may
experience a significant increase in risk up to the
level of the indigenous population. If the increase
is the result of unhealthy living or working conditions
caused by social deprivation, and the effects of
this deprivation could be avoided, this would constitute
an inequitable situation. However, the increase
could also be the result of deliberate changes in
lifestyle that are not forced by social deprivation,

e. g. a change in food habits. The increase in risk
might then be indeed avoidable, but not necessarily
unfair and so not an expression of inequity.
When morbidity or quality of life is considered, the
picture is equally complex and findings are sometimes
contradictory. For example, disadvantages in health status
among migrants, compared to the majority population
of the host country, sometimes become visible only
in middle age. In order to assess for equity and fairness,
it is therefore not sufficient to consider only risks. The
objective of migrant-sensitive health care systems and
research must be to analyze and consider the different
needs, risks and their causes in different social groups
( migrants, diversity management).

Tags: Health