Neighborhood Socioeconomic Status and Health: Context or Composition?

Does neighborhood socioeconomic status (SES) have a significant positive effect on health over and above the personal and household socioeconomic status of the residents who live there, and, if it does, what is its relative importance compared to an individual's own SES? Resolution of this question has been impeded by lack of conceptual clarity in the definitions of socioeconomic status on the micro– and macro–levels, and unreliable and noncomprehensive adjustment for micro–level socioeconomic status. Using the Community, Crime and Health Survey (CCH), based on a representative sample of Illinois households with linked census tract information, we find that, with adjustment for personal socioeconomic status, residents of socioeconomically disadvantaged neighborhoods have significantly higher levels of physical impairment than do residents of more advantaged neighborhoods. The neighborhood effect is small compared to individual socioeconomic status, especially education, employment status, household income, and economic hardship, all of which have larger associations with health than does neighborhood socioeconomic status (measured as home ownership, college–educated adults, and poverty). in comparison, home ownership on the micro–level does not have a significant effect on physical functioning. We conclude that about 40 percent of the association between neighborhood socioeconomic status and individual health is contextual and about 60 percent is compositional.

[1]  I. Kawachi,et al.  Income distribution, socioeconomic status, and self rated health in the United States: multilevel analysis , 1998, BMJ.

[2]  Kelvyn Jones,et al.  Individuals and their ecologies: analysing the geography of chronic illness within a multilevel modelling framework , 1995 .

[3]  James P. Smith.  Unraveling the SES health connection , 2004 .

[4]  M. Kreuter,et al.  Social environment and physical activity: a review of concepts and evidence. , 2006, Social science & medicine.

[5]  S. Cummins,et al.  Place effects on health: how can we conceptualise, operationalise and measure them? , 2002, Social science & medicine.

[6]  Bruce G. Link,et al.  Social conditions as fundamental causes of disease. , 1995, Journal of health and social behavior.

[7]  M. Lieberman,et al.  The stress process. , 1981, Journal of health and social behavior.

[8]  M. Wen,et al.  Explaining variation in health status across space and time: implications for racial and ethnic disparities in self-rated health. , 2003, Social science & medicine.

[9]  M. Blaxter.  Health and lifestyles , 1990 .

[10]  J. House,et al.  Socioeconomic Inequalities in Health: Integrating Individual-, Community-, and Societal-Level Theory and Research , 2000 .

[11]  N. Dragano,et al.  Education and health in 22 European countries. , 2006, Social science & medicine.

[12]  K. Cagney,et al.  Moving beyond poverty: neighborhood structure, social processes, and health. , 2003, Journal of health and social behavior.

[13]  G. Colditz,et al.  Individual, neighborhood, and state-level predictors of smoking among US Black women: a multilevel analysis. , 2006, Social science & medicine.

[14]  Emmanuel J. Lopez.  What Money Can't Buy: Family Income and Children's Life Chances , 2008 .

[15]  G W Comstock,et al.  Neighborhood environments and coronary heart disease: a multilevel analysis. , 1997, American journal of epidemiology.

[16]  Richard G. Wilkinson,et al.  Social Determinants of Health: The Solid Facts , 1998 .

[17]  David R. Williams,et al.  Us socioeconomic and racial differences in health: patterns and explanations , 1995 .

[18]  I. Plewis,et al.  Does health-selective mobility account for socioeconomic differences in health? Evidence from England and Wales, 1971 to 1991. , 1997, Journal of health and social behavior.

[19]  C. Ross,et al.  Education, Personal Control, Lifestyle and Health , 1998 .

[20]  D Kromhout,et al.  Educational level and mortality in a 32-year follow-up study of 18-year-old men in The Netherlands. , 1990, International journal of epidemiology.

[21]  G S Smith,et al.  Socioeconomic status and injury mortality: individual and neighbourhood determinants , 2000, Journal of epidemiology and community health.

[22]  J. S. Siegel.  A Generation of Change: A Profile of America's Older Population , 1993 .

[23]  R. Hodge,et al.  ON REVISING PRESTIGE SCORES FOR ALL OCCUPATIONS , 2004 .

[24]  M. Khanye,et al.  An urban experience. , 1989, Nursing RSA = Verpleging RSA.

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

[26]  W. Hadden,et al.  The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. , 1993, The New England journal of medicine.

[27]  Catherine E. Ross,et al.  The effects of power, knowledge, and trust on income disclosure in surveys , 1996 .

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

[29]  Duane F. Alwin,et al.  INFORMATION TRANSMISSION IN THE SURVEY INTERVIEW: NUMBER OF RESPONSE CATEGORIES AND THE RELIABILITY OF ATTITUDE MEASUREMENT , 1992 .

[30]  B. Giles-Corti,et al.  Relative influences of individual, social environmental, and physical environmental correlates of walking. , 2003, American journal of public health.

[31]  K. Fiscella,et al.  Poverty or income inequality as predictor of mortality: longitudinal cohort study , 1997, BMJ.

[32]  C. Ross,et al.  Economic Hardship across the Life Course , 1999, American Sociological Review.

[33]  William Julius Wilson,et al.  When Work Disappears , 1996 .

[34]  H. Joshi,et al.  Indicators of Deprivation in People and Places: Longitudinal Perspectives , 1998 .

[35]  S. Robert.  Community-level socioeconomic status effects on adult health. , 1998, Journal of health and social behavior.

[36]  Thomas A. DiPrete,et al.  Multilevel Models: Methods and Substance , 1994 .

[37]  W. Wilson,et al.  The Truly Disadvantaged: The Inner City, The Underclass, and Public Policy. , 1988 .

[38]  F. LeClere,et al.  Neighborhood social context and racial differences in women's heart disease mortality. , 1998, Journal of health and social behavior.

[39]  A. D. Diez Roux,et al.  Neighborhoods and health , 2010, Annals of the New York Academy of Sciences.

[40]  Brian Goesling,et al.  Education, Social Status, and Health , 2005 .

[41]  R. Araya,et al.  Perceptions of social capital and the built environment and mental health. , 2006, Social science & medicine.

[42]  Michael Duncan,et al.  Walking, bicycling, and urban landscapes: evidence from the San Francisco Bay Area. , 2003, American journal of public health.

[43]  C. Ross,et al.  Neighborhood disadvantage, disorder, and health. , 2001, Journal of health and social behavior.

[44]  Susan E. Mayer,et al.  Poverty and the Distribution of Material Hardship , 1989 .

[45]  Ye Luo,et al.  The impact of childhood and adult SES on physical, mental, and cognitive well-being in later life. , 2005, The journals of gerontology. Series B, Psychological sciences and social sciences.

[46]  S. Fortmann,et al.  Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. , 1992, American journal of public health.

[47]  C Duncan,et al.  Smoking and deprivation: are there neighbourhood effects? , 1999, Social science & medicine.

[48]  F. LeClere,et al.  Ethnicity and Mortality in the United States: Individual and Community Correlates , 1997 .

[49]  Richard J Jackson,et al.  The impact of the built environment on health: an emerging field. , 2003, American journal of public health.

[50]  K. Smith,et al.  Phantom of the area: poverty-area residence and mortality in the United States. , 1998, American journal of public health.

[51]  J. Sallis,et al.  Neighborhood-based differences in physical activity: an environment scale evaluation. , 2003, American journal of public health.

[52]  E. Pamuk,et al.  Social class inequality in mortality from 1921 to 1972 in England and Wales. , 1985, Population studies.

[53]  Catherine E. Ross,et al.  The links between education and health. , 1995 .

[54]  D. Ahn,et al.  Effect of cross-level interaction between individual and neighborhood socioeconomic status on adult mortality rates. , 2006, American journal of public health.

[55]  C. Jagger,et al.  Does socio-economic advantage lead to a longer, healthier old age? , 2006, Social science & medicine.

[56]  Toshiko Kaneda,et al.  Neighborhood Socioeconomic Disadvantage and Access to Health Care∗ , 2005, Journal of health and social behavior.

[57]  D. Jones,et al.  Social class mortality differentials: artefact, selection or life circumstances? , 1985, Journal of epidemiology and community health.

[58]  K. Cagney,et al.  Neighborhood structural disadvantage, collective efficacy, and self-rated physical health in an urban setting. , 2002, Journal of health and social behavior.

[59]  J. Billy,et al.  Social Context and Adolescent Behavior: The Impact of Community on the Transition to Sexual Activity , 1993 .

[60]  C. Ross,et al.  Does employment affect health? , 1995, Journal of health and social behavior.

[61]  C. Ross,et al.  Walking, exercising, and smoking: does neighborhood matter? , 2000, Social science & medicine.

[62]  G. Evans.  The built environment and mental health , 2003, Journal of Urban Health.

[63]  Constance F. Citro,et al.  Measuring poverty : a new approach , 1995 .

[64]  M. Wen,et al.  Poverty, affluence, and income inequality: neighborhood economic structure and its implications for health. , 2003, Social science & medicine.

[65]  H. Joshi,et al.  Higher mortality in deprived areas: community or personal disadvantage? , 1994, BMJ.

[66]  C. Ross,et al.  Socioeconomic status and subjective life expectancy , 2000 .

[67]  Kay Price,et al.  Aging, health, and public policy: demographic and economic perspectives , 2006 .

[68]  J. Popay,et al.  Theorising inequalities in health : the place of lay knowledge. , 1998 .