IS IT ALL ABOUT THE GOLD?: SOCIOECONOMIC STATUS & HEALTH IN THE UNITED STATES

AGENDA

• Focus on socioeconomic status

• In particular pay attention to both the results of class inequity and to the origin of class inequity

• Highlight how socioeconomic factors relate to health

SMART | QUOTES

Abraham Lincoln (1864)

• "As a result of the war, corporations have been enthroned and an era of corruption in high places will follow, and the money power of the country will endeavor to protect its reign by working upon the prejudices of the people until all wealth is aggregated in a few hands and the Republic is destroyed.”

Henry David Thoreau, Walden

(1854)• "Superfluous wealth can buy superfluities only."

Mr. Spock

• "This troubled planet is a place of the most violent contrasts. Those that receive the rewards are totally separate from those who shoulder the burdens. It is not a wise leadership.”

SOCIAL CLASS | MEDIA

Group Think

(Roles: Captain, Moderator, & Recorder)

Q - Where do we see class represented in media (TV or Film)?

1. Elite

2. Middle class

3. Working Class

4. Poor

SMALL GROUP | DISCUSSION

1. What’s your earliest memory of class differences?

2. What activities do we associate with:a) Upper class or social elite?b) Middle class?c) Working class & poor?

3. Have you ever done things “outside” of your perceived socioeconomic status range?

I've gotten down to my last pair of shoesCan't even win a nickel betBecause, ah them that's got are them that getsAnd I ain't got nothin yet

I'm sneakin in and out duckin' my landlordAll I seem to do is stay in debtBecause, ah them that's got (yeah) are them that getsAnd I tell you all I ain't got nothin' yet

That old sayin them that's got are them that getsIs somethin I can't seeIf ya gotta have somethinBefore you can get somethinHow do ya get your first is still a mystery to me

I see folk with long cars and fine clothesThat's why they're called the smarter setBecause they manage to getWhen only them that's got supposed to getAnd I ain't got nothin yet

Whoah, I tell you allI ain't found nothing yet.

You know I just don't understand itI can't seem to get a nickle or a dime for a cup of coffeeI need a hamburg- in fact a hot dog wouldn't be too badI would just be grateful if I could get my hands on most anything

Ray Charles – “Them that Got”

THE BASICS

• Socioeconomic Status (SES)

• Socioeconomic Class (SEC)

• SES is more than mere economics, it is an indicator of where an individual lies on the social hierarchy, and thus it serves to shape everyday experiences in profound ways

• There is a very high correlation between SES, stress, and health

• Even when SES is factored out, institutionalized isms lead to less quality health care for women and other Americans in “minority” groups

• Our task….is to figure out the why and the how…and fix it!

SCHOOL ON A SATURDAY | SOCIAL CLASS

Social class: groups of people whose members are characterized by relative similarities in wealth, health, ethnic identity, art, sport, income, prestige, lifestyle, education, connections, and culture.

• Capitalist class: Only @1%, but wield the most power and control most of the resources, CEOs, BODs, ruling class

• Upper class/Wealthy: property and home ownership, white-collar careers, BA/MA degrees, high salaries, high health outcomes, safe/healthy environments and schools, high wealth accumulation

• Middle-class, or what is left of it, often stands in opposition to working class, and seeks to remove itself from “middle status”

• Working class: generally own no property, high school education, jobs not careers, little change for upward mobility, debt, poor health outcomes, high stress

• Poor: own no property, little to no education, low health status, high mortality rates, likely to live in unsafe and unhealthy environments, in danger of violence, drugs, and alcohol abuse, incarceration

TERMS | CONCEPTS

Social Differentiation: Categorizing people by age, height, occupation, race, or other personal attribute

• Implies that inequality is recognized and to a large extent accepted as expected

Social Stratification: Social attributes are ranked hierarchically (seen as superior or inferior)

SOCIAL STRATIFICATION | DEFINED

• Structures of social inequity among groups of people is called social stratification• Those who possess social power and resources can control and

shape the lives of those who lack them

• Social stratification creates an oppressive sort of social consciousness that aids in the maintenance of structured inequalities. • So, we think differently about each other and ourselves• Remember, perceptions can lead to stress!

• Many Americans have a fear of a lack of adequate (or superfluous) funds• “Poverty consciousness” (Twist, 2003)

MAKE MONEY YO | CAPITALISM

• Refers to one of several economic systems that involve the means of producing and distributing goods and services

• Based on the accumulation and investment of capital by private individuals

• Class stratification is inherent in this system!• Life Chances (i.e., opportunities to achieve economic

success and gain economic power) vary from one social class to another in the social stratification system• So, structured economic inequities, particularly when

combined with other forms of inequity, contribute to more stress and less adequate resources for coping with stress and health problems!

DOES AMERICA HAVE SOCIAL CLASSES?

In 2009, 43.6 million people (14.3 percent) were in poverty.

In 2009, 8.8 million (11.1% percent) families were in poverty.

In 2009, 24.7 million (12.9 percent) of people ages 18-64 were in poverty.

In 2009, 15.5 million (20.7 percent) children under the age of 18 were in poverty.

In 2009, 3.4 million (8.9 percent) seniors 65 and older were in poverty.

Q – Will you be able to leave your class status after graduation?

BROKE IN AMERICAMedian Family Incomes (as of 2007)

• African-American family median income $33,916

• non-Hispanic White families median income $54,920

• Asian American families is $15,600 higher than the national median income for all households.

Living in Poverty

• 24.5 percent of African-Americans

• 8.2 percent of non-Hispanic Whites

• 21.5 percent of Hispanics

• 10% of Asian Americans

Unemployment Rates

• Blacks 8%

• non-Hispanic Whites 4%

Careers

• Management, professional and related occupations

• Asian Americans 45% ; 16.6 percent Hispanics; 39.9% Whites; 34% total population.

• Service Occupations

• 24.4 Hispanics: 13.7 percent non-Hispanic Whites;

EDUCATION | GAP25 years and older - high school diploma • African American 80%

• Non-Latino Whites 89%

• Asian 86%

• 61% Hispanics

College Degrees - bachelor's degree and up • Black women 16% ; Black men 14%

• Asian Americans 50%

• Asian Indians 64%

• 12.5 % Hispanics

• 30.5% non-Hispanic whites

• 28% of the total U.S. population had earned at least a bachelor’s degree

HEALTH INSURANCE RATES | NUMBERSEmployer-sponsored Health Insurance• 49% African-Americans

• 66% non-Hispanic Whites

• Private insurance coverage rates: 75.8 percent for Vietnamese, 81.5 percent for Filipino, 84.2 percent for Chinese and 81.3 percent for other Asian groups.

Public Health Insurance • 23.8 percent of African-Americans

• 9 percent of non-Hispanic Whites

• 11.2 percent for Vietnamese, 4.9 percent for Filipino, 3.8 percent for Chinese and 5.5 percent for other Asian groups.

Uninsured • 19.5 percent of African-Americans

• 10.4 percent of non-Hispanic whites

• 32.1 percent of Hispanics

Total Insured • Asian Americans was 83.9%

• 89.6% for the non-Hispanic White population

CASE STUDY | LATINO HEALTH INSURANCE RATES

Insured • 39.1 percent of Mexicans,

• 47.3 percent of Puerto Ricans,

• 57.9 percent of Cubans,

• 45.1 percent of other Hispanic and Latino groups.

• 2004 Medicaid coverage varied among Hispanic subgroups:

• 22.4 percent of Mexicans, 29.1 percent of Puerto Ricans, 17.9 of Cubans, and 20.8 percent of other Hispanic or Latino groups.

Without health insurance • 37.6 percent of Mexicans, 20.4 percent of Puerto Ricans, 22.8 percent

of Cubans and 32.3 percent of other Hispanic or Latino groups.

HEALTH CARE | SICK CARE

Roughly 45 million

Americans have NO health insurance

In 1990, the figure was 35

million.

About 8.5 million children are uninsured

18% of workers between 18 and

64 were uninsured in

1997 (increase of 15.7% over

1990)

69% white workers were covered by

employer-sponsored insurance, compared with 52% of African American workers and 44% of Latino

workers

SOCIAL SYSTEMS | MERIT

• Meritocracy - will gain rewards based on merit• Class relations in most Western societies are based on an

ideology in which economic success is equated with individual ability, worth, and character

• “American Dream”• Upward Mobility through material possesions

• Much like thinness is, in many ways• And higher education for that matter

MERITOCRACY | SOCIAL LADDER

• More Americans think the poor are poor because of a lack of effort than because of things beyond their control (including the poor!)

• Ideology of inequality

• 1) Talent + effort = level of success• 2) Because outcome is related to individual talents & efforts, results are fair. So,

people deserve their lot in life• Social class inequity viewed as natural, not ideological

• “Myth of meritocracy”• This is a tough issue, but think about what we’ve learned about social

inequities so far…• Pulling yourself up by bootstraps is tough when you have no boots!• Also tough when social forces, including institutionalized sexism and racism,

work against you…

NORMALIZING | POVERTY

More Americans think the poor are poor because of a lack of effort

than because of things beyond their control (rather than

systemic inequalities)

Because outcome is related to individual talents &

efforts, results are fair

(normalization of poverty)

CONSEQUENCES | CLASS DIVISIONSEducation:

• In 1979, the average male college graduate earned about a third more than the median high school graduate; by 2001, the gap had

widened to 79 percent. (Economic Policy Institute, 2002-03, p. 121)

Social Support: Access to social

networks, services

Marketing of drugs, alcohol:

availability of guns, drugs, booze in low SES

Environmental Stressors:Power lines, dumps, Cell

towers, over-crowded, noise, lack of green space

Unequal Justice:Incarceration rates, length

of punishments, criminalizing color

Personal Safety: Higher rates of crime,

police brutality, domestic violence

Exercise:Low SES less likely to

engage in PA

•In 1979, the average male college graduate earned about a third more than the median high school graduate; by 2001, the gap had widened to 79 percent. (Economic Policy Institute, 2002-03, p. 121)

CLASS & RACE | DIVISIONS

•Different treatments, outcome expectations.•Overt racist practices•Education & Healthcare•Safety of living conditions (dust, asbestos, lead, ground/h2o contaminants)•Uncertainty (psychological adaptive/coping energy)•Unemployment/underemployment•Nutrition, sedentary lifestyles, obesity•For children, poor health can influence SES later on•Lack of coping mechanisms available

Even when adjusting for SES, institutionalized racism contributes to health differences!

CONSEQUENCES | LIFESPAN

33 million Americans (including 13 million

children) regularly go hungry or can't afford

balanced meals (down 2.9 million since 1998).

The United States spends more on medical care--

13.1% of gross domestic product--than any other advanced industrialized

society

Yet among the top 30 nations, the US ranks 18th in female life expectancy and 19th in male life

expectancy. The average life expectancy for white Americans

is 77.3 years. For black Americans, it stands at 71.4

years

The most vulnerable pay the heaviest costs

SES, STRESS, AND HEALTH 101 (RECAP)

• As has been established, racial and ethnic minority populations in the U.S. have higher incidences of numerous diseases, higher mortality rates, and less access to health care• While there are exceptions (e.g. higher SES Asian groups), this

generally holds true, and SES is one of the strongest determinants of health.

• As well, there is a high correlation between race and SES in the U.S., as higher-than-norm percentages of most minority groups live below the mean income and poverty line.

SOCIAL JUSTICE | SOCIAL CHANGE Legislation

Accountability for those gain the most from the system

Taxes & Accountability for the rich

Socialized healthcare & medicine

Grassroots Social Action

Internet campaigns

Moveon.org (99%)

Change.org

Student Movements (yes, you!)

Marriage Equality

Reformation of the banking system

Caps on students loans

Loan forgiveness for public service