Health disparities through a psychological lens

“For example, one could compare RD to perceived control or access to resources as predictors of internal states (Adler, 2009; Schnittker & McLeod, 2005).”

“Other factors are important constituents of socioeconomic position, such as wealth, assets, symbolic capital and, notably, debt, but these are rarely considered in health research (Adler, 2009; Sweet, 2011).”

“Position in socioeconomic hierarchies (occupational status, education, income) is known precursors for stress exposures and psychosocial vulnerabilities (Adler, 2009; Matthews & Gallo, 2011).”

“Significant associations between SSS and health remain after controlling levels of negative affect [8, 18].”

“Rather, there is considerable evidence that the SES-health association is monotonic, extending beyond poverty to explain relative differences in health among higher status groups as well (e.g., Adler, 2009; Marmot et al., 1991).”

“Individuals with higher educational attainment and well-being are less likely to smoke, to be obese, and are more likely to exercise (Adler, 2009 ).”

“Health disparities consist of inequities in health resulting from social disadvantage (Adler, 2009), and are caused by powerful social factors such as This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).”

“, accumulated wealth), it is possible that subjective SEP indicators are “better” measures of SEP than any objective indicator of SEP that is limited to just one or more of the conventional aspects of SEP (education, income, occupation) (19).”

“One possibility, which we examine here, is that negative emotional states elicited in response to declining conditions (partially) explain the relationship between IRD and health (see Adler, 2009).”

“Likewise, low social status is associated with increased mortality in the human population (Adler, 2009, Adler et al., 1994).”

“Education may also serve as a marker for personality traits that are associated with better health.(36,37) Regardless of the direct mechanism, it is clear that education is significantly associated with BP, whereas African genetic ancestry is not.”

“More recently, research on the association between subjective social status (SSS)—or the perception of one's social standing—and mental disorders has emerged (Adler, 2009).”

“All of these factors are known to be critical social determinants of health (Adler 2009; Braveman and Gottlieb 2014; Link and Phelan 1995; Marmot 2005, 2006; Pascoe and Richman 2009; Pearlin et al. 1981; Yang, Schorpp, and Mullan Harris 2014).”

“Additionally, these disparities exist in both high- and low-income countries, as well as in countries with and without universal health care, and they are monotonic in nature, meaning that each reduction in social status is associated with increased risk for poor health (Adler, 2009).”

“…to growing evidence that health disparities associated with race/ethnicity and class may be largely attributable to differences in stress exposure (Adler, 2009 ; Goodman, McEwen, Dolan, Schafer-Kalkhoff, & Adler, 2005 ; Jackson, Knight, & Rafferty, 2010 ) and suggests the need for new approaches…”

“…of their lower social standing, which negatively shapes self-perceptions, fostering negative beliefs and evaluative emotionality such as poor self-esteem and shame (Dickerson, Grunewald, & Kemeny, 2004) and depression, even after controlling for objective socioeconomic status (Adler, 2009).”

“Further, linking SES to ABP in daily life is consistent with theory and suggestions that differences in everyday interactions may account for a significant portion of the graded relationship between status and health (Adler, 2009; Kamarck et al., 2012; Smith et al., 2012).”

“Another pathway pertained to the presence or absence of social and psychological resources (Adler, 2009).”

“Over the past decade, we have seen attention devoted to gender disparities [1, 2], racial/ethnic disparities [3–11], and SES disparities [12–14].”

“Populations living in more impoverished urban neighborhoods are disproportionately exposed to air pollutants and may also be more likely to experience stress (20, 21).”

“Subjective SES, or how individuals feel about their personal success relative to others, is related to income (Johnson and Benson 2012) and predictive of later health outcomes (Adler 2009).”

“2013), perceptions of inferiority (Adler 2009; Courtwright 2009; Mickelson and Williams 2008; Ritsher et al. 2003; Roy 2004; Twenge and Campbell 2002; Walker et al. 2013; Williams 1999) and unfavourable health behaviours (Roy 2004).”

“Rather, dominant institutional systems like polity, economy, law, medicine, and education often trigger the social identity and the trauma associated with it, and research shows that institutional disprivilege leads to stress and poorer health outcomes (Adler 2009).”

“In the literature it is clear that adolescent health is influenced by family income and parental resources (Adler, 2009; Conger & Donnellan, 2007; Gallo & Matthews, 2003).”

“This SES–morbidity relationship is similar across income groups, extending beyond poverty to explain relative differences in health among higher SES groups as well.(2) 4 The SES–health connection may relate to patterns of social behaviour and strengths and limitations of this study”

“2006)—might promote poor health behaviours, such as smoking, overeating, physical inactivity, and severe alcohol consumption (Adler 2009; Baum et al. 1999; Liu 2010).”

“1056/NEJMp1003729 Adler, N. E. (2009). Health disparities through a psychological lens. American Psychologist, 64, 663–673. http://dx.doi.org/10.1037/0003066X.64.8.663 Adler, N. E., & Stewart, J. (2010). Health disparities across the lifespan: Meaning, methods, and mechanisms.”

“, perception of one’s status; Adler, Epel, Castellazzo, & Ickovics, 2000), is robustly associated with higher mortality and morbidity (Adler, 2009; Adler et al., 1994).”

“Alternatively, psychological variables have been formulated as essential for understanding how health inequalities emerge (Adler, 2009; Kirsch, et al., 2019; Matthews & Gallo, 2011).”

“The biopsychosocial approach to healthcare, first outlined in 1977 by Engel, challenged the biomedical model and proposed that psychosocial factors significantly impacted on physical illness experiences.(2) However, despite increasing evidence regarding the therapeutic effect of a biopsychosocial approach,(2) 3 the bi…”

“Given that there are unique pathways to multiple health outcomes (cf., Adler, 2009) and that obesity is a dangerous risk factor for lifethreatening diseases, we propose a model that specifically highlights how the self and its processes can impact the physical health of stigmatized individuals.”

“The four subscales demonstrated good internal consistency among the present sample (panic a¼ 0.91; social anxiety a¼ 0.86; general depression a¼ 0.92; insomnia a¼ 0.83), consistent with past work among Latinx.44 Subjective social status (SSS45) Subjective social status was assessed with the community version of the Ma…”

“Subjective social status was assessed with the U.S. version of the MacArthur Scale (Adler, 2009; Singh-Manoux et al., 2003).”

“Linking both SES and marital quality to ambulatory blood pressure in daily life is consistent with theory and suggestions that differences in everyday social interactions and support processes may account for a portion of the association between SES and health [1, 37, 38] and the association between marital quality an…”

“Therefore, it demonstrates that one’s perceived social status is relatively accurate and can be used as a good indicator of one’s actual SES (Adler, 2009).”

“, 2006; Prus, 2011), a burgeoning literature has emerged focused on the connection between health and subjective social status (SSS), or how people perceive their position in a social hierarchy (Adler, 2009).”

“Subjective social status was assessed with the U.S. version of the MacArthur Scale (Adler 2009; Singh-Manoux et al.”

“…disparities (Priority 2) given its strengths in multicultural competence in health service psychology (e.g., clinical, counseling, and school psychology; Health Service Psychology Education Collaborative, 2013) as well as social psychology’s expertise on intergroup relations (e.g., Adler, 2009).”

“Previous research on health inequalities has described societal gradients or social hierarchies existing within societies (Adler, 2009; Adler et al., 1994; Singh-Manoux et al., 2003) suggesting a person's place on the gradient determines how long they will live and how healthy a life they will have…”

“The most commonly used measure of SSS presents respondents with the image of a ladder, and asks them to indicate the rung that best represents their standing in the specified group, most-commonly the population of their country or their local community (Adler, 2009; Adler et al., 2000).”

“The stress response, although initially adaptive, can become problematic if engaged excessively over the long-term [19].”

“Socioeconomic disparities in health, commonly referred to as health inequalities (Marmot, 2015) now frequently include assessment of psychological and behavioral factors that serve as pathways and mechanisms for understanding the processes contributing to foreshortened lives and increased risk of disease and disabilit…”

“link between subjective social status and health behaviors may be through psychological pathways.(14)”

“[70] Health disparities operate at different pathways such as health behaviors, stress hormones, and the perception of stress based on the social hierarchy.[71,72]”

“Each step up in social hierarchy is associated with health improvements, such as lower rates of morbidity and mortality from all causes (Adler, 2009; Chetty et al., 2016).”

“…Krueger, & Denney, 2010), researchers hypothesize that social stratification of psychosocial risk factors partially explain the SEP-health gradient (Adler, 2009; Cundiff & Smith, 2017; Fuller-Rowell, Curtis, Chae, & Ryff, 2018; Gallo & Matthews, 2003; Matthews & Gallo, 2011; J. E. Phillips &…”

“version of the MacArthur Scale of Subjective Social Status was used to measure subjective social status.(1) To measure childhood subjective social status, participants recorded their parent’s social status during childhood (ie, 0–12 years old) relative to the greater U.”

“Subjective Social Status (SSS; Adler, 2009).”

“SSS is distinct from objective social status, measured by indicators such as income or education [5], and predicts health separately from the objective social status indicators [5–7].”

“Social causal theory shows that long-term poverty, as a source of stress, has an impact on adolescents' mental health through the objective material environment, social psychology, and individual psychological factors (Adler, 2009; Fiske, 2010; Wadsworth et al., 2008).”

“Gender: % listed as females (coded: 0 = male and 1 = female); SSS, Subjective Social Status-Community Subscale [40],Neuroticism, Big Five Inventory-10 [46]; Anxiety sensitivity, Short-Scale Anxiety Sensitivity Index [47]; Anxious arousal, Inventory of Depression and Anxiety Symptoms-Anxious Arousal subscale [50]; Gene…”

“Some of these theories are considered reductive because they give too much weight to individual’s behaviour as sole determinants of their health and little to the impact on individual health of environmental conditions that surround them, that are not controlled by individuals and, to a great extent, avoidable, such a…”

“…can have an acute impact on health (Christie and Barling, 2009); that there are multiple pathways by which SES can exert an influence on behaviour (Adler, 2009); and that it has an entwined association with the social environment leading to what Adler and colleagues (1994) describe as the…”

“…social structures and policies that limit access to resources based solely on group or individual characteristics such as race/ethnicity, age, gender, sexual orientation, physical or developmental ability status, and/or immigration status, among others (e.g., Adler, 2009; Kenny et al., 2009).”

“Subjective social status was assessed using the community version of the MacArthur Scale (Adler, 2009).”

“49 Respondents were presented with a picture of a 10-rung ladder and asked to rate where they believe they stand in the community relative to others on a scale from 1 ( worst ) to 10 ( best ).”

“In evaluating SSS, individuals weigh their socioeconomic resources and consider the value attached to such resources (e.g., quality of one’s education and the returns to education) and other understated everyday life experiences, including the quality of social interactions [32].”

“Research suggests that feelings about self, relationships, and status in society have powerful influences on health, well-being, and economic outcomes (Adler 2009; Adler et al. 2000; Heck-man, Stixrud, and Urzua 2006).”

“Rather than objective national and individual income per se, Adler (2009) has suggested that individuals’ subjective social status might be a more powerful predictor of psychological outcomes(2).”

“Economic marginalization is often measured through singular indicators, such as education, occupation, and income (Adler, 2009).”

“Despite the aforementioned observations, both from this study and previous research (28, 71) it appears likely that perceived socioeconomic status exerts a distinct and unique influence on health, which is theoretically and empirically distinct from the effects captured by tangible, objective socioeconomic resources.”

“…effects across income, employment, and education are consistent with prior research indicating that these three SES indicators may play unique roles in smoking, other behaviors, and health (Adler, 2009; Adler & Newman, 2002; Braveman et al., 2005; Diemer, Mistry, Wadsworth, Lopez, & Reimers, 2013).”

“…(de Almeida et al. 2018) and have shown to be more strongly associated with well-being and health outcomes including stress levels, than objective socio-economic status (SES) measures like income and education,showing only weak correlation with such outcomes (Adler 2009, García et al. 2017).”

“Perception is essential to one’s understanding of their position in society, contributing to SSS being a more comprehensive measure of social positioning than OSS (Adler 2009).”