A social rank explanation of how money influences health.

Abstract

Objective: Financial resources are a potent determinant of health, yet it remains unclear why this is the case. We aimed to identify whether the frequently observed association between absolute levels of monetary resources and health may occur because money acts an indirect proxy for a person’s social rank. Method: To address this question we examined over 230,000 observations on 40,400 adults drawn from two representative national panel studies; the British Household Panel Survey and the English Longitudinal Study of Ageing. We identified each person’s absolute income/wealth and their objective ranked position of income/wealth within a social reference-group. Absolute and rank income/wealth variables were then used to predict a series of self-reported and objectively recorded health outcomes in cross-sectional and longitudinal analyses. Results: As anticipated, those with higher levels of absolute income/wealth were found to have better health than others, after adjustment for age, gender, education, marital status, and labor force status. When evaluated simultaneously the ranked position of income/wealth but not absolute income/wealth predicted all health outcomes examined including: objective measures of allostatic load and obesity, the presence of long-standing illness, and ratings of health, physical functioning, role limitations, and pain. The health benefits of high rank were consistent in cross-sectional and longitudinal analyses and did not depend on the reference-group used to rank participants. Conclusions: This is the first study to demonstrate that social position rather than material conditions may explain the impact of money on human health.

Explaining the income and suicidality relationship: income rank is more strongly associated with suicidal thoughts and attempts than income

“…The inclusion of income rank largely eliminated the relationship between absolute income and suicidality in the statistical models, indicating that it is income rank rather than income per se that accounts for the income-suicidality relationship. This is consistent with previous findings showing that the income rank variable within similar social comparison groups accounts for the associations between absolute income and life satisfaction [30], distress [31], and health [32].…”

“…This finding has received further support from Wood and colleagues [31] who found that the income rank variable wholly accounted for the relationship between income and mental distress. The psychosocial explanation of the effect of income upon health has also been strengthened by a recent study [32] where income rank explained the relationship between income/wealth and a number of health outcomes including physical functioning, obesity and long standing illness. The study authors concluded that social position rather than material conditions may account for the impact of money on health [32].…”

The interactive role of income (material position) and income rank (psychosocial position) in psychological distress: a 9-year longitudinal study of 30,000 UK parents

“…Moreover, associations between income rank and allostatic load strengthen the pathway between rank, stress and psychological distress, strongly suggesting that income rank relates to health (Daly, Boyce and Wood, 2015). These studies do however have methodological limitations: suicidal thoughts and attempts were restricted to cross-sectional analyses (Wetherall et al, 2015) and the longitudinal analyses (Wood, Boyce, et al, 2012;Hounkpatin et al, 2015) did not control for unobserved variance, introducing the possibility that unobserved variance influenced their results.…”

“…This is standard practice and approximates spending power (Wood, Boyce, et al, 2012;Daly, Boyce and Wood, 2015;Wetherall et al, 2015). Absolute income was log transformed to reduce skew, then normalised between 0 and 1.…”

Does Knowing Hurt? Perceiving Oneself as Overweight Predicts Future Physical Health and Well-Being

“…Prior research on racial and health inequalities, for example, has documented the physiological impact of social denigration; such stress can activate the PERCEIVED WEIGHT AND HEALTH 5 sympathetic nervous system and induce sustained neuroendorcrine responses with potential deleterious health consequences (Daly, Boyce, & Wood, 2015;Williams & Mohammed, 2009). Similarly, weight discrimination could mobilize the fight-or-flight response that is adaptive in times of acute physical threat but maladaptive if chronically activated in response to social threat.…”