Social Inequality and Health

The Social Gradient in Health

Health outcomes improve in a step-wise fashion at every rung of the socioeconomic ladder, not just between poor and non-poor. Socioeconomic status (SES) is measured through income, education, and occupational prestige.

The Whitehall Studies of British civil servants proved this gradient exists even when everyone has healthcare access. Lower employment grades showed worse health and higher mortality due to two pathways:

Common pitfall: assuming the social gradient is just about the very poorest versus everyone else. Data show a continuous gradient across EVERY level of the hierarchy, not a simple poor/non-poor divide.

$$\text{Health} \propto \text{SES, step by step}$$

Stress and Allostatic Load

Lower-SES individuals face more chronic daily stressors with fewer resources to cope, driving cumulative biological wear. Allostatic load is the physiological cost of chronically managing stress (such as elevated cortisol, blood pressure, and inflammation) that accumulates over time, a concept developed by Bruce McEwen.

$$\text{Chronic Stress} \rightarrow \text{High Allostatic Load} \rightarrow \text{Worse Health Outcomes}$$

Even comfortably middle-tier employees have worse health than those one level above them, showing that relative social hierarchy deeply impacts physiological health over a lifetime.