Abstract
In high-income countries, one's relative socio-economic position and economic inequality may affect health and well-being, arguably via psychosocial stress. We tested this in a small-scale subsistence society, the Tsimane, by associating relative household wealth (n = 871) and community-level wealth inequality (n = 40, Gini = 0.15-0.53) with a range of psychological variables, stressors, and health outcomes (depressive symptoms [n = 670], social conflicts [n = 401], non-social problems [n = 398], social support [n = 399], cortisol [n = 811], body mass index [n = 9,926], blood pressure [n = 3,195], self-rated health [n = 2523], morbidities [n = 1542]) controlling for community-average wealth, age, sex, household size, community size, and distance to markets. Wealthier people largely had better outcomes while inequality associated with more respiratory disease, a leading cause of mortality. Greater inequality and lower wealth were associated with higher blood pressure. Psychosocial factors did not mediate wealth-health associations. Thus, relative socio-economic position and inequality may affect health across diverse societies, though this is likely exacerbated in high-income countries.
Highlights
It is relatively uncontroversial that people with greater access to resources – usually operationalized as income, wealth, or broader indicators of socio-economic position, rank, or status – are likely to be in better health as resources can be converted into better nutritional status, access to health care, or insulation against health risks
This corrects for random variation in the age structure of sampled communities and arguably better captures the essence of relative socio-e conomic rank: what matters is how one compares to others, relative to general trends such as wealth accumulating with age
We tested whether within-community relative wealth, community wealth, and community-level wealth inequality were associated with a broad range of psychological, social, and health outcomes in a large sample of households and communities in a relatively egalitarian small-scale subsistence society
Summary
It is relatively uncontroversial that people with greater access to resources – usually operationalized as income, wealth, or broader indicators of socio-economic position, rank, or status (used interchangeably here) – are likely to be in better health as resources can be converted into better nutritional status, access to health care, or insulation against health risks. People living in poverty are more likely to struggle to afford nutritious food, lack access to health care, or be overworked or stressed. This may make them susceptible to chronic diseases, contribute to faster aging, and shorten their lifespans. Individuals who have a lower position in the social hierarchy report worse health outcomes, regardless of their incomes It is unclear why living in an unequal society or having a lower social status contributes to poorer health
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