Do wealth and inequality associate with health in a small-scale subsistence society?

Abstract

In high-income countries, one's relative socio-economic position and economic inequality may affect health and well-being, arguably via psychosocial stress. We tested this in a small-scale subsistence society, the Tsimane, by associating relative household wealth (n=871) and community-level wealth inequality (n=40, Gini = 0.15 – 0.53) with a range of psychological variables, stressors, and health outcomes (depressive symptoms [n=670], social conflicts [n=401], non-social problems [n=398], social support [n=399], cortisol [n=811], BMI [n=9926], blood pressure [n=3195], self-rated health [n=2523], morbidities [n=1542]) controlling for community-average wealth, age, sex, household size, community size, and distance to markets. Wealthier people largely had better outcomes while inequality associated with more respiratory disease, a leading cause of mortality. Greater inequality and lower wealth were associated with higher blood pressure. Psychosocial factors didn't mediate wealth-health associations. Thus, relative socio-economic position and inequality may affect health across diverse societies, though this is likely exacerbated in high-income countries.

Socioeconomic status effects on health vary between rural and urban Turkana

“…This disparity has made it difficult to comprehensively assess whether the relationship between SES and health is universal and consistent or instead varies as a function of resource availability and distribution, the nature of social relationships and hierarchies, or other socioecological features of a population (as has been shown for other species [ 13–15 ]). In particular, it has been hypothesized that the steep wealth-based gradients in health observed in HICs are recent byproducts of environmental changes precipitated by urbanization, globalized markets, capitalism and other modern advancements [ 16 , 17 ]. In other words, while social gradients in health have deep roots in primate and human evolution [ 1 , 7 ], the nature and magnitude of SES-health gradients have potentially changed as a function of modern lifeways.…”

Earth Dreams: Reimagining ARPA for Health of People, Places and Planet

“…Socioeconomic disadvantage is accompanied by higher levels of chronic psychosocial stress and daily hassles [ 115 ]. Put simply, the stress of structural poverty is bad for health [ 116 ]. In the case of minority ethnic and racial groups, the effects are compounded by everyday racism.…”

Going beyond lifestyle factors

“…Investigating inequalities in populations that have not adopted Western diets and activity levels – a challenging undertaking given the proliferation of this lifestyle worldwide – could be a way to confront the underlying assumption that behavioural differences are responsible for the observed inequality in CHD ( Kopp, 2019 ). Now, in eLife, Adrian Jaeggi (University of Zurich and Emory University), Aaron Blackwell (Washington State University) and co-workers based in the United States, France and Germany report the most comprehensive study on social structure and health in a pre-industrial society in the Bolivian Amazon known as the Tsimane ( Jaeggi et al, 2021 ).…”

“…Most Tsimane have normal blood pressure. This means that associations between wealth and individual blood pressure within communities, or between wealth inequality and overall blood pressure across communities both capture variations below a clinically significant level ( Jaeggi et al, 2021 ; Pontzer et al, 2018 ). However, these findings are not inconsequential: in post-industrial societies, small reductions in blood pressure in the overall population have proved effective in lowering CHD incidence ( Cook et al, 1995 ).…”

“…Social hierarchies, maintained by societal arrangements of power, lead to disadvantaged populations being disproportionally exposed to psychosocial stressors such as lack of community support, low control and autonomy, and an imbalance between effort and reward. In turn, psychosocial stress can have a severe impact on the body, triggering a sustained fight or flight response and altering the hormone system that controls biological reactions to stress ( Bartley, 2017 ; Jaeggi et al, 2021 ).…”