Background
Whilst it is generally recognised that material aspects of living
conditions such as income, wealth, quality of housing and diet are
important for physical and mental health, there is evidence to suggest
that health may also be affected by a person's socio-economic position
relative to others. If this is so, general increases in absolute
standards of living could not be expected to produce equivalent
gains in health in circumstances where relative differences in standards
of living are also increasing. Thus the question of how relative
deprivation contributes to the socio-economic gradient in health
is of considerable importance for the UK, where the economic gap
between the worst and best off in society widened through the 1980s
and early 1990s. The present study is designed to investigate this
issue and asks, 'Why is it that people who are not as well off as
others in society have poorer health?'
We are already
aware that psychological factors such as depression, self-esteem,
optimism and beliefs in personal control are associated with health-related
behaviours, health and recovery from illness. The study will examine
the role that such psychological factors play in the relationship
between relative deprivation and health, and the extent to which
these factors are triggered by feelings of relative deprivation.
A novel aspect
of the study will be the use of a range of different measures of
absolute and relative deprivation. This will allow us to link the
deprivation characteristics of individuals to those of their home
areas and to assess the association between various deprivation
measures and recovery from illness.
Aims and
Objectives
The aims of the study are:
- to explore
the role of and extent to which psychological factors influence
the relationship between deprivation and health;
- to establish
those aspects of deprivation which are most clearly related to
health and health changes;
- to examine
how people compare themselves with other people, and the relationship
between these comparisons and psychological factors known to affect
health.
Study Design
The study will involve the collection of data on the state of health,
deprivation and beliefs of people who have had a heart attack. A
sample of 200 patients will be interviewed within one month of their
heart attack and again three months later. Data from the National
Census Small Area Statistics will be used to map deprivation levels
in their home areas and to examine changes in these areas over the
1980s.
We will explore
the way in which individuals assess their own levels of deprivation
and, in particular, whether they make comparisons with others who
live near them. Our expectations are that people who perceive themselves
as being less well-off will show poorer recovery. Should this be
the case, we will examine the extent to which this is due to psychological
factors.
Policy Implications
It is anticipated that this detailed analysis of the relationships
between relative deprivation, absolute deprivation and health will
lead to a better understanding of the role of psychological factors
than is currently the case. The implications for interventions to
enhance patient outcomes would be very different if perceptions,
rather than objective deprivation, prove to be the key factor. Further,
a greater understanding of how other psychological factors have
an impact on recovery rates will provide a more sound basis from
which to develop effective policies to promote comparability in
health experiences between different socio-economic groups in society.
During the project
we will work directly with an NHS Trust providing coronary care
and cardiac rehabilitation services and will, therefore, establish
lines of communication with those responsible for policy development
in this area.
Project Summary
The project built on the growing research and policy interest in
the psycho-social processes linking social deprivation and health.
It examined the causal pathways which run between the socio-economic
characteristics of individuals and areas, and one particular health
outcome: recovery from first myocardial infarction (MI).
The team employed
a prospective design. Patients were recruited across a two-year
period (February 1998 to January 2000) from the Coronary Care Unit
of a large hospital in Scotland following admission for their first
(and acute) MI. They were interviewed in their own homes at 5 weeks
post-MI (T1) and then again at 15 weeks post-MI (T2). 219 patients
completed both interviews.
Key findings
- The relationship
between material deprivation and health. Four dimensions of material
deprivation were found to have independent effects on recovery,
with those on lower incomes, in poorer areas, surrounded by lower
numbers of ill people and in socially homogeneous areas making
a poorer recovery. Of these dimensions, area poverty contributed
most to the prediction of physical recovery and individual income
contributed least. As this suggests, for this sample of MI patients,
the area you live in appears to be more important to health outcome
than your individual wealth.
- In addition,
perceived deprivation was also related to physical recovery: those
who saw themselves as less well-off relative to others showed
a poorer recovery.
- Psychological
factors and health. Two psychological factors had main effects
on recovery: those with lower self-esteem and with more misconceptions
about the causes and consequences of MI recovered less well. Low
self-esteem was, in turn, predicted by deprivation. Those in poorer
neighbourhhoods and those who perceived themselves to be less
well-off than others showed lower self-esteem.
- Social comparisons.
A new instrument was developed to gather data on people's comparison
processes. It suggested that there is a neighbourhood effect and
one independent of income, which influences the valence of comparison
(whether comparisons are positive or negative). Social comparisons
are also related to perceptions of relative wealth and to self-esteem.
- Pathways
from material deprivation to recovery from MI. The findings suggest
a model in which the key pathways run from material deprivation
(of the patient and the area in which they live) through a set
of psychological factors (self-esteem, perceived relative wealth
and misconceptions about the causes and consequences of MI) to
physical recovery. Both the underlying material factors and the
intermediary psychological factors are potentially amenable to
change, suggesting points in the pathways which may offer opportunities
for intervention.
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