Psychological Resources, Material Deprivation, and Health in Europe: Direct Effects and Mediation of Educational Inequalities

Abstract: 
The article deals with the problem of mediation of social structural inequalities in health. According to theoretical explanations that require further empirical justification, inequalities in education — deterioration of health with its decline — may be associated with material deprivation. With a low educational status, a person does not have enough material resources necessary for high-quality nutrition, recreation and treatment. These inequalities may also arise due to the fact that poorly educated people lack the psychological reserves necessary for overcoming life's difficulties. Analysis of European Social Survey data (ESS 2012) for 27 countries, as well as the contextual factor of social protection expenditure was carried out using statistical methods of two-level modeling and regression models for mediation effects (HLM, MLmed macro, Process macro). Health inequalities in education are clearly manifest in any country. It was established that, along with education, material deprivations and especially personal resources play a significant role in differentiating the well-being of people, exerting an independent impact on it. According to the modeling results, in many countries, including the most developed, material deprivations that people with low levels of education suffer from, act as a mediator, partly clarifying the reasons for differences in health among people with different education. One of the lines of psychological mediation is also connected with material conditions — through two intermediaries, the first of which is deprivation, and the second is psychological qualities. At the same time, even when controlling all of these mediating effects, personal characteristics are an important mediator of SES inequalities, but not all over Europe, but only in countries with a relatively weak social state. In conclusion, a brief description of health inequalities and mediating effects in Russia is given.
Pages: 
23-38
doi: 

10.33491/telescope2019.5-603

References: 
  • Adler N. E., Boyce T., Chesney M. A., Cohen S., Folkman S., Kahn R. L, Syme S. L. (1994). Socioeconomic status and health: The challenge of the gradient. American Psychologist, vol. 49, no 1, pp. 15–24. doi: 10.1037/0003-066X.49.1.15
  • Adler N. E., Snibbe A.C. (2003). The role of psychosocial processes in explaining the gradient between socioeconomic status and health. Current Directions in Psychological Science, vol. 12, no 4, pp. 119–123. doi.org/10.1111/1467-8721.01245
  • Aldabe B., Anderson R., Lyly-Yrjänäinen M., Parent-Thirion A., Vermeylen G., Kelleher C. C., Niedhammer I. (2011). Contribution of material, occupational, and psychosocial factors in the explanation of social inequalities in health in 28 countries in Europe. Journal of Epidemiology and Community Health, vol. 65, no 12, pp. 1123–1131. doi:10.l136/jech.2009.102517
  • Bernard P., Charafeddine R., Frohlich K. L., Daniel M., Kestens Y., Potvin L. (2007). Health inequalities and place: a theoretical conception of neighbourhood. Social Science & Medicine, vol. 65, no 9, pp. 1839–1852. doi: 10.1016/j.socscimed.2007.05.037
  • Boehm J. K., Chen Y., Williams D. R., Ryff C., Kubzansky L. D. (2015). Unequally distributed psychological assets: Are there social disparities in optimism, life satisfaction, and positive affect? PLoS ONE, vol. 10, no 2, e0118066. doi:10.1371/journal.pone.0118066.
  • Boehm J. K., Peterson C., Kivimaki M., Kubzansky L. A. (2011). Prospective Study of Positive Psychological Well-Being and Coronary Heart Disease. Health Psychology, vol. 30, no 3, pp. 259–267. doi:10.1037/a0023124
  • Bosma H., Schrijvers C., Mackenbach J. P. (1999). Socioeconomic inequalities in mortality and importance of perceived control: cohort study. British Medical Journal, vol. 319, no 7223, pp. 1469–1470. doi: 10.1136/bmj.319.7223.1469
  • Brunello G., Fort M., Schneeweis N., Winter-Ebmer R. (2016). The causal effect of education on health: what is the role of health behaviors? Health Economics, vol. 25, no 3, pp. 314–336. doi: 10.1002/hec.3141
  • Daoud N., Soskolne V., Manor O. (2009). Examining cultural, psychosocial, community and behavioural factors in relationship to socioeconomic inequalities in limiting longstanding illness among the Arab minority in Israel. Journal of Epidemiology and Community Health, vol. 63, no 5, pp. 351–358. doi:10.1136/jech.2008.080465
  • Dowler E. A., Dobson B. M. (1997). Nutrition and poverty in Europe: an overview. Proceedings of the Nutrition Society, vol. 56, no 1A, pp. 51–62. doi: 10.1079/PNS19970009
  • Dunn J. R. (2000). Housing and health inequalities: review and prospects for research. Housing Studies, vol. 15, no 3, pp. 341–366. doi: 10.1080/02673030050009221
  • Elgar F., Pförtner T-K., Moor I., De Clercq B., Stevens  G. W. J. M., Currie C. (2015). Socioeconomic inequalities in adolescent health 2002-2010: a time-series analysis of 34 countries participating in the Health Behaviour in School-aged Children study. Lancet, vol. 385, no 9982, pp. 2088–2095. doi: 10.1016/S0140-6736(14)61460-4
  • ESS (2012). ESS Round 6: European Social Survey Round 6 Data. Data file edition 2.3. NSD — Norwegian Centre for Research Data, Norway — Data Archive and distributor of ESS data for ESS ERIC. URL: https://www.europeansocialsurvey.org/data/download.html?r=6
  • ESS (2014). Weighting European Social Survey Data. URL: https://www.europeansocialsurvey. org/docs/methodology/ESS_weighting_data_1.pdf
  • Festin K., Thomas K., Ekberg J., Kristenson M. (2017). Choice of measure matters: A study of the relationship between socioeconomic status and psychosocial resources in a middle-aged normal population. PLoS ONE, vol. 12, no 8, e0178929. doi: 10.1371/journal.pone.0178929
  • Fritzell J., Rehnberg J., Hertzman J. B., Blomgren J. (2015). Absolute or relative? A comparative analysis of the relationship between poverty and mortality. International Journal of Public Health, vol. 60, no 1, pp. 101–110. doi: 10.1007/s00038-014-0614-2
  • Fusco A., Guio A-C., Marlier E. (2013). Building a material deprivation index in a multinational context: lessons from the EU experience. Poverty and social exclusion around the Mediterranean Sea (eds. V. Bérenger, F. Bresson), New York: Springer, pp. 43–71. doi: 10.1007/978-1-4614-5263-8_2
  • Gallo L. C., Bogart L. M., Vranceanu A-M., Matthews K. A. (2005). Socioeconomic Status, Resources, Psychological Experiences, and Emotional Responses: A Test of the Reserve Capacity Model. Journal of Personality and Social Psychology, vol. 88, no 2, pp. 386–399. doi: 10.1037/0022-3514.88.2.386
  • Gallo L. C, Matthews K. A. (2003). Understanding the association between socioeconomic status and physical health: Do negative emotions play a role? Psychological Bulletin, vol. 129, no 1, 10–51. doi: 10.1037/0033-2909.129.1.10
  • Goldman N. (2001). Social inequalities in health: Disentangling the underlying mechanisms. Annals of the New York Academy of Sciences, vol. 954, no 1, pp. 118–139. doi:10.1111/j.1749-6632.2001.tb02750.x
  • Granström F., Molarius A., Garvin P., Elo S., Feldman I., Kristenson M. (2015). Exploring trends in and determinants of educational inequalities in self-rated health. Scandinavian Journal of Public Health, vol. 43, no 7, pp. 677–686. doi: 10.1177/1403494815592271
  • Groffen D. A. I., Bosma H., Tan F. E. S., van den Akker M., Kempen G. I. J. M., van Eijk J. Th. M. (2011). Material vs. psychosocial explanations of old-age educational differences in physical and mental functioning. European Journal of Public Health, vol. 22, no 4, pp. 587–592. doi: 10.1093/eurpub/ckr063
  • Guio A-C., Gordon D., Marlier E. (2012). Measuring material deprivation in the EU: indicators for the whole population and child-specific indicators, Luxembourg: Publications Office of the European Union.
  • Hatch S. L., Dohrenwend B. P. (2007). Distribution of traumatic and other stressful life events by race/ethnicity, gender, SES and age: a review of the research. American Journal of Community Psychology, vol. 40, no 3–4, pp. 313–332. doi: 10.1007/s10464-007-9134-z
  • Hayes A. F. (2018). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. 2nd ed., New York, London: The Guilford Press.
  • Hoven H., Siegrist J. (2013). Work characteristics, socioeconomic position and health: a systematic review of mediation and moderation effects in prospective studies. Occupational and Environmental Medicine, vol. 70, no 9, pp. 663–669. doi: 10.1136/oemed-2012-101331
  • Huppert F., Marks N., Michaelson J., Vázquez C., Vittersø J. (2013). European Social Survey Round 6 Module on Personal and Social Wellbeing — Final Module in Template, London: Centre for Comparative Social Surveys, City University London.
  • Infurna F. J., Gerstorf D., Zarit S. H. (2011). Examining dynamic links between perceived control and health: Longitudinal evidence for differential effects in midlife and old age. Developmental Psychology, vol. 47, no 1, pp. 9–18. doi: 10.1037/a0021022
  • International Labour Organization (2014). World Social Protection Report 2014/15: Building economic recovery, inclusive development and social justice, International Labour Office — Geneva: ILO.
  • Kaplan G. A., Pamuk E. R., Lynch J. W., Cohen R. D., Balfour J. L. (1996). Inequality in income and mortality in the United States: Analysis of mortality and potential pathways. British Medical Journal, vol. 312, no 7037, pp. 999–1003. doi: 10.1136/bmj.312.7037.999
  • Kawachi I., Subramanian S. V., Almeida-Filho N. (2002). A glossary for health inequalities. Journal of Epidemiology and Community Health, vol. 56, no 9, pp. 647–652. doi: 10.1136/jech.56.9.647
  • Kröger H., Pakpahan E., Hoffmann R. (2015). What causes health inequality? A systematic review on the relative importance of social causation and health selection. European Journal of Public Health, vol. 25, no 6, pp. 951–960. doi: 10.1093/eurpub/ckv111
  • Laaksonen M., Roos E., Rahkonen O., Martikainen P., Lahelma E. (2005). Influence of material and behavioural factors on occupational class differences in health. Journal of Epidemiology and Community Health, vol. 59, no 2, pp. 163–169. doi: 10.1136/jech.2003.019323
  • Lynch J. W., Smith G. D., Kaplan G. A., House J. S. (2000). Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. British Medical Journal, vol. 320, no 7243, pp. 1200–1204. doi: 10.1136/bmj.320.7243.1200
  • Macintyre S., Ellaway A., Hiscock R., Kearns A., Der G., McKay L. (2003). What features of the home and the area might help to explain observed relationships between housing tenure and health? Evidence from the west of Scotland. Health & Place, vol. 9, no 3, pp. 207–218. doi: 10.1016/S1353-8292(02)00040-0
  • Mackenbach J., de Jong J. P. (2018). Health Inequalities: an Interdisciplinary Exploration of Socioeconomic Position, Health and Causality, Amsterdam: FEAM/ALLEA Committee on Health Inequalities.
  • Mackenbach J. P., Kulhánová I., Artnik B., Bopp M., Borrell C., Clemens T., et al. (2016). Changes in mortality inequalities over two decades: register based study of European countries. British Medical Journal, vol. 353, no 1732. doi: 10.1136/bmj.i1732
  • Mackenbach J. P., Stirbu I., Roskam A. J., Schaap M. M., Menvielle G., Leinsalu M., Kunst A. E.; European Union Working Group on Socioeconomic Inequalities in Health (2008). Socioeconomic inequalities in health in 22 European countries. New England Journal of Medicine, vol. 358, no 23, pp. 2468–2481. doi: 10.1056/NEJMsa0707519
  • Mackenbach J. P., Valverde J. R., Artnik B., et al. (2018). Trends in health inequalities in 27 European countries. Proceedings of the National Academy of Sciences, vol. 115, no 25, pp. 6440–6445. doi: 10.1073/pnas.1800028115
  • Marmot M.G. (2004). The status syndrome. How social standing affects our health and longevity, New York: Henry Holt & Company.
  • Marmot M. (consortium lead) (2013). Health inequalities in the EU - Final report of a consortium, European Union: European Commission Directorate-General for Health and Consumers. doi: 10.2772/34426
  • Marmot M., Wilkinson R. G. (2001). Psychosocial and material pathways in the relation between income and health: a response to Lynch et al. British Medical Journal, vol. 322, no 7296, pp. 1233–1236. doi: 10.1136/bmj.322.7296.1233
  • Matthews K. A., Gallo L. C. (2011). Psychological perspectives on pathways linking socioeconomic status and physical health. Annual Review of Psychology, vol. 62, pp. 501–530. doi: 10.1146/annurev.psych.031809.130711
  • Matthews K. A., Gallo L. C., Taylor S. E. (2010). Are psychosocial factors mediators of socioeconomic status and health connections? A progress report and blueprint for the future. Annals of the New York Academy of Sciences, vol. 1186, no 1, pp. 146–173. doi: 10.1111/j.1749-6632.2009.05332.x
  • McDonough P., Berglund P. (2003). Histories of poverty and self-rated health trajectories. Journal of Health and Social Behavior, vol. 44, no 2, pp. 198–214. doi: 10.2307/1519808
  • McLeod J. D., Kessler R. C. (1990). Socioeconomic status differences in vulnerability to undesirable life events. Journal of Health and Social Behavior, vol. 31, no 2, pp. 162–172. doi: 10.2307/2137170
  • Moor I., Günther S., Knöchelmann A., Hoebel J., Pförtner T-K., Lampert T., Richter M. (2018). Educational inequalities in subjective health in Germany from 1994 to 2014: a trend analysis using the German Socio-Economic Panel study (GSOEP). British Medical Journal Open, vol. 8, no 6, e019755. doi: 10.1136/bmjopen-2017-019755
  • Moor I., Rathmann K., Stronks K., Levin K., Spallek J., Richter M. (2014). Psychosocial and behavioural factors in the explanation of socioeconomic inequalities in adolescent health: a multilevel analysis in 28 European and North American countries. Journal of Epidemiology and Community Health, vol. 68, no 10, pp. 912–921. doi: 10.1136/jech-2014-203933
  • Moor I., Spallek J., Richter M. (2017). Explaining socioeconomic inequalities in self-rated health: a systematic review of the relative contribution of material, psychosocial and behavioural factors. Journal of Epidemiology and Community Health, vol. 71, no 6, pp. 565–575. doi: 10.1136/jech-2016-207589
  • Pförtner T-K., Elgar F. J. (2016). Widening inequalities in self-rated health by material deprivation? A trend analysis between 2001 and 2011 in Germany. Journal of Epidemiology and Community Health, vol. 70, no 1, pp. 82–89. doi: 10.1136/jech-2015-205948
  • Ploubidis G. B., DeStavola B. L., Grundy E. (2011). Health differentials in the older population of England: an empirical comparison of the materialist, lifestyle and psychosocial hypotheses. BMC Public Health, vol. 11, 390. doi: 10.1186/1471-2458-11-390
  • Rasmussen H. N., Scheier M. F., Greenhouse J. B. (2009). Optimism and physical health: A meta-analytic review. Annals of Behavioral Medicine, vol. 37, no 3, pp. 239–256. doi: 10.1007/s12160-009-9111-x
  • Raudenbush S. W., Bryk A. S. (2002). Hierarchical Linear Models: Applications and Data Analysis Methods. 2nd ed., Thousand Oaks, California: Sage Publications.
  • Richter M., Moor I., van Lenthe F. J. (2012). Explaining socioeconomic differences in adolescent self-rated health: the contribution of material, psychosocial and behavioural factors. Journal of Epidemiology and Community Health, vol. 66, no 8, pp. 691–697. doi: 10.1136/jech.2010.125500
  • Robb K. A., Simon A. E., Wardle J. (2009). Socioeconomic disparities in optimism and pessimism. International Journal of Behavioral Medicine, vol. 16, no 4, pp. 331–338. doi: 10.1007/s12529-008-9018-0
  • Rockwood N. J. (2017). Advancing the Formulation and Testing of Multilevel Mediation and Moderated Mediation Models (MA Thesis), Columbus, Ohio: The Ohio State University.
  • Rusinova N. L., Safronov V. V. (2018). Psikhologicheskiye mediatory sotsialnykh neravenstv v zdorovye: «Uverennost v sebe» v Evrope i Rossii [The Psychological Mediators of Social Inequalities in Health: Self-efficacy in Europe and Russia]. Sociological Journal, vol. 24, no 4, pp. 30–53. doi: 10.19181/socjour.2018.24.4.6096.
  • Sacker A., Bartley M., Firth D., Fitzpatrick R. (2001). Dimensions of social inequality in the health of women in England: occupational, material and behavioural pathways. Social Science and Medicine, vol. 52, no 5, pp. 763–781. doi: 10.1016/S0277-9536(00)00176-3
  • Schmitz A. L., Pförtner T-K. (2017). Health inequalities in old age: the relative contribution of material, behavioral and psychosocial factors in a German sample. Journal of Public Health, vol. 40, no 3, e235–e243. doi: 10.1093/pubmed/fdx180
  • Schrijvers C. T., Stronks K., van de Mheen H. D., Mackenbach J. P. (1999). Explaining educational differences in mortality: the role of behavioral and material factors. American Journal of Public Health, vol. 89, no 4, pp. 535–540. doi: 10.2105/AJPH.89.4.535
  • Skalická V., van Lenthe F., Bambra C., Krokstad S., Mackenbach J. (2009). Material, psychosocial, behavioural and biomedical factors in the explanation of relative socio-economic inequalities in mortality: evidence from the HUNT study. International Journal of Epidemiology, vol. 38, no 5, pp. 1272–1284. doi: 10.1093/ije/dyp262
  • Stronks K., van de Mheen H. D., Looman C. W. N., Mackenbach J. P. (1996). Behavioural and structural factors in the explanation of socio-economic inequalities in health: an empirical analysis. Sociology of Health & Illness, vol. 18, no 5, pp. 653–674. doi: 10.1111/1467-9566.ep10934524
  • Thomson H., Thomas S., Sellstrom E., Petticrew M. (2013). Housing improvements for health and associated socio-economic outcomes. Cochrane Database Systematic Reviews, vol. 28, no 2, CD008657. doi: 10.1002/14651858.CD008657.pub2
  • Tøge A. G., Bell R. (2016). Material deprivation and health: a longitudinal study. BMC Public Health, vol. 16, 747. doi: 10.1186/s12889-016-3327-z
  • Townsend P. (1979). Poverty in the United Kingdom: a survey of household resources and standards of living, Berkeley: University of California Press.
  • Van Lenthe F. J., Brug J., Mackenbach J. P. (2005). Neighbourhood inequalities in physical inactivity: the role of neighbourhood attractiveness, proximity to local facilities and safety in the Netherlands. Social Science & Medicine, vol. 60, no 4, pp. 763–775. doi: 10.1016/j.socscimed.2004.06.013
  • Van Lenthe F. J., Gevers E., Joung I. M., Bosma H., Mackenbach J. P. (2002). Material and behavioral factors in the explanation of educational differences in incidence of acute myocardial infarction: the Globe study. Annals of Epidemiology, vol. 12, no 8, pp. 535–542. doi: 10.1016/S1047-2797(01)00279-4
  • Van Oort F. V., van Lenthe F. J., Mackenbach J. P. (2005). Material, psychosocial, and behavioural factors in the explanation of educational inequalities in mortality in The Netherlands. Journal of Epidemiology and Community Health, vol. 59, no 3, pp. 214–220. doi: 10.1136/jech.2003.016493
  • Wilkinson R. G. (1997). Socioeconomic determinants of health – Health inequalities: Relative or absolute material standards? British Medical Journal, vol. 314, no 7080, pp. 591–595. doi: 10.1136/bmj.314.7080.591
  • World Bank (2012). World Development Indicators. URL: https://databank.worldbank.org/data/ reports.aspx?source=2&series=SL.GDP.PCAP.EM.KD&country=WLD