Abstract
Health inequalities emerge during childhood and youth, before widening in adulthood. Theorising, testing and interrupting the mechanisms through which inequalities are perpetuated and sustained is vital. Schools are viewed as settings through which inequality in young people's health may be addressed, but few studies examine the social processes via which institutional structures reproduce or mitigate health inequalities. Informed by Markham and Aveyard's theory of human functioning and school organisation, including their concept of institutional boundaries, critical theories of marketisation and the concept of micro‐political practices within schools, this paper presents analysis of student survey data (N = 9055) from 82 secondary schools in Wales. It examines the role of socioeconomic composition, social relationships at school and institutional priorities in mitigating or perpetuating health inequality. It finds that affluent schools were most unequal in terms of student health behaviours and subjective wellbeing. In relation to health behaviours, students from affluent families accrue a disproportionate benefit. For wellbeing, students from poorer families reported lower subjective wellbeing where attending more affluent schools. Student–staff relationships appear to be a key mechanism underpinning these effects: poor relationships with staff were predicted by a pupil's position within schools’ socioeconomic hierarchy and associated with worse health outcomes. That is, students from the poorest families reported better relationships with teachers where attending less affluent schools. Universal approaches engaging with these social processes are needed to reduce health inequalities.
Highlights
Multifarious indicators of health, including disability-free life years, self-rated health, subjective wellbeing and life expectancy, are positively associated with socioeconomic status (SES) (Marmot et al, 2010)
In multi-level models comprising family and school-level markers of SES (Table 2), a higher level of family affluence was significantly associated with higher levels of healthy behaviour, self-rated health and subjective wellbeing
School-level affluence was associated with better health behaviour and an association with self-rated health approached significance (p = 0.05), it did not independently predict subjective wellbeing
Summary
Multifarious indicators of health, including disability-free life years, self-rated health, subjective wellbeing and life expectancy, are positively associated with socioeconomic status (SES) (Marmot et al, 2010). The most socioeconomically disadvantaged students typically benefit least from attending socioeconomically advantaged schools, despite apparent exposure to the same resources and support structures (OECD, 2012). This perverse compositional outcome has been explained by a process termed the ‘frog-pond’ effect (Marsh & Hau, 2003; Crosnoe, 2009; Okamoto et al, 2013). Within this process, the relatively small number of poorer students located towards the lower echelons of a school’s social hierarchy amplifies the effects of socioeconomic inequality, such as adverse social comparison, stigmatisation, disengagement and psychosocial problems (Espenshade et al, 2005)
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