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Global Inequalities
Published in Vincent La Placa, Julia Morgan, Social Science Perspectives on Global Public Health, 2023
Kafui Adjaye-Gbewonyo, Ichiro Kawachi
The alternative explanation for health inequalities is sometimes referred to as social selection (Solar and Iwrin, 2010; McKee et al., 2011). According to this hypothesis, people ‘select’ or drift into different social conditions and social classes because of their health status. For example, people with worse mental or physical health during their youth could end up attaining lower levels of education or earning less income because of their illnesses. Similarly, people with worse health may move to low-income neighbourhoods because of limited income due to their health conditions. From a social epidemiological perspective, this would be an example of ‘reverse causation’ (Bhopal, 2016), where low social status is not leading to or causing poor health, but low SES is the result of poor health. This explanation could be invoked to explain both within- and between-country gradients in health status. There is some evidence in support of social selection and reverse causation when it comes to education and health (Case et al., 2005). However, research shows that for measures of SES, such as education and income, ‘social causation’ instead is the more dominant causal mechanism (Kroger et al., 2015), making these health inequalities, not only unequal but also inequitable and modifiable.
Measuring social position in health inequality research
Published in Sridhar Venkatapuram, Alex Broadbent, The Routledge Handbook of Philosophy of Public Health, 2023
From this theoretical basis, it is easy to go on to the idea that health inequalities can never be ameliorated, but rather that “increased opportunities for social selection […] may have made the lower social groups more homogeneous with regard to personal characteristics like low cognitive ability and less favourable personality profiles” (Mackenbach 2012: 766). According to this point of view, intelligence, self-efficacy, and so on are the determinants of health-related behaviors, which, in turn, generate health inequality.
The causal debate
Published in Nick Spencer, Sir Donald Acheson, Poverty and Child Health, 2018
Nick Spencer, Sir Donald Acheson
Explanations based on social selection seek to explain socio-economic gradients in health on the basis that health determines social position rather than the reverse. Smith and co-workers identify two main explanations which fall within this category: intra-generational selection – sick individuals drifting down the social hierarchy and healthy individuals moving up; inter-generational selection – sick children tending to move to a social class position lower than that of their childhood.2 Social selection has been shown, particularly in longitudinal studies, to explain little of the difference between socio-economic groups.2–4
Social insurance literacy: a scoping review on how to define and measure it
Published in Disability and Rehabilitation, 2021
Christian Ståhl, Elin A. Karlsson, Jan Sandqvist, Gunnel Hensing, Sandra Brouwer, Emilie Friberg, Ellen MacEachen
A social medicine model developed by Diderichsen and Hallqvist [15] offers an understanding of the mechanisms involved in social stratification and health. According to Diderichsen and Hallqvist, an additional role of welfare systems is to even out or balance the structural forces of inequity. Social policy can directly target social selection through, for example, the educational system but it can also play an indirect role as a welfare system buffer. An important source of unequal health is exposure to detrimental work environments, which in turn can lead to absence from work. Sickness benefits schemes compensate for income losses and an anticipated negative spiral that, in the end, could start a downward social selection. The model discusses differential exposures, differential vulnerabilities and differential consequences as a result of the social gradient and differences in power and position. From this model, we can draw the assumption that differential social insurance management exists which involves a dynamic interplay between the client, the system and its officials. Social insurance literacy thus targets a specific part of the model in which the individual with health problems interacts with the social insurance system.
Low birthweight prevalence among Spanish women during the economic crisis: differences by parity
Published in Annals of Human Biology, 2020
José Manuel Terán, Sol Juárez, Cristina Bernis, Barry Bogin, Carlos Varea
However, there is a gap in knowledge regarding how the crisis has affected birth outcome by parity. The objective of the present study is to analyse trends in LBW from 1996 to 2016 in Spain by parity in order to better understand: (1) the impact of the economic crisis considering the reproductive expectations of women who might desire to become a mother for a first time, and (2) their consequences on birth outcome. Prior studies showed the existence of a social selection due to the economic crisis, through which women of a low socioeconomic position postponed childbearing (Ramiro-Fariñas et al. 2017), presumably leading to better perinatal health outcomes in the population. However, this hypothesis does not consider differences by parity. In this paper, we argue that selection might be even more important depending on the age and parity of the mother. Thus, older and especially primiparous-women might feel compelled not to delay childbearing, regardless of their socioeconomic position.