Abstract
This study examined the combined influences of national levels of socioeconomic status (SES), social capital, and rights and freedoms on population level physical and mental health outcomes. Indicators of mental health were suicide rates, alcohol consumption, and tobacco use. Indicators of physical health included life expectancy, infant mortality rates, and prevalence of HIV. Using pathway analysis on international data from a selected sample of European, North American, South American, and South Caucasus countries, similar models for mental health and physical health were developed. In the first model, the positive effects of SES and social capital on physical health were completely mediated via rights and freedoms. In the second model, the positive effect of SES on mental health was completely mediated, while the impact of social capital was partially mediated through rights and freedoms. We named the models, the “rights and freedoms gradient of health” in recognition of this latter construct’s crucial role in determining both physical and mental health.
Highlights
Understanding how social and political forces determine population health outcomes across the life cycle is an overwhelming task
Relations between socioeconomic status (SES) and health were substantial, relations between rights and freedom and health were even stronger, and our analyses indicated that rights and freedoms mediated the effects of SES rather than vice versa
Based on the World Health Organization (WHO) framework (Figure 1), we anticipated that social capital and civil society would moderate the effect of SES
Summary
Understanding how social and political forces determine population health outcomes across the life cycle is an overwhelming task. The diversity in the social and political systems that make up today’s global community makes this task even more daunting. Despite this diversity, there is one pattern that has emerged in virtually all societies, and for a wide range of outcomes: the social gradient of health (Marmot et al, 1991; Deaton, 2002; Kosteniuk and Dickinson, 2003; Wilkinson and Picket, 2009). In the context of international trends, the gradient demonstrates that poorer countries have worse health outcomes than wealthier counties (Dasgupta and Weale, 1992)
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