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Relationship between Socioeconomic Status and Negative Health Outcomes:
A Specific Look at Heart Disease and Diabetes in Americans
Introduction
The Centers for Disease Control and Prevention have identified heart disease as the leading cause of death in the United States . Just as concerning is the rising epidemic of diabetes as the seventh leading cause of death among Americans, and the recognition of heart disease as one of the major complications and potentially fatal co-occurring illnesses of people with type 2 diabetes. Because malnutrition is a commonality between the increase of diabetes and fatal heart disease, research suggests that changing the dietary and physical habits of individuals at risk for heart disease can have a profound effect on reversing this trend.
However, further research seeks to investigate the role that socioeconomic class has on the prevalence of these leading disease factors, and the degree of hindrance to which they may contribute to malnourishment, lack of medical resources, and education to help prevent negative health outcomes. The assumption that lack of exercise and poor diet is directly related to negative health outcomes is largely conclusive, and the link between social status, access to nutritious food and health conducive environments is becoming an increasingly researched topic of concern amongst sociologists and psychologists alike. It is through a comparison of studies performed in two different countries with similar health concerns, the United States and Finland, that the evidence supports the inexplicable link between lower socioeconomic class and higher rates of heart disease.
The evidence that supports the link between lower socioeconomic class and negative health outcomes are astounding, however the sociological perspective seeks to answer the underlying root cause of the problem and how it can be resolved in a society that has pledged responsibility for the wellbeing of the members of that society. This raises a lot of questions as to the validity of programs in place, the reason for limited access to care and education, and how this problem can be resolved before it adversely effects and even greater portion of the population, or contributes to a global epidemic that could have been resolved through proper intervention.
Environmental-Psychological Perspectives
Social Problems
The access to available resources, lack of education, and poor diet are only a few factors that contribute to the rising malnutrition epidemic in America. But, what lies at the foundation of individual and cultural preference in diet and lifestyle choice is a culture of poverty; an endless cycle that maintains the disadvantage for the lower socioeconomic class. This disadvantage raises many questions about the effectiveness of our social institutions, the social concepts that we value, and the sociological perspective that we uphold when implementing policies and social change.
Access to resources. People of lower socioeconomic classes often lack access to resources than higher social groups. Resources can include food, water, medical treatment and care, preventative care, shelter, supportive environments, and many other factors that people of higher socioeconomic classes may take for granted. This doesn’t mean that every low-income person has poor self-hygiene or that they are sick, but it does mean that there is a strong correlation between the two, and until this relationship is looked at from a social perspective, change is a word that doesn’t fit into the equation.
Often, access to resources, such as food, can simply mean that people have access to the wrong kinds of food. People of lower socioeconomic class may find themselves shopping at the least expensive market and buying fatty foods because their neighborhood may not offer options or because they don’t have the money to shop at higher-end food stores. Other factors such as high crime rates and violent neighborhoods may deter residents from travelling to markets that offer more nutritious food choices, however many of these problems exist at a level that is beyond the scope of the family unit and therefore needs to be addressed accordingly.
Lack of education. Although it can be perceived in many fashions, there is a direct correlation between education and increased intake of fruits and vegetables. Factors such as educational quality in lower-income neighborhoods, less available funding for low income school districts, and neighborhood crime rates are contributors to limited access to and quality of education in low income areas, not to mention the inadequate implementation of awareness campaigns and assistance for people of low-income communities. Other forms of education, such as general nutrition and dietary needs, need to be incorporated into the framework of lower-class communities if there is to be some success in increasing the educational component of the problem.
Poor diet. As mentioned earlier, access to foods that do not meet nutrition needs is often a problem for people of lower socioeconomic status, and that’s because food high in fat and sugar are generally less expensive that fresh fruits and vegetables. If faced with the choice to buy a high calorie food item that will feed a larger family as opposed to a healthier option that feeds less people for the same amount of money, the obvious choice is to purchase the more economical food item to provide for one’s family unit. Pricing the food in order to accommodate people of all income levels is a mere starting point to addressing the root of the problem, because diet changes are generally only accomplished through proper education.
Lack of exercise. Neighborhood factors including aesthetics and suitable walking environments coupled with violence, crime, lack of activities, and food insecurity can promote a lifestyle that does not include enough exercise. Urbanization has been the focus of many sociological topics related to health and obesity, reduction in self-sustenance, poor air and water quality, and increases in sedentary lifestyles, but it is not necessarily urbanization that is responsible for differences in lifestyle, rather socioeconomic class. People in low-income brackets can be found in rural areas as well as urban areas, and in many ways, the problems are very similar, because the lack of exercise can be traced back to socioeconomic status, its implications on poor diet, lack of education, and lack of resources.
Social Theories
Social theories and concepts are largely responsible for the way researchers interpret problems and develop solutions to those problems. There are a number of theories that can be considered relevant in terms of explaining the correlation between socioeconomic status and fatal heart disease. However, in this case there are two social theories that are particularly consistent in explaining the link between the psychological environment and the leading cause of death in the United States; Culture of Poverty and Institutional Discrimination.
Culture of Poverty. This theory, reaching back as a theory that was originally developed to explain stagnation amongst very poor and unindustrialized countries, has developed into a theory that helps explain subcultures within developed modern societies. The implication of this perspective is that people who are in poverty remain in poverty for generations. Because poverty becomes a culture, and upward social mobility is not considered an option, subsequent generations regard themselves as incapable of advancing socially, nor are they willing to take the chance and lose what little they have. Essentially, they become afraid of change and accept the reality that they will always hold a low socioeconomic status. Religion further perpetuates this cycle by convincing people that their impoverished situation is exactly where God wants them to be in life.
Institutional Discrimination. As a theory, institutional discrimination can be difficult to conceptualize in application, and because there are so many facets of society, from the social framework down to the very rhetoric of the English language, that promote structural inequality, it often goes unnoticed. Institutional discrimination is a social problem that breeds structural inequality, promotes racism, and further stratifies society based on socioeconomic class.
The theory of institutional discrimination closely resembles some characteristics of the culture of poverty concept, because both hinder upward social mobility and convince people of lower socioeconomic statuses that their value is less than that of people with more wealth, power, and prestige. However, the main difference between these two concepts is that institutional discrimination provides clearly drawn lines of structural inequality and social stratification based on race, gender, and ethnicity. The main focus of the theory does not necessarily target socioeconomic class as the main separation between groups, but cultures of poverty reveal themselves within pockets of these lower-class groups.
Relevant Research
As the leading cause of death in the United States, coronary heart disease has been a widely researched topic of interest in a medical context, including healthy food consumption, proper nutrient intake, and the investigations into the cholesterol levels of people with coronary heart disease. From a medical perspective, heart disease is not only a concern among regular patients, but also those with type two diabetes. Type two diabetes is often accompanied by comorbid diseases and other major complications, which has led researchers to investigate this hand-in-hand relationship between two of the major killers in America; Type two diabetes and coronary heart disease. Type two diabetes is the seventh leading cause of death and coronary heart disease is the first leading cause of death, so it is no coincidence that these two medical share similar social predispositions. The scholarly articles that follow explore the relationship between negatives health outcomes (diabetes and heart disease) and socioeconomic status.
Diabetes. A research study conducted among adults with type two diabetes (T2DM) found that “community and neighborhood characteristics can impact health outcomes of those with chronic illness, including T2DM” . That same study also found that, “Factors, such as crime, violence, and lack of resources have been shown to be barriers to optimal health outcomes in diabetes” . This information is important in a psychological and environmental context because it shows the relationship that low-income neighborhoods play in the increasing the chances of dying from diabetes or one of the major complications that accompany diabetes, such as heart disease.
Heart Disease. Similar to the findings of the diabetes research, patients with coronary heart disease lack behaviors of self-care as opposed to those of higher socioeconomic status. In fact, this study used education as a means to measure socioeconomic status and found that “Men with a low level of schooling had a higher intake of total and saturated fat, a lower consumption of vegetables and fruits, more frequently used butter or butter based spread and less frequently used oil” . The relevance of these findings not only show the correlation between socioeconomic status and poor diet, but also prove the relationship between socioeconomic status and negative health outcomes due to poor diet, lack of exercise, lack of education, and lack of available resources.
Methodology
Empirical Research. In order to conduct a follow-up study on the definitive effects that socioeconomic class has on fatality due to heart disease, not only should the findings of relevant research be studied, but the analysis methods should be closely replicated in order to produce sound scientific results. It would be necessary to take into consideration and measure all social implications as they pertain to lifestyle differences and predispositions to death from heart disease, including environmental, social, cultural, hereditary, and age/gender related characteristics.
Scientific Process. The first step of this process is to collect all data and observations relevant to the research being conducted in order to form a sound hypothesis. After the hypothesis is formed, the process of deduction is used to gather new data, and that data is subsequently tested using the stated hypothesis. After all data is analyzed and categorized, the results can be evaluated and a conclusion drawn, based on the findings. This is the acceptable method of performing research within the social sciences and not only provides new data, but provides a fresh perspective on old data while implementing new hypothesizes.
Research Methods. Although the field of social science utilizes a wide range of correlational and descriptive research methods, the most commonly used research methods to gather quantitative data are surveys, laboratory research, and natural observations. Because laboratory studies have determined the direct correlation between specific lifestyle factors that contribute to heart disease, these reports are necessary for further survey and natural observation research.
However, because social accountability is on the docket, it would be wise to include a cross sectional study that includes a case study of each individual and/or family unit investigated. Socioeconomic status is a term that accompanies a broad range of qualifying demographics, and in order to produce concrete results, relative situations, as opposed to absolute, would be useful in determining methods to intervene and provide successful social change. After all, scientific research is conducted because there is a problem present for which a solution is sought.
Conclusion
It is apparent that there is a definitive correlation between lower socioeconomic groups and negative impacts on their health. As the leading cause of death in the United States, heart disease is a severely concerning problem that transcends every field of social and medical science. It is up to healthcare professionals and medical researchers to pinpoint the physical and environmental attributes responsible for the continued progression of a fatal disease as well as the individual and community actions that can be taken to alleviate these problems. On the other hand, it is the responsibility of social scientists and social workers to identify and address the root cause of these issues as they manifest themselves in a social, environmental, and cultural setting. This means that everyone must work together toward a concerted effort to reduce the amount of fatalities caused by heart disease and the negative effects that lower socioeconomic status has on physical, mental, and emotional health.
In a perfect world, the use of renewable energy sources, more open space, and healthier food sources may contribute to a reduction in social stratification created by the attainment of money, power, and prestige. Social movements are often created in an effort to improve quality of life for human beings, but that requires the health of their environment. Environmental movements are often created to improve the quality of life for the ecosystem, with an added benefit of improving quality of life for human beings along with other organisms. If these two focuses can come together, they can improve the quality of food, water, and air in the world, leading to a residual effect on human beings and their perspective on the environment.
As important as environmental justice is to the health of the human population, it is often ignored as a social issue. Once people realize that how they impact the environment has a direct impact on their health, there will be no other option but to drastically change the social framework upon which we are so accustomed. The environment and society are uniquely interdependent and if people do not come to the realization that social stratification has negative effects on both, there will no longer be an environment to sustain the human species.
References
Centers for Disease Control and Prevention. (2016, April 27). Leading Causes of Death. Retrieved from National Center for Health Statistics: http://www.cdc.gov/
Erkkila, A., & Sarkkinen, E. (1999). Diet in relation to socioeconomic status in patients with coronary heart disease. European Journal of Clinical Nutrition., 53(8), 662-668.
Smalls, B. L., Gregory, C. M., Zoller, J. S., & Egede, L. E. (2015). Assessing the relationship between neighborhood factors and diabetes related health outcomes and self-care behaviors. BMC Health Services Research, 15(1), 1-11.
