A Life-Span Developmental Perspective on Social Status and Health

Journals of Gerontology: SERIES B Copyright 2005 by The Gerontological Society of America 2005, Vol. 60B (Special Issue II): 7–14 Overview A Life-Span Developmental Perspective on Social Status and Health Duane F. Alwin1 and Linda A. Wray2 Downloaded from 1Department of Sociology and Population Research Institute, and 2Department of Biobehavioral Health and Gerontology Center, The Pennsylvania State University, University Park. This article presents a life-span developmental (LSD) perspective on the linkages between social status and health. The objective is to develop a conceptual framework that is useful in understanding why people are differentially exposed to http://psychsocgerontology.oxfordjournals.org/ risks of disease or protective factors and the social conditions that link the effects of risk and protective factors to the social environment over the life span. The discussion distinguishes between the complementary concepts of ‘‘life span,’’ ‘‘life cycle,’’ and ‘‘life course,’’ critical theoretical distinctions that may help refine hypotheses about the relationship between health and social status. We argue that life-cycle and life-course concepts can be viewed as embedded in a more general LSD perspective. Using the theoretical principles derived from this perspective, the review examines (a) gender differences, (b) race–ethnic experiences, (c) childhood experiences, (d) educational levels, (e) socioeconomic differences, and (f) age differences. The emphasis in the review is to highlight the value of a broader LSD perspective in the study of health inequalities. The article ends with a brief summary of where future research is headed and novel developments in the study of social status and health. OCIAL inequalities in power, privilege, certification, and America, the renewed awareness of pockets of poverty led to S economic well-being have always been part of society, as the widely acclaimed policy of the Johnson Administration— we know it, and these inequalities are as prevalent in today’s The War on Poverty—and a renewed focus on social inequal- society as they ever were. Sociologists and epidemiologists ities in health and illness. During this era, Saxon Graham at MPI Human Development on February 21, 2012 have long known about the consequences of social inequality (1958) documented the greater prevalence of certain chronic for the health and well-being of individuals, although for some conditions among the socially disadvantaged, and the classic reason this issue has until recently been ignored by the medical demographic analysis of mortality by Kitagawa and Hauser community. Fortunately, this connection was rediscovered by (1964) established the importance of race and socioeconomic researchers in the early 1990s, and as a consequence, it is now factors in health and well-being. A few years later, John Kosa, a prominent focus of requests for research by the National Aaron Antonovsky, and Irving Kenneth Zola’s (1969) edited Institutes of Health. One of the important features of the volume Poverty and Health: A Sociological Analysis included scholarly terrain in this area is that it is multidisciplinary, with an exhaustive investigation of social inequalities in health and researchers using many different theoretical perspectives to illness, concluding that ‘‘Whatever aspect of health, whatever contribute to the accumulation of knowledge. Even the popular stage of the morbid episode is examined, the [less socioeco- press has discovered that social status is related to health nomically advantaged] are at a [greater] disadvantage’’ (1969, (Cohen, 2004). p. 325). In other words, the basic idea that social inequal- As David Mechanic (2000) pointed out in a recent review ities are related to health and disease has been around for a essay, the connection between social inequality and health has long time. been known for centuries. In his words, ‘‘by the mid-19th With these origins in the 1960s, studies of social status and century there were already careful, detailed inquiries in health grew exponentially beginning in the 1990s, driven partly England, France, Germany, and the United States on how the by the increasing numbers of disciplines that started to focus conditions of the poor cut life short’’ (Mechanic, 2000, p. 269). on the issue and partly by federal mandates that called eventu- Some of these inquiries included Edwin Chadwick’s (1842) ally for research aimed at eliminating health disparities, e.g., Report on the Sanitary Condition of the Labouring Population Healthy People 2010. In an important review article, Oakes of Great Britain and John Griscom’s (1845) The Sanitary and Rossi (2002) plotted the trends in the number of articles on Condition of the Laboring Population of New York: With the relationship between socioeconomic status (SES) and health Suggestions for Its Improvement. In the early 1960s, there was in health journals, documenting that between 1990 and 1999, a resurgence of interest in the topic when Michael Harrington’s the mean number of published articles with SES keywords book The Other America (1962) pointed out that mass poverty in title fields was 175.6 per year or a cumulative total of continued to exist in America despite the unprecedented 3,544 articles! prosperity of the nation and the social welfare legislation of While decades of studies provide evidence of the relation- Roosevelt’s New Deal. Whether among the racial and ethnic ship between social conditions and health, the ‘‘reinvigoration’’ minorities in the urban ghetto or the populations of rural of the focus on this relationship has brought both renewed 7 8 ALWIN AND WRAY awareness of ‘‘health disparities’’ and an increased understand- income, education, and occupational status are not necessarily ing of some of their origins. Recent studies have focused on alternative indicators of the same latent concept of SES, but attempts to understand the social processes underlying the refer to different institutional structures and are, in fact, causally observed differences and the mechanisms that mediate these ordered (Blau & Duncan, 1967). Education is arguably causally processes (e.g., Williams, 1990; Link & Phelan, 1995). Recent prior to occupation, that is, level of schooling is a criterion for research has contributed important conceptual, methodological, access to jobs, and occupational status is linked causally to and empirical strategies that further illuminate these relation- wage rates and earnings. Moreover, as studies of social mobility ships. New conceptualizations have stressed the multidimen- have shown, although there may be linkage between parental sional nature of social status, the importance of a life-span statuses and one’s own, they are not necessarily the same. Thus, perspective on inequality—including the use of life-course an LSD perspective would argue that to focus only on adult concepts—and behavioral mechanisms of transmission. The achieved statuses without any attention to family background recent literature has also emphasized the increasing importance ignores what may be an even more important source of social Downloaded from and availability of longitudinal data to address issues of inequality that has consequences for health in adulthood (e.g., stability and change in the analysis of the effects of social see Elo & Preston, 1992; Preston, Hill, & Drevenstedt, 1998; inequalities on health, and new analytic techniques (such as Wadsworth, 1997). event history analysis, latent growth models, and multilevel More importantly, it should be recognized that global contextual models) have enhanced the ability of researchers concepts such as ‘‘socioeconomic status’’ are in themselves to articulate the nature of the role of social status in health very limiting, because they are not specific about what aspect of http://psychsocgerontology.oxfordjournals.org/ and disease. social status is important for a particular outcome, and they exclude consideration of other statuses, particularly ascribed statuses. Without a complete specification of the inequalities ATHEORETICAL PERSPECTIVE experienced across the entire life span, it is difficult to infer the This section briefly reviews a life-span developmental (LSD) direct impacts of status characteristics. Recent developments perspective on the relationship between social status and health. have emphasized the value of specifying more concretely the This is a framework that can be used to understand why people meaning of social inequality and the relationship of compo- are differentially exposed to risks of disease and/or protective nents of various forms of ‘‘capital’’ to health and well-being. factors as well as the social conditions that link the effects of For example, O’Rand (2001, pp. 200–202) distinguishes risk and protective factors to the social environment (Link & between ‘‘human capital’’ (the stock of productive knowledge Phelan, 1995). This perspective takes the long view by and skills), ‘‘social capital’’ (the stock of direct and indirect emphasizing the need to understand the role of inequalities in social relationships, i.e., ‘‘strong and weak ties’’), ‘‘personal health and disease across the entire life span—from birth to capital’’ (resiliency, positive affect, self-confidence, and death—and includes the consideration of life-course factors (or at MPI Human Development on February 21, 2012 control), and ‘‘psychophysical capital’’ (physical and mental social pathways) in understanding linkages between social health). Similarly, Oakes and Rossi (2002) emphasize

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