Socio-economic health inequalities: Their origins and implications

Abstract

Evidence attests to substantial variations in health contingent on socioeconomic position. It is argued that these effects cannot be dismissed as artefact nor can they be explained, in the main, by either social selection or an unequal distribution of accepted behavioural risk factors among different social groups. The most likely explanation would seem to be social causation. However, it is continuing social and material inequality that appears most implicated; accounts which locate the effects in childhood social and material causes are far less compelling. The persistence of socioeconomic health differentials into the materially better-off social strata and the possible determining role of relative as well as absolute living standards suggest that psychological, in addition to material, variables are likely to be involved. Isolating the key psychological variables and identifying the nature of their influences will not be easy tasks, although social relations, psychological stress, uplifts, and control have emerged as possible candidates. However, psychological mediators of this sort most probably constitute surface rather than basic causes. Socio-economic inequality, it is contended, remains the basic cause, and, as such, the proper target for intervention. Psychological interventions are unlikely to yield much in the way of dividends in this context and indeed could inadvertently contribute to victim blaming.     

Risk factors for psychological morbidity in women attending a one-stop diagnostic clinic with suspected breast disease

Abstract

The present study was designed to identify risk factors for psychological morbidity in women attending a one-stop diagnostic clinic with suspected breast disease. A cohort of 158 women were recruited and were asked to complete scales measuring psychological morbidity and psychosocial factors in the period immediately before their appointment and to repeat the assessments of psychological morbidity on the day of the appointment. Relevant clinical and demographic data were also collated. Within the cohort 1.4% of respondents received a diagnosis of malignant disease. Psychological morbidity, both prior to and during the diagnostic appointment was strongly predicted by psychosocial factors (i.e., acceptance-resignation coping, personal self esteem and discrepancies in social support), accounting for 54% and 63% of the variance at pre-appointment and appointment day phases respectively. Other measured variables were found not to be correlated with and/or to account for a significant proportion of the variance in the measures of morbidity. These results suggest that these psychosocial variables should be targeted in interventions designed to reduce psychological morbidity in this patient group.     

Interrelationships between Reading Disability and Attention-Deficit/Hyperactivity Disorder

Evidence from a number of investigations suggests a considerable overlap between reading disability (RD) and attention deficit-hyperactivity disorder (ADHD). We investigate the relationship between RD and ADHD in a cohort of 186 children 7.5–9.5 years of age, recruited explicitly to address classification and definitional issues in these disorders. Using multivariate methods, we examine the hypothesis that RD and ADHD represent separate diagnostic entities that frequently co-occur in the same individual. The results suggest that RD is characterized by deficits within the language system, in particular a subcomponent within that system, phonological processing; in contrast, such linguistic deficits are not characteristic of ADHD unless ADHD is associated with RD. When children with both RD and ADHD are examined, both the linguistic deficits associated with RD and the behavioral characteristics associated with ADHD are apparent, but these deficits are not synergistic. We conclude that RD and ADHD represent separate disorders that frequently co-occur.     

State Aid to Religiously Affiliated,Non-Public Schools: An Emerging Trend or Same Old Same Old?

This article reviews judicial attitudes with regard to the constitutionality of aid for children in religiously affiliated non-public schools. The first part highlights the extent to which the Supreme Court appears to have turned the corner in its willingness to examine the effective use of resources in regular education rather than just the acceptability of aid. The second section reviews how Congressional and regulatory activities have contributed to lower court decisions that continue to focus on the narrow issues of how much money can be spent and the appropriate locations for the delivery of services to children who attend religiously affiliated non-public schools rather than the quality of education that they may be eligible to receive. Given the distinctions between the ways in which children in religiously affiliated non-public schools are treated based on whether they have disabilities, this article examines recent legal trends in considering whether there will be a new era in providing children who attend religiously affiliated non-public schools with the state aid that they deserve.     

The Relation of Lifetime Cognitive Activity and Lifetime Access to Resources to Late-life Cognitive Function in Older African Americans

ABSTRACT

Research in older Caucasians has demonstrated that cognitive activity is related to cognitive function in late adulthood. Knowledge of this association is limited in older minority populations. We examined the relation of cognitive activity and access to cognitive resources, with cognitive function in a group of 108 older African Americans. We constructed two scales to measure the frequency of cognitive activity and the presence of resources that promote cognitive activity during early and late life. Both measures had high internal consistency and the cognitive activity scale had adequate temporal stability over a 4-week interval. In analyses that controlled for age and education, more frequent lifetime cognitive activity was related to current cognitive function, but lifetime cognitive resources only approached significance. The results suggest that both measures are psychometrically sound in a minority population and that lifetime cognitive activity may contribute to current cognitive function in African Americans.     

Type 2 Diabetes Mellitus and Cognitive Performance in a Population-Based Sample of the Oldest Old: Impact of Comorbid Dementia

We examined the relationship between type 2 diabetes mellitus and cognitive function in a population-based sample of very old people. The sample comprised 338 persons, aged 80-93 years (mean age 83.5 years), of whom 70 persons had type 2 diabetes mellitus. Measures of cognitive functioning included tests of perceptual speed, visuo-spatial ability, inductive reasoning, short-term memory, semantic memory, episodic memory, and the Mini-Mental State Examination. Regression analyses showed that type 2 diabetes mellitus duration was related to test performance across all cognitive domains, with the exception of short-term memory, such that longer duration was associated with lower test performance. When cases with dementia were excluded from the sample, further analyses showed that diabetes duration was not associated with cognitive test performance. This indicates that diabetes is not related to lower cognitive function in the general population of non-demented old people. Diabetes, however, increases the risk for cerebrovascular incidents, like stroke, that may contribute to vascular dementia.     

Anticipating the Societal Challenges of Nanotechnologies

“In this article we sketch out the landscape for this Special Issue on anticipating and embedding the societal challenge of nanotechnologies. Tools that actors may choose to employ for these processes are articulated, and further explored through the introduction of the seven articles which comprise this Issue. Taken together, these articles create a cogent narrative on the societal challenges posed by nanotechnologies. They are drawn together by three distinct themes, each of which is briefly considered within this context of this Introductory article”.     

Information underpinning anticipation of goal-directed throwing

We identified the information used to anticipate throw direction in handball. In two experiments, we examined how anticipation performance is affected when the information from one of five body areas (right arm, shoulders, hips, trunk, or total throw side) was either neutralized or decoupled from the motion of other body segments. In the first experiment, performance was significantly reduced when information from the throwing arm was neutralized, irrespective of skill levels. Skilled participants were negatively affected when the shoulders, hips, and trunk were neutralized, whereas less-skilled participants showed trends toward improvement under identical conditions. In the second experiment, partially disrupting relative motion via decoupling was not enough to reduce the anticipation performance among skilled participants to chance levels, whereas less-skilled participants lost their ability to anticipate in three conditions. Our findings suggest that skilled and less-skilled participants employ different information extraction strategies, yet information from the throwing arm is critical to anticipation for both groups. The two experiments suggest that relative motion mediated by both the absolute displacement trajectories of individual marker locations and their relative timings are important in informing anticipation, irrespective of skill level.     

The Role of Psychological Climate in Neutralizing the Effects of Organizational Politics on Work Outcomes

The present study examined the moderating impact of psychological climate on the relationship between perceived organizational politics and both commitment and turnover intent. Data were gathered from 131 restaurant employees who completed surveys at work. Confirmatory factor analysis revealed that a 6-factor conceptualization (supportive management, role clarity, contribution, recognition, self-expression, and challenge) provided the most adequate model representation of the psychological climate construct. Results indicate that politics perceptions interacted with each climate factor (with the exception of challenge) in predicting commitment. Conversely, politics perceptions interacted only with supportive management and self-expression to predict turnover intent. Implications for theoretical development and empirical research in this domain are provided.     

Explanatory Style and Health: Mechanisms Linking Pessimism to Illness1

This study tests the relationship between pessimistic explanatory style and illness with questionnaire data. Questionnaires were administered to 234 college students at a mid‐sized Western university. Four variables were tested as potential mediators of the pessimistic explanatory style/illness relationship: symptoms of depression, perceived stress, social support, and poor health practices. Results indicated that only the global dimension of pessimistic explanatory style was related to experiences of illness, and hence was the only dimension that could be mediated by the proposed variables. Results demonstrated that symptoms of depression mediated the relationship between global attributions for negative events and illness. Exploratory analyses also suggest that stress is implicated in this process such that it increases symptoms of depression, which in turn influence illness.