A model of underlying socioeconomic vulnerability in human populations: evidence from variability in population health and implications for public health.

Drawing from insights into the variability of complex biologic systems we propose that the health of human populations reflects the interrelationship between underlying vulnerabilities (determined by population-level social and economic factors; e.g., income distribution) and capacities (determined by population-level salutary resources, e.g., social capital) and how populations, shaped by these vulnerabilities and capacities, respond to intermittent stressors (e.g., economic downturns) and protective events (e.g., introduction of a school). Monitoring this dynamic at the population-level can be accomplished by examining not only rates of illness and mortality, but variability in rates, either between populations or within populations over time. We used mortality data from New York City neighborhoods between 1990 and 2001 to test two related hypotheses consistent with this model of population health: (a) There is greater variability in mortality rates at a point in time between neighborhoods that are characterized by socioeconomic vulnerability; and (b) there is greater variability in mortality rates over time within neighborhoods that are characterized by socioeconomic vulnerability. We found that neighborhoods characterized by social and economic vulnerability displayed substantial variability in particular mortality rates. Mortality rates displaying the greatest variability were from causes that may be sensitive to social conditions (e.g., homicide or HIV/AIDS rates). Variability in population health existed both between neighborhoods with underlying vulnerability at one point in time and within vulnerable neighborhoods over time. The results of this analysis are consistent with a theory of underlying socioeconomic vulnerabilities of human populations and suggest that variability in population health may be an important consideration in population health assessment.

[1]  G. Bankoff.  Constructing vulnerability: the historical, natural and social generation of flooding in metropolitan Manila. , 2003, Disasters.

[2]  Patricia O'Campo,et al.  Invited commentary: Advancing theory and methods for multilevel models of residential neighborhoods and health. , 2003, American journal of epidemiology.

[3]  Ichiro Kawachi,et al.  Social trust and self-rated health in US communities: a multilevel analysis , 2002, Journal of Urban Health.

[4]  Sheldon Cohen,et al.  Stable individual differences in physiological response to stressors: implications for stress-elicited changes in immune related health , 2003, Brain, Behavior, and Immunity.

[5]  I. Schmalhausen,et al.  Factors of evolution , 1949 .

[6]  T. Raghunathan,et al.  Relative or absolute standards for child poverty: a state-level analysis of infant and child mortality. , 2003, American Journal of Public Health.

[7]  R Levins,et al.  DISCUSSION PAPER: THE QUALITATIVE ANALYSIS OF PARTIALLY SPECIFIED SYSTEMS , 1974, Annals of the New York Academy of Sciences.

[8]  S. Folkman,et al.  Socioeconomic Status and Health , 1994 .

[9]  M G Marmot,et al.  Social/economic status and disease. , 1987, Annual review of public health.

[10]  J. Diamond,et al.  Ecology and Evolution of Communities , 1976, Nature.

[11]  D. Jacobs,et al.  An after-school obesity prevention program for African-American girls: the Minnesota GEMS pilot study. , 2003, Ethnicity & disease.

[12]  S. Galea,et al.  Income distribution and risk of fatal drug overdose in New York City neighborhoods. , 2003, Drug and alcohol dependence.

[13]  J. Lynch,et al.  Inequality in income and mortality in the United States: analysis of mortality and potential pathways , 1996, BMJ.

[14]  Ana V. Diez Roux.  Multilevel analysis in public health research , 2000 .

[15]  T. Breurch,et al.  A simple test for heteroscedasticity and random coefficient variation (econometrica vol 47 , 1979 .

[16]  A. Heath,et al.  Effects of the interaction between genotype and environment. Research into the genetic epidemiology of alcohol dependence. , 2002 .

[17]  Richard Levins,et al.  Variability and vulnerability at the ecological level: implications for understanding the social determinants of health. , 2002, American journal of public health.

[18]  R. Levins,et al.  Toward an Ecosocial View of Health , 1999, International journal of health services : planning, administration, evaluation.

[19]  T. Waidmann,et al.  Poverty, time, and place: variation in excess mortality across selected US populations, 1980-1990. , 1999, Journal of epidemiology and community health.

[20]  S. Curtis,et al.  Is There a Place for Geography in the Analysis of Health Inequality , 1998 .

[21]  I. Kawachi,et al.  Social capital, income inequality, and mortality. , 1997, American journal of public health.

[22]  L. Shi,et al.  Vulnerable Populations and Health Insurance , 2000, Medical care research and review : MCRR.

[23]  A. Whaley.  Ethnicity/race, ethics, and epidemiology. , 2003, Journal of the National Medical Association.

[24]  R. Burnett,et al.  Health and Air Quality: Directions for Policy-Relevant Research , 2003, Journal of toxicology and environmental health. Part A.

[25]  J S Koopman,et al.  Individual causal models and population system models in epidemiology. , 1999, American journal of public health.

[26]  S. Timmermans,et al.  Handbook of medical sociology. , 1972 .

[27]  J. Andrews,et al.  Heart disease mortality in women: racial, ethnic, and geographic disparities. , 2001, The Journal of cardiovascular nursing.

[28]  A. Leon,et al.  Poverty and fatal accidental drug overdoses of cocaine and opiates in New York City: an ecological study. , 1997, The American journal of drug and alcohol abuse.

[29]  M. Shediac-Rizkallah,et al.  Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. , 1998, Health education research.

[30]  A. Elster,et al.  Racial and ethnic disparities in health care for adolescents: a systematic review of the literature. , 2003, Archives of pediatrics & adolescent medicine.

[31]  S. Messner,et al.  A study of homicides in Manhattan, 1981. , 1986, American journal of public health.

[32]  S. Raudenbush,et al.  Neighborhoods and violent crime: a multilevel study of collective efficacy. , 1997, Science.

[33]  Bruce G. Link,et al.  Controlling Disease and Creating Disparities: A Fundamental Cause Perspective. , 2005, The journals of gerontology. Series B, Psychological sciences and social sciences.

[34]  R. Sampson,et al.  ASSESSING "NEIGHBORHOOD EFFECTS": Social Processes and New Directions in Research , 2002 .

[35]  Carl A Latkin,et al.  Norms, social networks, and HIV-related risk behaviors among urban disadvantaged drug users. , 2003, Social science & medicine.

[36]  Sandro Galea,et al.  Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks. , 2003, American journal of epidemiology.

[37]  A. Heath,et al.  Effects of the Interaction Between Genotype and Environment , 2002, Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism.

[38]  A. Leon,et al.  Accidental fatal drug overdoses in New York City: 1990-1992. , 1996, The American journal of drug and alcohol abuse.

[39]  S. Robert.  SOCIOECONOMIC POSITION AND HEALTH: The Independent Contribution of Community Socioeconomic Context1 , 1999 .

[40]  J. Rimmer,et al.  Feasibility of a Health Promotion Intervention for a Group of Predominantly African American Women With Type 2 Diabetes , 2002, The Diabetes educator.

[41]  D. Nelson.  Mitigating disasters: power to the community. , 1990, International nursing review.

[42]  P. Philippe,et al.  Nonlinearity in the Epidemiology of Complex Health and Disease Processes , 1998, Theoretical medicine and bioethics.

[43]  James P. Smith.  Socioeconomic Status and Health , 1998 .

[44]  R. Kasperson,et al.  A framework for vulnerability analysis in sustainability science , 2003, Proceedings of the National Academy of Sciences of the United States of America.

[45]  I. V. McKeehan.  A multilevel city health profile of Moscow. , 2000, Social science & medicine.

[46]  J. Healy,et al.  Excess winter mortality in Europe: a cross country analysis identifying key risk factors , 2003, Journal of epidemiology and community health.

[47]  I M Longini,et al.  The ecological effects of individual exposures and nonlinear disease dynamics in populations. , 1994, American journal of public health.

[48]  The sociology of health inequalities , 2000 .

[49]  Eliminating racial and ethnic disparities in health. , 1998, Public health reports.

[50]  Sankaran Subramanian.  Income Inequality and Health , 2004 .

[51]  Ichiro Kawachi,et al.  Income inequality and health: what have we learned so far? , 2004, Epidemiologic reviews.

[52]  N. Herrmann,et al.  Old and Homeless: A Review and Survey of Older Adults Who Use Shelters in an Urban Setting , 2003, Canadian journal of psychiatry. Revue canadienne de psychiatrie.