|Relative Deprivation and Resource Utilization as Explanations for SES Differentials in Adult Morbidity and Mortality
|Year of Publication
|Doctor of Philosophy
Several hypotheses have been proposed to explain how socioeconomic status translates into different health outcomes, especially in the context of the industrialized world. This dissertation sought to examine the relative merit of two theoretical explanations, Relative Deprivation and Resource Utilization, by providing supporting evidence as to the whether material resources or psychosocial processes matter more in mediating the associations between SES, health, and longevity. To test the relative contribution of each perspective, gender-specific prospective cohorts were constructed using the Health and Retirement Study (HRS) dataset. Measures of SES, relative deprivation, and resource utilization were specified in logistic regression models to examine the extent to which each mechanism could account for the direct effect of SES on three health outcomes: self-reported health, having any life-threatening condition, and mortality. Relative deprivation was measured using two indicators: relative income position, the difference between a respondent's household income and the median income level of the respondent's residential state, county and zip code, and financial dissatisfaction. Resource utilization was measured using a summative score that indexed the extent to which respondents engaged in or employed health-promoting, risk-reducing strategies. Results indicate that financial dissatisfaction, rather than relative income position, mediates a portion of the SES-health association, although it is not found to act as the primary mechanism through which social conditions influence morbidity and mortality as theorized by Wilkinson. While health-related resource utilization as measured is not found to mediate the SES-health association, results indicate that resource utilization as specified by Link and Phelan is linked to both SES and health outcomes. Findings suggest that the mechanisms through which SES shapes health outcomes are complex and multifactorial, comprised of both material and psychosocial components.