Primary Submission Category: Socioeconomic status
SES-Based Disrespect, Discrimination and Shaming: A Potential Source of Health Inequalities?
Authors: Bruce Link Rengin Firat Junita San Garcia Shayna La Scalla Jo Phelan
Presenting Author: Bruce Link*
Observing an association between socioeconomic status (SES) and health reliably leads to the question, “What are the pathways involved?” Despite enormous investment in research on the characteristics, behaviors and traits of people disadvantaged with respect to health inequalities, the issue remains unresolved. We turn attention to actions of more advantaged groups by asking people of lower SES to self-report exposure to disrespect, discrimination, exclusion, and shaming (DDES) from people above them in the SES hierarchy. A review by Link and Garcia (2021) found very few studies of health inequalities addressing these issues and no major publicly available data sets that incorporate them. As a result, we use fundamental cause theory’s elaboration to racism and stigma and to the idea that a enduring desire to keep other people down (exploit/dominate them), in (control them), or away (exclude or segregate them) might also apply to SES health inequalities. In light of this reasoning, we developed measures of SES-based DDES and administered them to a cross-sectional US national probability sample (N= 1209). Variables assessing DDES accounted for substantial percentages of the association between SES and anxiety (100%), self-reported health (43.8 %), and cardiovascular-related conditions (49.4%). Sensitivity analyses reveal that unmeasured confounding or reverse causation processes would need to extremely large to account for the results. While this turn to a relational perspective – to what people do to each other – requires further elaboration and testing our results suggest its potential value in understanding socioeconomic inequalities in health.