Exploring relative deprivation: Is social comparison a mechanism in the relation between income and health?

doi:10.1016/S0277-9536(02)00541-5

Social Science & Medicine

Volume 57, Issue 8, October 2003, Pages 1463-1473

https://doi.org/10.1016/S0277-9536(02)00541-5 Get rights and content

Abstract

During the last decade there has been a growing interest in the relation between income and health. The discussion has mostly focused on the individual's relative standing in the income distribution with the implicit understanding that the absolute level of income is not as relevant when the individual's basic needs are fulfilled. This study hypothesises relative deprivation to be a mechanism in the relation between income and health in Sweden: being relatively deprived in comparison to a reference group causes a stressful situation, which might affect self-rated health. Reference groups were formed by combining indicators of social class, age and living region, resulting in 40 reference groups. Within each of these groups a mean income level was calculated and individuals with an income below 70% of the mean income level in the reference group were considered as being relatively deprived. The results showed that more women than men were relatively deprived, but the effect of relative deprivation on self-rated health was more pronounced among men than among women. In order to estimate the importance of the effect of relative income versus the effect of absolute income, some analyses on the effect of relative deprivation on self-rated health were also carried out within different absolute income levels. When restricting the analysis to the lowest 40% of the income span the effect of relative deprivation almost disappeared. Relative deprivation may have a significant relation to health among men. However, for the 40% with the lowest income in the population the effect of relative deprivation on health is considerably reduced, possibly due to the more prominent relation between low absolute income and poor health.

Introduction

During the last decade research on the relation between income and health has been studied on both individual and ecological level, where income inequality has been shown to affect morbidity and mortality rates (Wilkinson (1992), Wilkinson (1996); Kennedy, Kawachi, & Prothrow-Stith, 1996; Kawachi & Kennedy, 1997; Lynch & Kaplan, 1997; Wolfson, Kaplan, Lynch, Ross, & Backlund, 1999). Critique and other interpretations have been raised (Judge, 1995; Lynch, Kaplan, & Shema, 1997; Fiscella & Franks, 1997; Gravelle, 1998; Mackenbach, 2002; Osler et al., 2002) and, recently, this ecological relationship has been argued to not be valid outside the United States (Mackenbach, 2002). A Danish study analysed whether income inequality at the parish level predicted increased mortality after adjustment for individual income. Their result showed no such relation, but could confirm the inverse relation between individual income and mortality (Osler et al., 2002).

Focusing on the importance of the individual's relative standing in the income distribution more than the absolute income level (Wilkinson (1992), Wilkinson (1996); Kennedy, Kawachi, & Prothrow-Stith, 1996; Kaplan, Pamuk, Lynch, Cohen, & Balfour, 1996) implies a mechanism of relative deprivation. Within the discussion on different pathways and interpretations within the income inequality and health relation (Kawachi & Kennedy, 1999; Lynch, Davey Smith, Kaplan, & House, 2000) the mechanism of relative deprivation has previously been mentioned (Kawachi & Kennedy, 1999), but rarely used in analyses (see, however, Lundberg & Fritzell, 1994). This study aims to explore the mechanism of relative deprivation when analysing the income–health relation.

Section snippets

Relative deprivation and reference groups

Relative deprivation is often seen as a process in which people compare their circumstances to the circumstances of others (Runciman, 1966) or compare their circumstances in relation to a set of objective circumstances or at least the individual's perception of such circumstances (Townsend, 1979). The concept relative deprivation was introduced by Stouffer, Suchman, De Vinney, Star, and Williams (1949), who compared individuals with different opportunities for promotion. Opposite to what one

Aim of the study

The aim of the study is to explore the mechanism of relative deprivation and to analyse whether it contributes in explaining the relation between income and health. The study will also include an attempt to disentangle the effect of relative economic deprivation from that of absolute income. From the literature discussed above it is evident that there are a number of possible ways to explore the role of relative deprivation, and this study represents one of them.

Data and method

The study is based on the Swedish Survey of Living Conditions (ULF), which is a cross-sectional survey, representative for the Swedish population, with measures on health, economic and social conditions, conducted annually in Sweden from 1975 and onwards. In this study, we use collapsed data from 1991 to 1997 on 26,918 men and women aged 25–64 years. The non-response rate was around 20% during these years (Statistics Sweden, 1997). Due to the risk of reverse causation, that is ill health

Results

The prevalence of relative deprivation was higher in non-manual groups than in manual groups, and also higher in the older age group. Since all comparisons are done within each category this is not due to a lower income among these groups. In fact the opposite is the case and the reason for the result is instead a wider income span within non-manual groups resulting in more individuals being further away from the mean income of their reference group. There were also differences in the

Discussion

The vast amount of studies that recently have focused on the relation between income inequality and health is in itself an indication of how problematic this relationship really is (Wilkinson (1992), Wilkinson (1996); Kennedy et al., 1996; Kawachi & Kennedy, 1997; Lynch & Kaplan, 1997; Wolfson et al., 1999; Judge, 1995; Lynch et al., 1997; Fiscella & Franks, 1997; Gravelle 1998; Mackenbach 2002; Osler et al., 2002). If income inequality would affect health, relative deprivation is one possible

Conclusion

The aim of the study was to explore the mechanism of relative deprivation and to analyse whether it contributes in explaining the relation between income and health. Our results show significant differences between relatively deprived and non-deprived men except among foreign-born men, but no statistically significant results for women. Restricting the analyses to the bottom 40% of the income distribution in the study there was no significant effect of relative deprivation on self-rated health.

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Exploring relative deprivation: Is social comparison a mechanism in the relation between income and health?

Abstract

Introduction

Section snippets

Relative deprivation and reference groups

Aim of the study

Data and method

Results

Discussion

Conclusion

Journal of Health Economics

The constant flux. A study of class mobility in industrial societies

Poverty or income inequality as predictor of mortalityLongitudinal cohort study

Brtish Medical Journal

Incorporating gender inequality into income distribution research

International Journal of Social Welfare

Network approaches to social evaluation

Annual Review of Sociology

How much of the relation between population mortality and unequal distribution of income is a statistical artefact?

British Medical Journal

Self-rated health and mortalityA review of twenty-seven community studies

Journal of Health and Social Behaviour

Income distribution and life expectancyA critical appraisal

British Medical Journal

Inequality in income and mortality in the United StatesAnalysis of mortality and potential pathways

British Medical Journal

Health and social cohesionWhy care about income inequality?

British Medical Journal

Income inequality and healthPathways and mechanisms

Health Services Research

Income distribution and mortalityCross-sectional ecological study of the Robin hood index in the United States

British Medical Journal

Assessing reliability of a measure of self-rated health

Scandinavian Journal of Social Medicine

Income inequality and mortalityImportance to health of individual income, psychosocial environment, or material conditions

British Medical Journal