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Others’ income, one’s own fate: How income inequality, relative social position and social comparisons contribute to disparities in health
Stockholm University, Faculty of Social Sciences, Department of Sociology.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis is to contribute to a greater understanding of how social inequalities in health evolve causally and to explore the missing links between social position and health in different social and economic contexts.

A premise in the thesis is that in affluent societies, not only material aspects and purchasing power linked to income and social positions are important explanations for the health of individuals, but also the relative socio-economic standards in society. The concept of relative income position was used to explore this notion across time and country contexts: A comparison of income-related health inequalities between the different welfare contexts of Sweden and Germany showed similar magnitudes in poor health. When exploring the role of absolute and relative income changes over time in Sweden, income volatility was found to influence individuals’ health.

Another aim was to explore the specific social mechanisms reflecting intra- and interpersonal social comparisons and their role for health. Subjective measures of social position were found to capture non-material aspects of social positions. Self-rated class affinity revealed strong associations with health, particularly for women. Income satisfaction, predicting mortality, was shown to be a measure that accounts for internalized reference standards regarded as meaningful by individuals.

Conceptually, the used subjective measures capture aspects of social comparisons and relative deprivation and further suggest that not the material dimension of social position alone matters for health. It is also shown that income satisfaction operates as a mediator between income position and mortality. Subjective measures such as income satisfaction and class affinity provide a plausible link in the understanding of how social inequality entails persistent effects on health and mortality.

Place, publisher, year, edition, pages
Stockholm: Department of Sociology, Stockholm University , 2014. , 74 p.
Health Equity Studies, ISSN 1651-5390 ; 19
Keyword [en]
Social inequality, health, income, subjective social position, income satisfaction, relative deprivation, Sweden, Germany
National Category
Research subject
URN: urn:nbn:se:su:diva-102669ISBN: 978-91-7447-868-6 (print)OAI: diva2:712353
Public defence
2014-05-22, Willam-Olssonsalen, Geovetenskapens hus, Svante Arrhenius väg 14, Stockholm, 10:00 (English)

At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 3: Manuscript.

Available from: 2014-04-29 Created: 2014-04-14 Last updated: 2014-04-23Bibliographically approved
List of papers
1. The relevance of objective and subjective social position for self-rated health: A combined approach for the Swedish context
Open this publication in new window or tab >>The relevance of objective and subjective social position for self-rated health: A combined approach for the Swedish context
2012 (English)In: Social Indicators Research, ISSN 0303-8300, E-ISSN 1573-0921, Vol. 111, no 1, 161-173 p.Article in journal (Refereed) Published
Abstract [en]

The study investigates the health effects of subjective class position stratified by objective social position. Four types of subjective class were analysed separately for individuals with manual or non-manual occupational background. The cross-sectionalanalysis is based on the Swedish Level-of-Living Survey from 2000 and includes 4,139 individuals. The dataset comprises information on perceived class affinity and occupational position that was combined to conduct logistic regression models on self-rated health. An inverse relationship between self-rated health and the eight combinations of objective and subjective social position was found. Lower socio-economic position was associated with poor health. The largest adverse health effects were found for lower subjective social position in combination with lower occupational position. When the covariates education, father’s occupational position and income were added to the model, adverse effects on health remained only for females. Subjective social position helps to explain health inequalities. Substantial gender differences were found. It can be assumed that subjective class position captures a wide range of perceived inequalities and therefore complements the measure of occupational position.

Subjective social position, Objective social position, Health inequalities, Self-rated health, Sweden
National Category
Health Sciences Sociology
urn:nbn:se:su:diva-68940 (URN)10.1007/s11205-011-9988-1 (DOI)000314338700008 ()
Available from: 2012-01-09 Created: 2012-01-09 Last updated: 2017-12-08Bibliographically approved
2. Income and health in different welfare contexts: A comparison of Sweden, East and West Germany
Open this publication in new window or tab >>Income and health in different welfare contexts: A comparison of Sweden, East and West Germany
2013 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 41, no 3, 260-268 p.Article in journal (Refereed) Published
Abstract [en]

Background: The aim of the present study is to explore whether the association between income and self-rated health in Sweden is similar to that in Germany. Both countries represent relatively similar economic contexts, but also different welfare traditions and historic experiences. Thus, the study compares Sweden with East Germany and West Germany in order to incorporate the aftereffects of reunification in East Germany. Methods: The association between adjusted disposable household income and self-rated health is investigated by exploring cross-sectional survey data for the year 2000. In a sequence of logistic regression models, the risk for poor self-rated health across income quintiles is analysed, controlling for educational status and occupational position. Data sources are the Swedish Level-of-Living Survey and the German Socio-Economic Panel. Results: A relationship between income and health was observed for Sweden, East Germany and West Germany, before as well as after controlling for education and occupational position. The associations were somewhat stronger for women than for men. Similar magnitudes of income-related poor health were detected across the investigated subsamples, but patterns were distinct in the three regions. The highest estimates were not always found in groups with the lowest income position. Conclusions: Given the variation in the results, we found neither advantages nor disadvantages that can be linked to the effectiveness of the welfare contexts under study. We could also not identify an income threshold for poor health across the investigated countries and settings. Nevertheless, the association between income and health persists, although the patterns vary across regional contexts.

East Germany and West Germany, relative income inequality, self-rated health, Sweden, welfare state
National Category
Sociology Health Sciences
Research subject
urn:nbn:se:su:diva-83201 (URN)10.1177/1403494812472264 (DOI)000318632100007 ()
Available from: 2012-12-05 Created: 2012-12-05 Last updated: 2017-12-07Bibliographically approved
3. Persistence and variability in income: Exploring their role in self-rated health in Swedish survey data
Open this publication in new window or tab >>Persistence and variability in income: Exploring their role in self-rated health in Swedish survey data
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The adverse relationship between income and health is well documented, but less is known of how income trajectories, i.e. downward or upward trends in income, determine health. We therefore link longitudinal income information to cross-sectional data on self-rated health and conduct logistic regression models in order to investigate income trends over time and their relationship with health.

The data, with the exception of income information, are derived from the Swedish Level-of-Living Survey 2000. The information on income was drawn from the income register covering the period 1995 to 2000. We used an age-restricted sample of those 30-64 years of age, and generated a series of models accounting for average income position, lagged income position, income decrease and increase, and annual periods in specific income positions. The analysis was conducted for men and women separately.

Apart from the overall association between income and health, we found a similar pattern when including average and lagged income in the model. The analysis of length of time in a specific income position showed substantial sex differences in poor health. Income decrease was more strongly associated with men’s poor health, whereas income increase revealed only weak associations with self-rated health.

It was shown that income changes and the time dimension of income are important for self-rated health. Self-rated health responds to decreases in absolute and relative income to a greater extent than to income gains over time. Lagged lower income position and its associations with health suggest that socio-economic disadvantages accumulate over time.

National Category
Research subject
urn:nbn:se:su:diva-102667 (URN)
Available from: 2014-04-14 Created: 2014-04-14 Last updated: 2014-04-16
4. A matter of perception: Exploring the role of income satisfaction in the income-mortality relationship in German survey data 1995-2010
Open this publication in new window or tab >>A matter of perception: Exploring the role of income satisfaction in the income-mortality relationship in German survey data 1995-2010
2013 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 99, 72-79 p.Article in journal (Refereed) Published
Abstract [en]

Individual- and community-level income has been shown to be linked to social inequalities in health and mortality. On the individual level, social comparisons and relative deprivation resulting from them have been identified as relevant mechanisms involved in the relationship between income and health, but it is mainly income-based measures of relative deprivation that have been considered in previous studies. Using income satisfaction, this study employs a perception-based indicator of relative deprivation.

The study, covering the period between 1995 and 2010, utilized the German Socio-Economic Panel. The follow-up included 11,056 men and 11,512 women at employment age 25–64. Discrete-time survival analysis with Cox regression was performed to estimate the effects of relative income position and income satisfaction on all-cause mortality.

The univariate analysis revealed an income gradient on mortality and further showed a strong association between income satisfaction and survival. After education and employment status were adjusted for, the effect of discontent with income on mortality was still present in the female sample, whereas in the male sample only the income gradient prevailed. When self-rated health was controlled for, the hazard ratios of income satisfaction attenuated and turned non-significant for both men and women while the effects of income position remained stable.

In conclusion, the findings suggest that income satisfaction and income position measure different aspects of income inequality and complement one another. Income satisfaction appeared to be a possible contributing component to the causal pathway between income and mortality.

Income satisfaction, relative income position, mortality, relative deprivation, Germany
National Category
Sociology Health Sciences
Research subject
urn:nbn:se:su:diva-94953 (URN)10.1016/j.socscimed.2013.10.017 (DOI)000329773200010 ()
Available from: 2013-10-18 Created: 2013-10-18 Last updated: 2017-12-06Bibliographically approved

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