Is Stress the Link Between Low Social Status and Poor Health?
New research examines the mechanisms that connect status and health.
Posted Jun 30, 2020
Money and status matter to us all. Perhaps we do not become aware of how much they matter until we lose our status or can not afford things we value. To get a sense of the kind of difficult decisions poor people are faced with in prioritizing their spending, try playing the SPENT simulation.
One such priority involves health spending, given that many individuals of lower socioeconomic status (SES)—social, educational, and occupational rank—experience poor health. Why do people with lower SES have worse health?
In an article published in the April issue of Current Directions in Psychological Science, Cundiff and colleagues argue lower status and poor health are linked through increased stress exposure and response. In their article, the authors summarize recent research on health and status and then discuss the methodological limitations of this body of research and ways to improve it.1
Status and health
Previous research has shown people of higher SES live longer and experience lower rates of disease than people of lower socioeconomic status. This association has also been noted in a variety of studies all over the world, in countries that have universal health care and ones without it, and in both low-income and high-income countries.
Health and socioeconomic status mutually affect each other in complex ways. For example, a person’s health at birth and during the childhood period is influenced by parental resources. And the individual’s health during childhood will directly influence his or her health during adolescence, and indirectly, his or her quality of education. Similarly, adolescent health will impact health and occupation/income in adulthood. Last, health in adulthood affects health and retirement income in old age.2
Through what mechanisms does status influence health? One view suggests psychological mechanisms linking lower status and poor health involve a lack of interpersonal resources (e.g., social support) and intrapersonal resources (e.g., optimism, perceived control). For instance, individuals of lower status are usually exposed to a greater number of stressful situations that drain their resources. In addition, their current environments often do not allow them to develop or replenish their resources.3 So, might stress exposure and response explain why people of lower status are more likely to experience ill health?
Are status and health linked through stress exposure and response?
Stress can be conceptualized in a number of ways, including in terms of situations that cause a stress reaction (e.g., divorce), the emotional and behavioral stress response to a situation (e.g., feeling unable to cope), and biological changes (e.g., high blood pressure).1
What is the evidence for stress as the pathway that connects lower status and poor health?
Some research suggests lower status increases the likelihood of disease through more frequent and longer exposure to sources of stress (e.g., homelessness, fewer job opportunities, living in a high crime neighborhood). Other studies, however, have not found a connection between stress and health. Why?
The authors of this review believe the lack of evidence is due to the methodological limitations of those investigations.
For example, objective measures of stress fail to capture the duration and severity of the stressors. Another issue is related to the conceptualization of stress in terms of biological response (e.g., level of inflammation): Biological responses are influenced by multiple factors (e.g., inflammation is impacted by stress but also by body fat) so may not capture only the effects of stress.
In addition, laboratory manipulations of stress (e.g., doing mental arithmetic, performing public speaking) are not specific to status-related stress. The sort of status-related stress we should be measuring usually concerns financial problems, social subordination (whether real or perceived), experiences of discrimination, being repeatedly devalued, feeling unable to control one’s environment, and being regularly controlled by others.
Research on these status-specific measures of stress might show stronger support for stress exposure and response as a pathway linking status and health (see Figure 1).
In summary, many individuals are exposed to sources of stress that are severe or frequent enough to leave them struggling to cope. For some individuals, these encounters are more likely to result in poor health because these sources of stress are more specific to the experiences associated with lower socioeconomic status, such as working in low-status and low-paying jobs.
Low SES individuals might regularly experience instances of being discriminated against, rejected, belittled, dominated, and controlled. They often feel they have little control over what happens to them and their families. These individuals are more likely to experience poor health. And a major mechanism explaining this relationship may be stress exposure and response.
1. Cundiff, J. M., Boylan, J. M., & Muscatell, K. A. (2020). The pathway from social status to physical health: Taking a closer look at stress as a mediator. Current Directions in Psychological Science, 29(2), 147-153.
2. Adler, N. (2009). Health disparities through a psychological lens. American Psychologist, 64, 663–673.
3. Matthews, K. A., & Gallo, L. C. (2011). Psychological perspectives on pathways linking socioeconomic status and physical health. Annual Review of Psychology, 62, 501–530.