Behavioural and structural factors in the explanation of socio‐economic inequalities in health: an empirical analysis

Abstract

The aim of this study was to investigate the importance of 'cultural/behavioural' and 'materialist/structuralist' explanations for socio-economic inequalities in health, and to examine the interrelationship between them. We used data from a survey among a sample of the population in the southeastem part of the Netherlands. When analysed separately, both behavioural and structural factors contributed substantially to observed inequalities in health. In a simultaneous analysis, both groups of factors had a substantial part of their contribution in common. We defined the overlap as an indirect contribution of structural conditions, through behaviour. If that overlap is ignored, this could lead to an overestimation of the behavioural explanation. In our analysis, the total (direct plus indirect) contribution of structural factors is larger than that of behavioural factors. However, because of, in particular, the cross-sectional character of the data, these analyses must not be considered a. final answer as to the question of the relative contribution of behavioural and stmctural factors. Instead, they are an illustration of the way their importance could be assessed, taking the effect of structural conditions on lifestyle into consideration.

Does education buffer the impact of disability on psychological distress?

“…This is surprising as education is an important social determinant of health and well-being (Dupre, 2008;Link, Phelan, Miech, & Leckman Westin, 2008;Ross & Wu, 1995;Zimmer & House, 2003). We argue that there is ample reason to expect that education buffers the impact of a disability because education provides people with behavioral, material, and psycho-social resources that are positively related to health (Link et al, 2008;Ross & Wu, 1995;Stronks, Mheen, Looman, & Mackenbach, 1996). Education enables and motivates people to take control over their lives.…”

The differences in selected health-related behaviour indicators among women with different educational attainment in Slovenia / Razlike v izbranih kazalnikih vedenj, povezanih z zdravjem, med različno izobraženimi ženskami v Sloveniji

“…Other studies also indicate better results on average for women with a higher educational attainment, which can be explained by the fact that a higher educational attainment is as a rule connected to a better economic, cultural and social capital (37)(38), which reduces material, psychological and behavioural risks relating to health while at the same time enabling better access to behavioural, material and psychosocial resources that have a positive relation to health (39)(40)(41). Women with a higher educational attainment are supposed to have more knowledge and skills, stronger social support and are supposedly also more motivated to control their life (40,42).…”

The effect of education on adult mortality and disability: a global perspective

“…Since material, lifestyle and psychosocial factors have all been shown to mediate the effect of SES, it stands to reason that researchers have assembled models with variables from two or more of these components (Stronks et al 1996;Schrijvers et al 1998;Van Oort et al 2005). Schrijvers and associates used six years of mortality follow-up data from the Netherlands to generate the relative risk of mortality across four categories of education; the model applied had the significant material factors-financial problems, employment status and an income proxy-affecting mortality both directly and indirectly through a set of behavioural risk factors-alcohol use, smoking, Body Mass Index (BMI) and physical activity-which also had direct effects.…”