Welcome back. This is still week 2 or lecture 2.

And this is the second module or second part of a 3 part series of lecture 2. Remember for, in this first lecture we're talking about 3 ideas, why is social epidemiology difficult, the key relationship of socioeconomic status and health. And then finally the idea of multilevel phenomena. In this module we're going to talk about this key relationship of socioeconomic status, sometimes called socioeconomic position and health. I'll explain. Again there are three readings and you'll be quizzed on these readings so please get to them when you can. Okay, so socioeconomic status, it's a very slippery term. Socioeconomic status, it's really a measure, an idea of where one fits within the social system. Technically we can define it as access to resources. What kind of resources? Resources such as money. Resourches, resources such as being able to get stuff done by say knowing a lawyer, knowing a physician. Having access to these kinds of resources gives one an advantage with respect to their social health, social mates. And they can get more stuff done, they can have more money to buy a better neighborhood environment. They can have more skills to work in a cleaner, more healthy workplace. And this of course all enhances health. So socioeconomic status again sometimes called socioeconomic positions is a maker, a measure of where one fits in the social stratification system. Social stratification system, it's related to the idea of social class, but it's not exactly the same thing and scholars have debated this for a long time. There is no really good measure or perfect measure of socioeconomic status. It's a hotly debated political topic and that's why there's no solution. Keys ideas are that most every health outcome is related to SES. And this kind of idea that relationship between SES position and health, seems to be true over time and place. And it seems to be increasingly true.

As medical technology and public health infrastructure improves. That is in say the 1700s, a king could be as susceptible to a virus as a pauper. Today, that distinction is going away where, if you will, the king, or advantaged person. Has much greater access to medical care much greater access to clean environments. And here or she, therefore has a healthier life and tends to live longer. So in, if you will, contemporary times, the relationship between SES and health is strong. And we're going to discuss this idea in this module. Let's start with a simple graph. And I'm going to build the graph for you. And we'll start here with a simple axis, measuring some measure of socioeconomic status. That might be ones income, it could be a family wealth measure. It could be educational attainment. And in this simple diagram, we have low and high socioeconomic status. Now we'll add some health measure, and health could be probability of living to a hundred. It could be risk for heart disease. It could be depression. Again, low and high. So any health measure you wish. We put these two axis together, and now we have a little graph. And we're going to explore the relationship between SES and health with this graph. I want to emphasize that this is a exercise in trying to understand this key relationship. And there's tons of science behind this. And it's worth, if you want to, to explore the details. And the exceptions to the rules I'll be talking about. So here's a line mapping the relationship between SES and health. And the line, of course, is flat. What does this mean? This means that health does not depend on SES. SES can be low or high. And health doesn't change. That's not how the world seems to work, but I lay this out to you as a baseline. Many people tend to think that the relationship between SES and health looks like this.

That as people who are impoverished, who have low SES have low health. But then at some point lower middle-class, middle class whatever you want to call it, everyone has the same potential or health outcomes. So this is a step function, where we go from low SES, and then all of a sudden boom. Everyone after that everyone on the SES scale has equal or optimum health. We can change that cup point, so now, only the rich or advantaged have optimum health. But it's still the same step function. Relationship could be like this, something curvilinear in some strange fashion. This said that as SES increases, health goes up and down. That is one's lives chances, one's health quality goes up and down. Again this is interesting intellectually, but it's not how the world seems to work. This is in fact how the world seems to work. That is one increases their SES their health goes up a little bit. In other words there is a linear function here. For every increase in SES, health increases a little bit. The graph here can be on different angles, technically different slopes. So we can go back, and say oh, that's a modest slope or more steep. Depending on the disease and measure of SES, these slopes vary slightly within this range. Lets think about this minute. Here we have a person mapped just above low SES. And we draw the vertical in this case red line up to the slope. And then what we do is we draw the line over to health. And what we see is a person with moderately low SES Has moderately low health outcome. And again health outcome can be anything you wish. Risk of cancer, risk of death, depression or happiness, if you want to flip flop the scale. Here's another person, now in the green. High SES, we draw them over. And now we have the person of low, red and high, green SES. And we see the difference in their health outcomes.

That difference we can call the health gap, or health disperity. And it's a function of SES, or in other words, a function of the social system. The social system has some people at the bottom, some people at the top. And since it's related to health, we end up with a health gap. What kind of things can we imagine? We can imagine increasing the health of the lower SES person, without changing their SES. So instead of moving them up and down this slope. We move their health straight up. What kinds of things do this? Medical vaccines are the prototypical, prototypical example. Medical vaccines don't really alter the social structure, but they can improve health dramatically. We could also imagine improving the health of everyone in society by changing from, in this case the black slope to the blue. Here we moved up, everyone on the health scare without really changing any relationship between SES and health. That line is parallel to this back line, and so this is an advance for everyone. Everyone's health has improved, but of course the gap between the high and low SES people remains the same. We could also imagine altering the slope of society. Such that now the persons who are advantaged have lower health than they would have had. And the person of low advantage have better health than they would have had. This is changing the slope, and, therefore, changing the relationship between SES and health. So we start with the original health gap. We could also reduce inequality in society. We could push together the lower SES, push them up, up. And take the high SES and push them down. And then we can have a lower distribution, a lower difference in the socioeconomic straight to other given society. And of course what this does is if we map our persons, is to reduce the health gap. Now importantly this is just a theory, but this is the kind of question socia epidemiologists work on. That key relationship between socioeconomic status and health.

It's fundamental to this study in understanding of social epidemiology.