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January 2003, Vol 93, No. 1 | American Journal of Public Health 13
© 2003 American Public Health Association

LETTER

DALY ET AL. RESPOND

Mary C. Daly, PhD, Greg Duncan, PhD, Peggy McDonough, PhD and David R. Williams, PhD

Mary C. Daly is with the Federal Reserve Bank of San Francisco, San Francisco, Calif. Greg J. Duncan is with the Institute for Policy Research, Northwestern University, Evanston, Ill. Peggy McDonough is with the Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada. David R. Williams is with the Institute for Social Research, University of Michigan, Ann Arbor.

Correspondence: Requests for reprints should be sent to Mary C. Daly, PhD, Federal Reserve Bank of San Francisco, 101 Market St, San Francisco, CA 94105 (e-mail: mary.daly{at}sf.frb.org).

Braveman and Cubbin are correct in pointing out that the optimal indicators of socioeconomic status (SES) may vary across health outcomes and health behaviors. Indeed, we alluded to this point when we noted that "various measures of SES may summarize different components of overall health risk." We also agree that systematic evaluation of the importance of various SES measures is required before an "optimal" set can be recommended.

That said, we are more convinced than Braveman and Cubbin about the power of economic measures to predict a wide range of health outcomes and behaviors. Our assessment is based on a growing body of longitudinal research in health studies, economics, and demography evaluating the links between health and income. As in our own empirical work, researchers have found important linkages between income and mortality.1–7 Recently, scholars also have shown economic variables such as income and wealth to be important correlates of self-reported health, functional limitations, and work disability. A great deal of this research is now focused on understanding the causal pathways underlying the correlations between income, wealth, and health.

While this is not to say that economic factors are crucial for all health outcomes and behaviors, it does underscore their utility in understanding a wide range of health issues. And, as Braveman and Cubbin point out, if economic variables were regularly collected on health-based surveys, their importance could be evaluated more systematically. Given this evidence and the reliability of survey-based economic measures, we join Braveman and Cubbin in supporting the collection and use of economic variables in understanding health dynamics across various populations and over the life course.

References

1. Backlund E, Sorlie PD, Johnson NJ. A comparison of the relationships of education and income with mortality: the National Longitudinal Mortality Study. Soc Sci Med.1999;49:1373–1384.

2. Benzeval M, Judge K. Income and health: the time dimension. Soc Sci Med.2001;52:1371–1390.

3. Fiscella K, Franks P. Individual income, income inequality, health, and mortality: what are the relationships? Health Serv Res.2000;35(1, pt 2):307–318.[ISI][Medline]

4. House JS, Lepkowski JM, Kinney AM, Mero RP, Kessler RC, Herzog AR. The social stratification of aging and health. J Health Soc Behav.1994;3:213–234.

5. Lynch JW, Kaplan GA, Shema SJ. Cumulative impact of sustained economic hardship on physical, cognitive, psychological and social functioning. N Engl J Med.1997;337:1889–1895.[Abstract/Free Full Text]

6. McDonough P, Duncan GJ, Williams D, House J. Income dynamics and adult mortality in the United States, 1972 through 1989. Am J Public Health.1997;87:1476–1483.[Abstract/Free Full Text]

7. Menchik PL. Economic status as a determinant of mortality among black and white older men: does poverty kill? Popul Stud.1993;47:427–436.

8. Daly MC. The Economic Well-Being of Men With Disabilities: A Dynamic Cross-National View [dissertation]. Syracuse, NY: Syracuse University; 1994.

9. Deaton A, Paxton C. Aging and inequality in health and income. American Economic Review. May 1998;2:248–253.

10. Preston SH, Taubman P. Socioeconomic differences in adult mortality and health status. In: Martin LG, Preston SH, eds. Demography of Aging. Washington, DC: National Academy Press; 1994:279–318.




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This Article
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