# Social Inequality and Health

Psychology I · Society and Health · https://tryals.app/learn/psychology-i/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:

| Pathway | Mechanism |
|---|---|
| **Material deprivation** | Fewer physical resources like housing, nutrition, and safety |
| **Psychosocial stress** | More chronic stressors and less buffering capacity |

> **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.

## Practice questions

6 of this lesson's 13 practice questions, with answers. The full set is in the app.

### 1. Select every statement that is TRUE about social inequality and health.

A. Two people can differ in health because of where they stand relative to others, not only because of what they lack.
B. The gradient is continuous across every level of the hierarchy.
C. Only the very poorest have worse health than everyone else.
D. Chronic stress leaves a physical residue that accumulates across years.
E. The Whitehall gradient is fully explained by differences in healthcare access.

**Answer:** A. Two people can differ in health because of where they stand relative to others, not only because of what they lack.; B. The gradient is continuous across every level of the hierarchy.; D. Chronic stress leaves a physical residue that accumulates across years.

**Why:** The SES measures, the continuous gradient, and allostatic load are all true. The Whitehall gradient held despite equal healthcare access, and it spans every level (not just the poorest) - so those two are false.

Page: https://tryals.app/practice/psychology-i/social-inequality-and-health/select-every-statement-that-is-true-about-social-inequality-and

### 2. Match each concrete case to the concept it illustrates.

**Answer:**

- Damp housing and poor nutrition → Material deprivation
- Chronic financial stress with few resources to buffer it → Psychosocial stress
- Cumulative bodily wear from constantly managing stress → Allostatic load
- Civil servants' health worsening step-wise down the grades → Social gradient (Whitehall)

**Why:** Poor housing/nutrition is material deprivation, chronic buffered-poorly stress is psychosocial stress, bodily wear from stress is allostatic load, and the step-wise grade gradient is the social gradient. Each case maps to one concept.

Page: https://tryals.app/practice/psychology-i/social-inequality-and-health/match-each-concrete-case-to-the-concept-it-illustrates

### 3. **Allostatic load** is described as the *price of adapting successfully*. Why is that phrasing deliberate rather than a paradox?

A. Because the stress response works; the cost is running it for years
B. Because it refers to people who cope badly, whose bodies pay the highest price
C. Because adaptation always fails eventually, so success is only apparent
D. Because the load is psychological, and the word 'price' is figurative

**Answer:** A. Because the stress response works; the cost is running it for years

**Why:** Nothing is broken, the response is doing its job, for years instead of minutes. Raised cortisol suppresses immunity and strains the cardiovascular system, so the damage comes from sustained success rather than failure. That is the route from low rank to a worse scan.

Page: https://tryals.app/practice/psychology-i/social-inequality-and-health/allostatic-load-is-described-as-the-price-of-adapting-successfully

### 4. According to the Whitehall data, even a comfortably middle-tier employee tends to have worse health than someone one grade above them.

**Answer:** True

**Why:** True. The Whitehall gradient is continuous - health improves at every step up, so even middle-tier employees fare worse than those one grade higher. This is exactly why the gradient is not just a poor-versus-everyone-else divide.

Page: https://tryals.app/practice/psychology-i/social-inequality-and-health/according-to-the-whitehall-data-even-a-comfortably-middle-tier

### 5. Two departments have identical pay and hours. One runs on fixed rotas set head-office; the other lets staff choose their shifts. Whitehall predicts a health difference. What is carrying it?

A. Job control, which is one of the gradient's active ingredients
B. Self-selection, healthier people choose flexible workplaces
C. Nothing, pay and hours are matched, so the health outcomes should match too
D. Effort, the flexible department will simply work fewer hours in practice

**Answer:** A. Job control, which is one of the gradient's active ingredients

**Why:** Latitude over your own work is one of the things rank buys, and it tracks health after income is held fixed. It is also the most actionable finding in the unit: pay is set by budgets, and who decides the rota is set by a manager on a Tuesday.

Page: https://tryals.app/practice/psychology-i/social-inequality-and-health/two-departments-have-identical-pay-and-hours-one-runs-on-fixed-rotas

### 6. Whitehall found that senior administrators had worse health than the permanent secretaries above them - not merely that the lowest grade did worst of all. Why does a step at every rung, rather than a cliff at the bottom, change what you can conclude?

A. Because it shows the gradient comes from healthcare access.
B. Because a step at every rung points to relative standing.
C. Because a continuous pattern means income is the measure.
D. Because the effect is small near the top of the scale.

**Answer:** B. Because a step at every rung points to relative standing.

**Why:** A cliff and a gradient accuse different suspects. Deprivation stops mattering above a line; rank does not, and these were civil servants, all employed, all housed, all covered by the same health service. That is what forces the explanation toward control, security and where you stand relative to the person above you.

Page: https://tryals.app/practice/psychology-i/social-inequality-and-health/whitehall-found-that-senior-administrators-had-worse-health-than-the