Socioeconomic Status and Health Among Californians: An Examination of Multiple Pathways

Health inequalities manifest as a gradient, rather than as a distinction between “haves” and “have nots.” Therefore, eliminating health inequalities will require targeting interventions at segments of the entire population, not just particular subgroups at the disadvantaged end of the social hierarchy. Developing such interventions, however, has been stymied by an unclear understanding of how socioeconomic status (SES) influences health. The literature offers 5 fundamental explanations, including 1) selection effects, 2) differences in lifestyle patterns, 3) differential exposure to life stresses, 4) differences in psychosocial resources, and 5) differential access to, and poorer quality health care resources.1–9 A major limitation of this literature is that these explanations are frequently viewed as competing hypotheses, rather than complementary explanations representing the broad context of social experiences conditioned by location in the social structure.1,10–13 Evidence indicates that no single explanation has accounted for as much variance as all of the explanations combined,12,14,15 and different causal mechanisms for the SES–health relationship may be operative at different socioeconomic levels. In this study, we examine the ability of different mediators to account for socioeconomic differences in health status at different points in the social hierarchy.