Special Issue on Health Inequalities Across the Life Course

Abstract

T HE articles making up this special issue were originally presented at a conference, ‘‘Health Inequalities Across the Life Course,’’ held at Penn State University in June 2004. The conference was organized by Steve Zarit and Len Pearlin and supported by a grant from the National Institute on Aging (R13 AG22994). Each of the articles is guided by both a concern with the persistent and systemic inequalities in rates of morbidity and mortality in society and by the belief that many of the important antecedents of these inequalities can be traced back to circumstances present at earlier stages of the life course. It has been recognized for many decades that health and longevity vary with the social and economic statuses of people, yet the pathways and mechanisms by which these statuses come to be associated with health and well-being at mid-life and late-life are not thoroughly understood. A central goal of the conference was to bring together the theoretical, conceptual, and research perspectives that will advance our understanding of these matters and that will serve as a spur to future research. The outstanding expertise of the contributors to this issue of the Journal of Gerontology: Social Sciences and the excellence of their scholarship provide a large step toward this goal. Although each article makes a separate and independent contribution, collectively they yield a comprehensive statement about the life-course context of health inequalities. The first paper, by Alwin and Wray, provides a useful historical and theoretical backdrop to research into health inequality. The following papers by House, Lantz, and Herd, Phelan and Link, and Almeida, Neupert, Banks, and Serido essentially lay out the epidemiological evidence for health disparities and probe their social, economic, and experiential causes. Intermingled with the social and economic influences on health are considerations of biological substrata. Rieker and Bird focus on these processes in exploring the paradox of gender differences, that is, why women live longer despite social disadvantage and higher rates of certain chronic illnesses. Biological issues are also taken up by Horwitz in his interesting examination of interpretive biases in weighing the influences on health of social and biological factors. Like gender, the meanings and definitions of race and ethnicity are socially and culturally constructed. Race and ethnicity are also statuses around which considerable health disparities have been revealed. Williams, Jackson, and Markides and Eschbach give us both updated epidemiological information about the rates of morbidity and mortality in relation to minority status, and thoughtful and penetrating analyses of the reasons for these relationships. It is evident that many of the life-course circumstances that eventually impact health arise within the institutional structures of the society. Research leaves no doubt about the importance of the economic and educational statuses in this regard, the subject matter at the center of the papers by Kahn and Fazio, Wray, Alwin, and McCammon, and Miech, Eaton, and Brennan. Together these articles provide a picture of how past and present economic hardships and educational attainments contribute to later health, especially as these factors interact with race and gender. Other life-course circumstances reflected in health and health disparities operate through conditions people encounter within the family context. The gendered division of family roles as well as the conflicts and disruptions of family relations are considered as conditions affecting the health and well-being of people in the articles by Moen and Chermack, Umberson and Williams, and Avison and Davies. A final set of articles looks at processes of cumulative adversity that are quintessentially an element of the life course and its effects on health. Cumulative adversity connotes the layering, intensification, or enlargement of the spheres of hardship that develop over a span of time. The articles by O’Rand and HamilLuker and by Wickrama and Conger demonstrate the impact of cumulative adversity on later health, while that by Hatch gives deserved attention to the conditions that protect people from adversity and its health effects. Finally, Linda George has ably and thoughtfully taken on the task of providing a wrap-up overview of the papers, identifying important themes and some promising directions for future research. It is with pleasure that we convey our thanks to the authors for their intellectually generous contributions to this special issue. We are confident that, for years to come, a large audience will benefit from their work. The Publications Committee of The Gerontological Society of America also has our gratitude for approving this project. Charles F. Longino, Jr., editor of the Journal, gave his support and encouragement of the project from beginning to end. Finally, our hats off to Jon (Joe) Hendricks, the editor of this special issue, and to the anonymous reviewers he assembled for their critiques of the papers and their excellent guidance.