This document discusses the relationship between socioeconomic status and health in the United States. It begins by outlining the agenda to focus on socioeconomic status and class inequity, and how these relate to health. It then provides examples of quotes highlighting the impact of wealth concentration and the separation of those with resources from those without. The document goes on to present data on social class representations in media, differences in social class experiences, healthcare access and outcomes between racial groups, and consequences of class divisions such as in education, social support, environmental exposures, and lifespan. It emphasizes that socioeconomic factors and institutionalized racism contribute significantly to health inequities in the United States.

1. IS IT ALL ABOUT THE GOLD?:
SOCIOECONOMIC STATUS & HEALTH IN
THE UNITED STATES

2. AGENDA
• Focus on socioeconomic status
• In particular pay attention to both the results of class
inequity and to the origin of class inequity
• Highlight how socioeconomic factors relate to health

6. SMART | QUOTES
Abraham
Lincoln (1864)
• "As a result of the war, corporations have been
enthroned and an era of corruption in high places
will follow, and the money power of the country
will endeavor to protect its reign by working upon
the prejudices of the people until all wealth is
aggregated in a few hands and the Republic is
destroyed.”
Henry David
Thoreau, Walden
(1854)
• "Superfluous wealth can buy superfluities only."
Mr. Spock
• "This troubled planet is a place of the most
violent contrasts. Those that receive the rewards
are totally separate from those who shoulder the
burdens. It is not a wise leadership.”

7. SOCIAL CLASS | MEDIA
Group Think
(Roles: Captain, Moderator, & Recorder)
Q - Where do we see class represented in media
(TV or Film)?
1. Elite
2. Middle class
3. Working Class
4. Poor

8. SMALL GROUP | DISCUSSION
1. What’s your earliest memory of class
differences?
2. What activities do we associate with:
a) Upper class or social elite?
b) Middle class?
c) Working class & poor?
3. Have you ever done things “outside” of your
perceived socioeconomic status range?

9. I've gotten down to my last pair of shoes
Can't even win a nickel bet
Because, ah them that's got are them that
gets
And I ain't got nothin yet
I'm sneakin in and out duckin' my landlord
All I seem to do is stay in debt
Because, ah them that's got (yeah) are
them that gets
And I tell you all I ain't got nothin' yet
That old sayin them that's got are them
that gets
Is somethin I can't see
If ya gotta have somethin
Before you can get somethin
How do ya get your first is still a mystery
to me
I see folk with long cars and fine clothes
That's why they're called the smarter set
Because they manage to get
When only them that's got supposed to
get
And I ain't got nothin yet
Whoah, I tell you all
I ain't found nothing yet.
You know I just don't understand it
I can't seem to get a nickle or a dime for
a cup of coffee
I need a hamburg- in fact a hot dog
wouldn't be too bad
I would just be grateful if I could get my
hands on most anything
Ray Charles – “Them that Got”

10. THE BASICS
• Socioeconomic Status (SES)
• Socioeconomic Class (SEC)
• SES is more than mere economics, it is an indicator of where an
individual lies on the social hierarchy, and thus it serves to shape
everyday experiences in profound ways
• There is a very high correlation between SES, stress, and health
• Even when SES is factored out, institutionalized isms lead to less
quality health care for women and other Americans in “minority”
groups
• Our task….is to figure out the why and the how…and fix it!

11. SCHOOL ON A SATURDAY | SOCIAL CLASS
Social class: groups of people whose members are characterized
by relative similarities in wealth, health, ethnic identity, art, sport,
income, prestige, lifestyle, education, connections, and culture.
• Capitalist class: Only @1%, but wield the most power and control most
of the resources, CEOs, BODs, ruling class
• Upper class/Wealthy: property and home ownership, white-collar
careers, BA/MA degrees, high salaries, high health outcomes,
safe/healthy environments and schools, high wealth accumulation
• Middle-class, or what is left of it, often stands in opposition to working
class, and seeks to remove itself from “middle status”
• Working class: generally own no property, high school education, jobs
not careers, little change for upward mobility, debt, poor health
outcomes, high stress
• Poor: own no property, little to no education, low health status, high
mortality rates, likely to live in unsafe and unhealthy environments, in
danger of violence, drugs, and alcohol abuse, incarceration

12. TERMS | CONCEPTS
Social Differentiation: Categorizing people by
age, height, occupation, race, or other
personal attribute
Social Stratification: Social attributes are
ranked hierarchically (seen as superior or
inferior)
• Implies that inequality is recognized and to a large
extent accepted as expected

13. SOCIAL STRATIFICATION | DEFINED
• Structures of social inequity among groups of people is
called social stratification
• Those who possess social power and resources can control and
shape the lives of those who lack them
• Social stratification creates an oppressive sort of social
consciousness that aids in the maintenance of
structured inequalities.
• So, we think differently about each other and ourselves
• Remember, perceptions can lead to stress!
• Many Americans have a fear of a lack of adequate (or
superfluous) funds
• “Poverty consciousness” (Twist, 2003)

14. MAKE MONEY YO | CAPITALISM
• Refers to one of several economic systems that involve the
means of producing and distributing goods and services
• Based on the accumulation and investment of capital by
private individuals
• Class stratification is inherent in this system!
• Life Chances (i.e., opportunities to achieve economic
success and gain economic power) vary from one social
class to another in the social stratification system
• So, structured economic inequities, particularly when
combined with other forms of inequity, contribute to
more stress and less adequate resources for coping with
stress and health problems!

15. DOES AMERICA HAVE SOCIAL CLASSES?
In 2009, 43.6 million people
(14.3 percent) were in poverty.
In 2009, 8.8 million (11.1%
percent) families were in
poverty.
In 2009, 24.7 million (12.9
percent) of people ages 18-64
were in poverty.
In 2009, 15.5 million (20.7
percent) children under the
age of 18 were in poverty.
In 2009, 3.4 million (8.9
percent) seniors 65 and older
were in poverty.
Q – Will you
be able to
leave your
class status
after
graduation?

18. BROKE IN AMERICA
Median Family Incomes (as of 2007)
• African-American family median income $33,916
• non-Hispanic White families median income $54,920
• Asian American families is $15,600 higher than the national median income for all households.
Living in Poverty
• 24.5 percent of African-Americans
• 8.2 percent of non-Hispanic Whites
• 21.5 percent of Hispanics
• 10% of Asian Americans
Unemployment Rates
• Blacks 8%
• non-Hispanic Whites 4%
Careers
• Management, professional and related occupations
• Asian Americans 45% ; 16.6 percent Hispanics; 39.9% Whites; 34% total population.
• Service Occupations
• 24.4 Hispanics: 13.7 percent non-Hispanic Whites;

19. EDUCATION | GAP
25 years and older - high school diploma
• African American 80%
• Non-Latino Whites 89%
• Asian 86%
• 61% Hispanics
College Degrees - bachelor's degree and up
• Black women 16% ; Black men 14%
• Asian Americans 50%
• Asian Indians 64%
• 12.5 % Hispanics
• 30.5% non-Hispanic whites
• 28% of the total U.S. population had earned at least a bachelor’s degree

20. HEALTH INSURANCE RATES | NUMBERS
Employer-sponsored Health Insurance
• 49% African-Americans
• 66% non-Hispanic Whites
• Private insurance coverage rates: 75.8 percent for Vietnamese, 81.5 percent for Filipino, 84.2 percent
for Chinese and 81.3 percent for other Asian groups.
Public Health Insurance
• 23.8 percent of African-Americans
• 9 percent of non-Hispanic Whites
• 11.2 percent for Vietnamese, 4.9 percent for Filipino, 3.8 percent for Chinese and 5.5 percent for other
Asian groups.
Uninsured
• 19.5 percent of African-Americans
• 10.4 percent of non-Hispanic whites
• 32.1 percent of Hispanics
Total Insured
• Asian Americans was 83.9%
• 89.6% for the non-Hispanic White population

21. CASE STUDY | LATINO HEALTH INSURANCE RATES
Insured
• 39.1 percent of Mexicans,
• 47.3 percent of Puerto Ricans,
• 57.9 percent of Cubans,
• 45.1 percent of other Hispanic and Latino groups.
• 2004 Medicaid coverage varied among Hispanic subgroups:
• 22.4 percent of Mexicans, 29.1 percent of Puerto Ricans, 17.9 of
Cubans, and 20.8 percent of other Hispanic or Latino groups.
Without health insurance
• 37.6 percent of Mexicans, 20.4 percent of Puerto Ricans, 22.8 percent
of Cubans and 32.3 percent of other Hispanic or Latino groups.

22. HEALTH CARE | SICK CARE
Roughly 45
million Americans
have NO health
insurance
In 1990, the
figure was 35
million.
About 8.5 million
children are
uninsured
18% of workers
between 18 and
64 were uninsured
in 1997 (increase
of 15.7% over
1990)
69% white workers
were covered by
employer-sponsored
insurance, compared
with 52% of African
American workers and
44% of Latino workers

24. SOCIAL SYSTEMS | MERIT
• Meritocracy - will gain rewards based on merit
• Class relations in most Western societies are based on an
ideology in which economic success is equated with individual
ability, worth, and character
• “American Dream”
• Upward Mobility through material possesions
• Much like thinness is, in many ways
• And higher education for that matter

25. MERITOCRACY | SOCIAL LADDER
• More Americans think the poor are poor because of a lack of effort than because of
things beyond their control (including the poor!)
• Ideology of inequality
• 1) Talent + effort = level of success
• 2) Because outcome is related to individual talents & efforts, results are fair. So,
people deserve their lot in life
• Social class inequity viewed as natural, not ideological
• “Myth of meritocracy”
• This is a tough issue, but think about what we’ve learned about social
inequities so far…
• Pulling yourself up by bootstraps is tough when you have no boots!
• Also tough when social forces, including institutionalized sexism and racism,
work against you…

26. NORMALIZING | POVERTY
More Americans think the poor
are poor because of a lack of
effort than because of things
beyond their control (rather
than systemic inequalities)
Because outcome is related to
individual talents & efforts,
results are fair (normalization
of poverty)

27. CONSEQUENCES | CLASS DIVISIONS
Education:
• In 1979, the average male college
graduate earned about a third more than
the median high school graduate; by
2001, the gap had widened to 79
percent. (Economic Policy Institute,
2002-03, p. 121)
Social Support:
Access to social networks,
services
Marketing of drugs,
alcohol:
availability of guns, drugs,
booze in low SES
Environmental Stressors:
Power lines, dumps, Cell
towers, over-crowded, noise,
lack of green space
Unequal Justice:
Incarceration rates, length of
punishments, criminalizing color
Personal Safety:
Higher rates of crime, police
brutality, domestic violence
Exercise:
Low SES less likely to engage
in PA
•In 1979, the average male
college graduate earned
about a third more than the
median high school graduate;
by 2001, the gap had widened
to 79 percent. (Economic
Policy Institute, 2002-03, p.
121)

28. CLASS & RACE | DIVISIONS
• Different treatments, outcome expectations.
• Overt racist practices
• Education & Healthcare
• Safety of living conditions (dust, asbestos, lead, ground/h2o
contaminants)
• Uncertainty (psychological adaptive/coping energy)
• Unemployment/underemployment
• Nutrition, sedentary lifestyles, obesity
• For children, poor health can influence SES later on
• Lack of coping mechanisms available
Even when adjusting for SES,
institutionalized racism
contributes to health differences!

29. CONSEQUENCES | LIFESPAN
33 million Americans (including 13
million children) regularly go
hungry or can't afford balanced
meals (down 2.9 million since
1998).
The United States spends more
on medical care--13.1% of gross
domestic product--than any other
advanced industrialized society
Yet among the top 30 nations, the
US ranks 18th in female life
expectancy and 19th in male life
expectancy. The average life
expectancy for white Americans is
77.3 years. For black Americans, it
stands at 71.4 years
The most vulnerable pay the heaviest costs

30. SES, STRESS, AND HEALTH 101 (RECAP)
• As has been established, racial and ethnic minority populations in the
U.S. have higher incidences of numerous diseases, higher mortality
rates, and less access to health care
• While there are exceptions (e.g. higher SES Asian groups), this
generally holds true, and SES is one of the strongest determinants of
health.
• As well, there is a high correlation between race and SES in the U.S.,
as higher-than-norm percentages of most minority groups live below
the mean income and poverty line.

31. SOCIAL JUSTICE | SOCIAL CHANGE
 Legislation
 Accountability for those gain the most from the system
 Taxes & Accountability for the rich
 Socialized healthcare & medicine
 Grassroots Social Action
 Internet campaigns
 Moveon.org (99%)
 Change.org
 Student Movements (yes, you!)
 Marriage Equality
 Reformation of the banking system
 Caps on students loans
 Loan forgiveness for public service