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 our attention to actions of more advantaged groups by asking people to self-report their exposure to disrespect, discrimination, exclusion, and shaming (DDES) from people above them in the SES hierarchy. We developed measures of these phenomena and administered them to a cross-sectional U.S. national probability sample (N = 1,209). Consistent with the possibility that DDES represents a pathway linking SES and health, the SES→health coefficient dropped substantially when DDES variables were controlled: 112.9% for anxiety, 43.8% for self-reported health, and 49.4% for cardiovascular-related conditions. These results illustrate a need for a relational approach emphasizing the actions of more advantaged groups in shaping health inequities.

中文翻译：

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基于社会经济地位的不尊重、歧视、排斥和羞辱：健康不平等的潜在来源？


可靠地观察社会经济地位 （SES） 与健康之间的关联会引出一个问题，“涉及哪些途径？尽管在对健康不平等方面处于不利地位的人群的特征、行为和特征的研究进行了大量投资，但这个问题仍未得到解决。我们将注意力转向更有利群体的行为，要求人们自我报告他们遭受 SES 层次结构中高于他们的人的不尊重、歧视、排斥和羞辱 （DDES） 的影响。我们开发了这些现象的测量方法，并将其应用于横断面美国国家概率样本 （N = 1,209）。与 DDES 代表连接 SES 和健康的途径的可能性一致，当 DDES 变量得到控制时，SES→健康系数大幅下降：焦虑为 112.9%，自我报告的健康状况为 43.8%，心血管相关疾病为 49.4%。这些结果表明需要一种关系方法，强调更有利群体在塑造健康不平等方面的行动。