Health Psychology, 2nd Edition

SOCIO-ECONOMIC STATUS, STRESS AND HEALTH

Poverty is linked to poorer health within most countries. It is easy to think of reasons
why this might be the case. Poorer housing conditions, inadequate diet and reduced
access to health care services are just a few potential explanations. However, there is
a difference between the relationship found within each country and what we observe
when we compare one country with another (i.e. comparisons between countries).
We might expect that, even in the Western world, relatively more prosperous
countries would have relatively lower mortality than poorer countries. However,
comparing countries, we find that in poor countries increases in gross national product
(and average income) over time are correlated with life expectancy but above a certain
threshold this correlation disappears, that is, there is no further increase in longevity
as people become richer. Wilkinson (1996: 29) calls this the ‘epidemiological transi -
tion’. Yet within these countries there remains a strong link between income and
mortality.
Wilkinson suggested that in affluent societies (beyond the epidemiological transi -
tion), health is affected less by changes in material standards and more by relative
poverty (Wilkinson, 1992, 1996, 1997). Wilkinson argues that it is our position in this
hierarchy, including our feelings of relative advantage/disadvantage within society,
which causes stress and poorer health. He considered England and Japan to illustrate
this phenomenon. In 1970 England and Japan had very similar life expectancies and
similar income distribution. However, between 1970 and the 1990s Japan’s income
distribution shifted to become much narrower (that is, people had more similar incomes
clustered around the mean), while in England the distribution became much wider
(with increasing differences between the richest and poorest). At the same time, Japan’s
life expectancy increased dramatically while the UK moved down the international
longevity league tables. Wilkinson argues that this phenomenon is not easily explained
by factors such as health policies or nutrition.
Potential explanations of this effect include the role of psychological factors associ -
ated with the stress of relatively low social status in an affluent society. This explanation
is bolstered by animal studies. For example, Wilkinson (1996) draws on Sapolsky’s
(1993) work, which reveals that baboons lower in dominance hierarchies show higher
levels of glucocorticoids indicating more frequent stress responses that could be
detrimental to immunological functioning. In addition these lower dominance animals

STRESS AND HEALTH IN CONTEXT 69

When you have completed this chapter you should be able to:

1 Discuss the impact and the causes of social inequality on health.

2 Describe and evaluate key theories of work stress.

3 Describe the impacts on well-being of a range of different types of stressor, e.g.

family stressors, conflict between home and family, etc.

4 Discuss the ways stress can be reduced in the workplace.

LEARNING OUTCOMES