Abstract
During the last decade there has been a growing interest in the relation between income and health. The discussion has mostly focused on the individual's relative standing in the income distribution with the implicit understanding that the absolute level of income is not as relevant when the individual's basic needs are fulfilled. This study hypothesises relative deprivation to be a mechanism in the relation between income and health in Sweden: being relatively deprived in comparison to a reference group causes a stressful situation, which might affect self-rated health. Reference groups were formed by combining indicators of social class, age and living region, resulting in 40 reference groups. Within each of these groups a mean income level was calculated and individuals with an income below 70% of the mean income level in the reference group were considered as being relatively deprived. The results showed that more women than men were relatively deprived, but the effect of relative deprivation on self-rated health was more pronounced among men than among women. In order to estimate the importance of the effect of relative income versus the effect of absolute income, some analyses on the effect of relative deprivation on self-rated health were also carried out within different absolute income levels. When restricting the analysis to the lowest 40% of the income span the effect of relative deprivation almost disappeared. Relative deprivation may have a significant relation to health among men. However, for the 40% with the lowest income in the population the effect of relative deprivation on health is considerably reduced, possibly due to the more prominent relation between low absolute income and poor health.
Introduction
During the last decade research on the relation between income and health has been studied on both individual and ecological level, where income inequality has been shown to affect morbidity and mortality rates (Wilkinson (1992) and Wilkinson (1996); Kennedy, Kawachi, & Prothrow-Stith, 1996; Kawachi & Kennedy, 1997; Lynch & Kaplan, 1997; Wolfson, Kaplan, Lynch, Ross, & Backlund, 1999). Critique and other interpretations have been raised (Judge, 1995; Lynch, Kaplan, & Shema, 1997; Fiscella & Franks, 1997; Gravelle, 1998; Mackenbach, 2002; Osler et al., 2002) and, recently, this ecological relationship has been argued to not be valid outside the United States (Mackenbach, 2002). A Danish study analysed whether income inequality at the parish level predicted increased mortality after adjustment for individual income. Their result showed no such relation, but could confirm the inverse relation between individual income and mortality (Osler et al., 2002).
Focusing on the importance of the individual's relative standing in the income distribution more than the absolute income level (Wilkinson (1992) and Wilkinson (1996); Kennedy, Kawachi, & Prothrow-Stith, 1996; Kaplan, Pamuk, Lynch, Cohen, & Balfour, 1996) implies a mechanism of relative deprivation. Within the discussion on different pathways and interpretations within the income inequality and health relation (Kawachi & Kennedy, 1999; Lynch, Davey Smith, Kaplan, & House, 2000) the mechanism of relative deprivation has previously been mentioned (Kawachi & Kennedy, 1999), but rarely used in analyses (see, however, Lundberg & Fritzell, 1994). This study aims to explore the mechanism of relative deprivation when analysing the income–health relation.
Conclusion
The aim of the study was to explore the mechanism of relative deprivation and to analyse whether it contributes in explaining the relation between income and health. Our results show significant differences between relatively deprived and non-deprived men except among foreign-born men, but no statistically significant results for women. Restricting the analyses to the bottom 40% of the income distribution in the study there was no significant effect of relative deprivation on self-rated health. This way of testing relative deprivation has not been used before and included some difficulties. Relative deprivation may have a significant relation to less than good health among men. However, at the lower end of the income distribution the effect of relative deprivation on health is considerably reduced, possibly because of the more prominent association between low absolute income and poor health. Further studies developing this type of analysis may contribute to the understanding of the different pathways between income and health.
