Others’ income, one’s own fate : How income inequality, relative social position and social comparisons contribute to disparities in health

Abstract: The overall aim of this thesis is to contribute to a greater understanding of how social inequalities in health evolve causally and to explore the missing links between social position and health in different social and economic contexts.A premise in the thesis is that in affluent societies, not only material aspects and purchasing power linked to income and social positions are important explanations for the health of individuals, but also the relative socio-economic standards in society. The concept of relative income position was used to explore this notion across time and country contexts: A comparison of income-related health inequalities between the different welfare contexts of Sweden and Germany showed similar magnitudes in poor health. When exploring the role of absolute and relative income changes over time in Sweden, income volatility was found to influence individuals’ health.Another aim was to explore the specific social mechanisms reflecting intra- and interpersonal social comparisons and their role for health. Subjective measures of social position were found to capture non-material aspects of social positions. Self-rated class affinity revealed strong associations with health, particularly for women. Income satisfaction, predicting mortality, was shown to be a measure that accounts for internalized reference standards regarded as meaningful by individuals.Conceptually, the used subjective measures capture aspects of social comparisons and relative deprivation and further suggest that not the material dimension of social position alone matters for health. It is also shown that income satisfaction operates as a mediator between income position and mortality. Subjective measures such as income satisfaction and class affinity provide a plausible link in the understanding of how social inequality entails persistent effects on health and mortality.