Socioeconomic Status (Ses) Is
Socioeconomic status (SES) is a major determinant of most human being’s health realities. Those who have a low SES are far more prone to a number of health conditions, including diabetes, low birthweight and cancer (Adler and Newman, 2002). However, the most prevalent health risk among those with a low SES is the likelihood of getting cardiovascular disease (CVD). This is due to the fact that the chances of getting CVD increase when factors such as diet, activeness, and condition management are poorly controlled. The likelihood of these being well-controlled strongly correlate with high socioeconomic status. Women are also more likely to get cardiovascular disease than their male counterparts, making women of low socioeconomic status the most at-risk population for having cardiovascular disease.
Socioeconomic status is defined as the social standing or class of an individual. It is typically determined by three factors: an individual’s income, education, and occupation. These, in combination with one’s idea of what socioeconomic status they hold, determines a significant portion of a person’s life. One of these factors alone holds enough power to change someone’s life dramatically, whether that be in a positive or negative way. However, the three factors are all deeply intertwined, making it nearly impossible, for example, to have a positive status for one without also having positive status for the others. With a low socioeconomic status, access to healthcare becomes much harder to come by. Access and opportunities that many take for granted, such as transportation, are difficult for those in a lower SES to find. This affects both their chances of having a higher socioeconomic status and their ability to receive high quality health care.
Education is likely the most important factor in determining a person’s socioeconomic status, as it opens the door to both higher occupational and income possibilities. Besides the fact that those with education become contenders for higher level occupations with significantly higher incomes, those with educations also tend to be more knowledgeable when it comes to knowing what to do in health predicaments and how to avoid them in the first place.
Income provides access to better schooling, healthier nutrition options, better housing and the freedom to be active. These all contribute to better overall health and lower the risk of cardiovascular disease. A review in the journal Appetite noted that “people with lower incomes can afford high calorie foods, leading to an excess of calorie intake, with higher risk of becoming overweight or obese” (Claassen, Klein, Bratanova, Claes, & Corneille, 2019). Without a good income, families are less likely to be able to purchase healthy foods to avoid these symptoms of being overweight or obese. Obesity negatively affects one’s health, as being overweight increases one’s chances of getting cardiovascular disease dramatically (Claassen et al., 2019). In addition to these factors, income also ensures that an individual will be able to purchase better health insurance (Adler and Newman, 2002). In “Socioeconomic Disparities In Health: Pathways And Policies,” Adler and Newman argue that while health throughout the entire hierarchy of socioeconomic status’ can be negatively effected, those who live in poverty are the most affected by health issues by far (Adler and Newman, 2002). This is most likely because those living in poverty are unable to afford good healthcare, if any at all. This results in ridiculously expensive visits to the emergency room, because those without insurance are unable to afford a primary care doctor and have less ability to obtain, attend and pay for those appointments. As such, it is less likely that they will seek care until health issues become acute, when they are significantly more expensive to deal with as they have gotten much worse than they originally were in the first place.
On a surface level, the straightforward fact regarding occupation is simply that those who are employed have better health then those who are unemployed. However, it becomes more complicated when you look only at those who are employed and the differences among them. Among the employed, factors such as prestige, qualifications, rewards and job characteristics affect the health of those who work said jobs (Adler and Newman, 2002). Adler and Newman argue that “lower status jobs expose workers to both physical and psychological risks.” In addition to this, most people get their health insurance through their job. The better the job, the better the health insurance will be. Therefore, if an employee is injured at a lower status job, they may not have the insurance or the means to pay for it.
The three determinants of socioeconomic status greatly impact the quality of one’s life overall. This remains true when regarding the impact it has on one’s health and the quality of healthcare they receive. Unfortunately, the population of those with low SES suffer the most from disparities such as cardiovascular disease due to the fact that their lack of a positive income, education, and occupation creates a seemingly never ending cycle.
Cardiovascular disease (CVD) is the leading cause of death in the United States, accounting for almost one in four deaths overall (Gæde et al. 2003). According to Kalman and Wells (2018), around 2,200 adults in the United States die of CVD every day. They also noted that almost two million Americans live with cardiovascular disease, which can lead to myocardial infarction, strokes, heart failure, renal disease, and peripheral artery disease. There are a multitude of factors that can contribute to one’s risk of getting cardiovascular disease, including family history, diabetes, hypertension, obesity, smoking, and physical activity (Psaltopoulou et al. 2017). However, making lifestyle choices and creating habits from a young age can prevent cardiovascular disease from affecting one’s life from the start. These choices include eating a healthy diet, not taking up smoking cigarettes, keeping blood pressure at a healthy number, and managing conditions such as diabetes.
However, many people are not knowledgeable about the realities of cardiovascular disease, let alone how to prevent it. In a study by Trejo, Cross, Stephenson, & Edward, (2018) the authors contend that most “young adults demonstrate limited knowledge and poor attitudes regarding cardiovascular disease and its risk factors.” For example, those with Type Two diabetes are two to six times more likely to die from cardiovascular disease than those without (Gæde et al. 2003). If those in the diabetes population aren’t educated on how they should manage their diabetes and how they should be eating and exercising, they are at a much higher risk. Although this is especially true for those with diabetes, this remains true for all at-risk populations.
Perhaps the most astonishing statistic regarding cardiovascular disease is that it is the number one killer of women in the United States, killing more women than all cancers combined (Merz et al., 2017).While this information would seem incentive enough to take action against it, according to a study in the Journal of the American College of Cardiology, 45% of women were not even aware of the severity of the disease and were unaware of its high fatalities. These are partially due to the fact that women’s risks when it comes to CVD are higher, as women who smoke or have diabetes are at greater risk than men who do the same (Kalman and Wells, 2018). In addition to women being undereducated about the realities of cardiovascular disease, “physicians are more likely to assign a lower CVD risk category to female patients compared with risk-matched male patients, as well as underestimate the probability of CVD in women” (Merz et al., 2017). This results in women being deprived of healthcare resulting from the doctor’s unconscious bias.
Women who are of low socioeconomic status are even more vulnerable. They deal with many struggles that get in the way of receiving the most basic forms of healthcare. These include being unable to find transportation or being late due to public transportation, resulting in missed appointments. Multiple missed appointments can cause patients to be let go from the practice, making it even harder for women to find care. This phenomena can also reinforce or encourage many people’s distrust in medical professionals.
Jackson, Yang, and Zhang (2018), noted that “cardiovascular risk factors in adolescents are important because they can track into adulthood.” In a study, titled “Income Disparities and Cardiovascular Risk Factors Among Adolescents,” Many trends that contribute to factors that develop into cardiovascular disease were examined. This included examining the participants’ diets, smoking habits, weight, level of activity, pre-diabetes and diabetes variables, and other prevalent factors. Because risk factors start in adolescence, actions need to be taken in children’s lives today in order to avoid cardiovascular risks developing during childhood. One effective way to accomplish this would be to introduce legislation that requires states to educate students in elementary, middle, and high school about the risks of cardiovascular disease and how they can make easy adjustments to one’s lifestyle in order to avoid fatal heart issues in the future. By supplementing this with information about socioeconomic status and how that could additionally affect one’s future, the next generation would be significantly more knowledgeable about how to prevent cardiovascular disease and about the impact of SES inequalities in society. Adding this information to curriculum in public schools may originally be frustrating to teachers and administrators due to the fact that it takes time away from teaching curriculum that will be on state administered exams. However, to lower every student’s risk of having cardiovascular issues when they become older saves them both the physical toll and the money that they would have to pay trying to fix problems that can be be effectively solved starting at a younger age. To further the spread of information, seminars should be held at community centers and churches, where adults spend time. Having a speaker talk about how it would affect their personal lives and their communities would be extremely influential. In addition to that, free blood pressure readings and pamphlets could be offered. This would allow adults to know what risk they are at, in addition to giving them information that they could look over in the future.
Many healthcare providers are unaware of unconscious biases that they may have when treating patients that are of lower socioeconomic status and women. A positive first step to combat this is to simply make them aware of the bias that occurs so frequently. Holding mandatory seminars regarding the prevalence of unconscious biases and how they directly affect the decisions made by doctors could go far. Once they become aware, the relationships between healthcare providers and patients could be improved, as the providers would be significantly less likely to hold those biases and hinder their relationships with patients. This alone would result in the delivery of higher quality health care.
At the end of the day, knowledge is power. This remains true for both healthcare providers and for all patient populations. Without education, it is nearly impossible to have a good income and a good occupation. Comprehensive initiatives that address gaps in education and income would improve general socioeconomic status, which determines (currently) the quality of care one will receive in general, but specifically regarding cardiovascular disease especially if one is of low socioeconomic status. If patients knew the risks of cardiovascular disease and how their socioeconomic status left them exposed to the disease, they might also take more individual action to mitigate the likelihood, for example they might eat a healthier every and commit to an exercise routine.
The best and most common healthcare does not occur in the hospital. It occurs when a parent decides to add more vegetables to their child’s dinner because they saw a flyer saying that it would reduce their risk of cardiovascular disease in the future. It occurs when a person decides not to smoke a cigarette after learning about how smoking is a major risk factor for many diseases. To help those who suffer from cardiovascular disease, we must start at the root of the issues. We cannot begin at the hospitals where people of low socioeconomic status arrive too late to do anything but triage their heart issues. The risks of cardiovascular disease develop in the long term and so must be dealt with in long term ways. By dealing with cardiovascular issues in the short term, such as by putting a stent in to avoid blood clots, only the individual benefits and in ways that provide near-term relief rather than prevention. To make it worse, this benefit is sometimes short lasting and does not deal with the problem at the source, making it likely that the same person will continue to have significant heart problems. In addition to this, operations such as stents are expensive. Those who have a low socioeconomic status, who are most likely to have cardiovascular disease, are also those least able to pay for these late fixes. It is most economically, logically, and ethically beneficial to begin cardiovascular care at a young age. Instilling the importance of basic actions and habits that can positively affect people’s lives avoids expensive, emergency operations that create a temporary fix for a problem that has developed over a lifetime.
Conversations about the realities of cardiovascular disease and its correlation with socioeconomic status need to be had. Although they may at first be difficult and uncomfortable, they will eventually lead to a much healthier population. Those who are not familiar with the struggles of having a low socioeconomic status are unaware of the biases and hardships undergone by those who are of a lower status. This results in confusion and frustration coming from those of all socioeconomic status. The the only way to create a better healthcare system with a healthier population is to break down social barriers that often make stereotypes reality, allowing those of any SES to make the decisions and have the opportunities that will result in a healthy lifestyle. By breaking those barriers, every single person would have an have equal opportunity of having a life without the significant risk of cardiovascular disease. While this is by no means an easy task, teaching everyone from a young age about the risks of cardiovascular disease and how they are linked to socioeconomic status starts that essential conversation that will lead to a better, healthier future.