Sociologists have argued that groups with higher social status will maintain a health advantage across time and space even though drastically different intervening mechanisms will underlie the association. Regardless of changing disease profiles, medical innovations, policy interventions, and changes in other social conditions, people belonging to higher social status groups have greater access to resources that can be used to maximize health. This argument for the fundamentally social – not biomedical or individual – causes of health inequalities has been tested mainly in wealthy societies, while my work extends it to other societies that provide new insights. In another stream of research focused on the United States, I go beyond cataloguing social disparities in health and unpack some of the specific mechanisms that underlie and maintain them at home and at work. Both bodies of research converge around demonstrating the sometimes subtle but important ways in which local populations, policies and expectations can modify the associations between race/ethnicity, gender, socioeconomic position and health.
Health Disparities in Diverse Societies
Understanding and reducing health disparities are goals shared by academics and policy makers, but much of our existing knowledge is drawn from studies of North Americans and Europeans. Relatively few scholars have examined disparities in health and their underlying mechanisms across a more diverse set of societies. In my dissertation work and in more recent projects, I assess whether, to what extent, and in what ways powerful identities like race and gender have similar associations with health in different societies. I also search out societal differences that condition their influence.
My dissertation examined how social conditions prevailing in South Africa and Brazil, two multiracial societies with among the highest levels of inequality in the world, shape racial disparities in children’s health and in women’s use of reproductive health services. In a new series of papers focusing on Black youth in South Africa, I examine how gender structures their decision making about contraceptive use in the context of devastatingly high levels of HIV/AIDS. With colleagues, I have also examined how gender influences child growth trajectories in China and the Philippines, and how household social and economic resources influence childhood diarrheal disease and its treatment. A related set of papers examines trends in health disparities in some of these societies. Examining societies in transition can provide a strong test for the argument that while the mechanisms linking social status to health may change, higher status groups will maintain their advantage. In South Africa, Brazil, and China, we have found resilient disparities despite policy changes and interventions. My research has suggested that policies and interventions aiming to improve and equalize health outcomes in diverse social contexts must focus on more than broadened health care access, because longstanding and deeply rooted socioeconomic disparities remain fundamental causes of persisting inequalities in maternal and child health.
Mechanisms Linking Social Inequality to Health Inequality
Some of my more recent projects have examined trajectories of cumulative disadvantage that can amplify health disparities over adulthood. I focus on events and processes that occur in households and workplaces, key social contexts in which disparities are maintained or renegotiated.
In one project, I examine how these contexts shape gender differences in sleep time and quality in the United States. Expectations and responsibilities at work and at home vary by gender, so men and women may be differentially exposed to threats to adequate sleep. With students, I have shown that frequently being bothered or upset on the job is associated with poorer sleep quality for men and women. We have also shown that men in the U.S. sleep slightly less than women, even net of their worker, parent, and partnership responsibilities, but men’s deficit in sleep time is dwarfed by their relative advantage in leisure time, and women shoulder most of the burden of nighttime caregiving responsibilities, especially among new parents. In these and future papers we will show how the 1/3 of each day we spend in sleep may be important site for the analysis of micro-level processes that reflect and reproduce inequality at home and at work.
In another project, I have focused on the enormous transformations at work that could shape social disparities in health. The recent “Great Recession” has only heightened our need to understand the consequences of job insecurity and employment disruptions for workers. With colleagues, I have shown that individuals who lose their jobs experience health declines, whether or not they lost their job for health reasons, and also are less likely to be socially engaged later in life. We also showed that persistent perceived job insecurity – believing that there is a good chance of losing one’s job in the near future – was associated with health decline, even net of actual job losses. A related line of research examines how U.S. immigrants navigate employment experiences and changes in their social status, and how these are linked to their mental health. In the new Michigan Recession and Recovery Study, we are re-interviewing about 900 adults in Southeast Michigan in spring and summer 2011, and using data from this and several future interviews, we are exploring the cascades of events that link job loss, foreclosures, and financial insecurity to mental and physical health. This study will provide novel information on the ways individuals experience and deal with economic and employment shocks and how these and federal intervention through stimulus funding may exacerbate or mitigate prevailing health disparities by race and socioeconomic status. We are also re-entering the field to conduct the fifth wave of the American’s Changing Lives , the 25th anniversary year of the baseline interviews! The paid and unpaid work of aging Americans, their experiences in the recent recession, and the ways that health trajectories diverge due to these and other factors will be the focus of future work with these data.