528 Women’s Health Psychology
physical disorders may differ from those documented by re-
search conducted on men. However, it is equally important
that researchers and health care professionals understand
and appreciate women•s health on a sociocultural level. Lee
(1998, p. 3) made the point that the study of •women•s
healthŽ has primarily focused on the study of women•s ill-
ness, with little focus on understanding women from a social
standpoint. Lee suggests that women•s health should not be
limited to the prevention and treatment of illness, but it
should encompass the complex social factors that play into
being a woman. The focus of this section is to examine the
in”uence of socioeconomic status, multiple roles, and gender
socialization on the psychological and physical health of
women.
Socioeconomic Status and Women
Socioeconomic status(SES) refers to •a composite measure
that typically incorporates economic status, measured by in-
come; social status, measured by education; and work status,
measured by occupationŽ (D. Dutton & Levine, 1989). The
relationship between SES and health is quite relevant for
women because 35.6% of female-headed households fell
below the federal poverty level, according to the U.S. Bureau
of the Census (1995). Gender differences in SES can be
largely explained from a social standpoint. Comparing me-
dian annual income, women earn 73.8% of what men earn,
with women earning a median salary of $23,710 and men
earning $32,144 (U.S. Department of Labor, 1997a). Such
gender differences may be explained in large part by the fact
that the majority of employed women continue to hold jobs
in traditional female occupations (e.g., 45% of employed fe-
males work in clerical or service occupations, 22% work in
sales, and secretary was the leading occupation for women in
both 1981 and 1996), allowing little opportunity for career
advancement that may lead to comparable salary increases.
Many of these female-dominated occupations also put
women at increased risk for physical injury, speci“cally,
carpal tunnel syndrome, where 71% of those injured or
forced to miss work have been women (U.S. Bureau of Labor
Statistics, 1991; U.S. Department of Labor, 1997a, 1998).
While gender alone places women at increased risk for
poverty and, consequently, poor health, ethnicity also has an
association with SES. Annual salary differences according to
ethnic racial status indicate that European American women
earn $2,687 more than African American women and $5,495
more than Hispanic women (U.S. Department of Labor,
1997a). In the United States, 51% of female-headed house-
holds run by Hispanic women, 44% run by African American
women, and 27% run by European American women, were
below the poverty level (U.S. Bureau of the Census, 1997),
indicating minority women are further at risk for poverty.
Adler, Boyce, Chesney, Folkman, and Syme (1993) found
a linear relationship between SES and health. Speci“cally,
they reported that those in the highest SES bracket had the
lowest morbidity and mortality rates, with these rates steadily
increasing as SES level decreases (Adler & Coriell, 1997).
The following sections examine the association between SES
and both physical and mental health.Physical Health and SESResearch addressing the association between SES and health
consistently “nd the poor, unemployed, and poorly educated
to have increased mortality and morbidity for the great ma-
jority of diseases and health conditions (Illsley & Baker,
1991). One explanation involves the link between poor health
behaviors that may be risk factors for various physical ill-
nesses and low SES (Adler et al., 1993). For example, in a re-
view of speci“c health risks for women, Rimer, McBride, and
Crump (2001) reported that approximately 25% of women
currently smoke cigarettes, 20% have high cholesterol
(greater than 240 mg/dl), 35% are obese, and 73% do not
exercise regularly.
Women from lower SES backgrounds may face a greater
number of challenges in the pursuit of a healthy lifestyle.
Some of the challenges associated with “nancial adversity
and increased risk for physical health problems include lim-
ited access to or high cost of healthful foods (e.g., fresh fruits
and vegetables) resulting in consumption of less expensive,
high-fat foods that are low in nutritional value (Adler &
Coriell, 1997); lack of, or inadequate, health insurance cover-
age that subsequently results in limited access to health
care services (National Center for Health Statistics, 1996);
and increased likelihood of residing in poorer neighbor-
hoods, resulting in greater exposure to environmental stres-
sors (e.g., violence, crime, pollution; B. Miller & Downs,
2000; Silbergeld, 2000). These challenges have implications
for families because women traditionally are responsible for
grocery shopping and food preparation, as well as for making
health care decisions and taking children to health care
appointments. With respect to the high percentage of impov-
erished households headed by females, it is important to ad-
dress the in”uence of SES on the lifestyle and health of the
entire family.
Low SES has been linked to increased morbidity and mor-
tality rates in the majority of the speci“c physical illnesses
we reviewed earlier in this chapter. For some conditions, this
association has been linked with health risk behaviors. For
example, Winkleby, Fortmann, and Barrett (1990) found that