International Journal of Public Health

, Volume 56, Issue 4, pp 373–384 | Cite as

Income or living standard and health in Germany: different ways of measurement of relative poverty with regard to self-rated health

  • Timo-Kolja Pfoertner
  • Hans-Juergen Andress
  • Christian Janssen
Original Article

Abstract

Objectives

Current study introduces the living standard concept as an alternative approach of measuring poverty and compares its explanatory power to an income-based poverty measure with regard to subjective health status of the German population.

Methods

Analyses are based on the German Socio-Economic Panel (2001, 2003 and 2005) and refer to binary logistic regressions of poor subjective health status with regard to each poverty condition, their duration and their causal influence from a previous time point. To calculate the discriminate power of both poverty indicators, initially the indicators were considered separately in regression models and subsequently, both were included simultaneously.

Results

The analyses reveal a stronger poverty–health relationship for the living standard indicator. An inadequate living standard in 2005, longer spells of an inadequate living standard between 2001, 2003 and 2005 as well as an inadequate living standard at a previous time point is significantly strongly associated with subjective health than income poverty.

Conclusion

Our results challenge conventional measurements of the relationship between poverty and health that probably has been underestimated by income measures so far.

Keywords

Poverty Subjective health Poverty measures Living standard Income Deprivation 

References

  1. Andress HJ (1999) Living in poverty. Analyses of the behaviours of poor households with survey data. Westdeutscher, Opladen/Wiesbaden (in German)Google Scholar
  2. Andress HJ (2003) Does low income mean poverty? Some necessary extensions of poverty indicators based on economic resources. In: Krause P, Bäcker G, Hanesch W (eds) Combating poverty in Europe. The German welfare regime in practice. Ashgate, Aldershot, pp 117–130Google Scholar
  3. Andress HJ (2006) To the development of living standard and deprivation in Germany between 1996 and 2003. Vierteljahresh Wirtsch 75:131–151 (in German)CrossRefGoogle Scholar
  4. Andress HJ, Lipsmeier G (1999) Living standard depending not only on income. Results from a current study. Inf Soz Indik 21:5–9 (in German)Google Scholar
  5. Andress HJ, Lipsmeier G (2000) Research project: poverty and living standard. Circumstances in Germany. Survey in line with the first Poverty and Wealth Report. BMGS, Bonn (in German)Google Scholar
  6. Andress HJ, Lipsmeier G, Lohmann H (2001) Income, expenditures and standard of living as poverty indicators—different measures, similar results? Schmollers Jahrb 121:165–198Google Scholar
  7. Andress HJ, Krueger A, Sedlack BK (2004) Poverty and living standard. To the development of the necessary living standard in the population between 1996–2003. Circumstances in Germany. Survey in line with the second Poverty and Wealth Report. BMGS, Bonn (in German)Google Scholar
  8. Atkinson AB (1998) Poverty in Europe. Blackwell, OxfordGoogle Scholar
  9. Benzeval M, Judge K (2001) Income and health: the time dimension. Soc Sci Med 52:1371–1390PubMedCrossRefGoogle Scholar
  10. Benzeval M, Tayler J, Judge K (2000) Evidence on the relationship between low income and poor health: is the government doing enough? Fisc Stud 21:375–399CrossRefGoogle Scholar
  11. Blane D, Davey Smith G, Bartley M (1993) Social selection: what does it contribute to social class differences in health? Soc Health Illn 15:1–15CrossRefGoogle Scholar
  12. Boarini R, d’Ercole MM (2006) Measures of material deprivation in OECD Countries. OECD Social, Employment and Migration Working Papers No. 37, ParisGoogle Scholar
  13. Böhnke P, Delhey J (1999) Poverty in a multidimensional perspective. Great Britain and Germany in comparison. FS III 99-413, WZB-papers, BerlinGoogle Scholar
  14. Böhnke P, Delhey J (2001) Living standard and income poverty. A pleading for an advanced poverty research. In: Barlösius E, Ludwig-Mayerhofer W (eds) The poverty of the society (in German). Leske + Budrich, OpladenGoogle Scholar
  15. Bradshaw J, Finch N (2003) Overlaps in dimensions of poverty. J Soc Policy 32:513–525CrossRefGoogle Scholar
  16. Callan T, Nolan B, Whelan CT (1993) Resources, deprivation and the measurement of poverty. J Soc Policy 22:141–172CrossRefGoogle Scholar
  17. Citro CF, Michael RT (1995) Measuring poverty. A new approach. National Academy Press, WashingtonGoogle Scholar
  18. Deleeck H, van den Bosch K (1992) Poverty and adequacy of social security in Europe: a comparative analysis. J Eur Soc Policy 2:107–120CrossRefGoogle Scholar
  19. Delhausse B, Luttgens A, Perelman S (1993) Comparing measures of poverty and relative deprivation. An example of Belgium. J Popul Econ 6:83–102PubMedCrossRefGoogle Scholar
  20. Desai M, Shah A (1988) An econometric approach to the measurement of poverty. Oxf Econ Pap 40:505–522Google Scholar
  21. Dowler EA, Dobson BM (1997) Nutrition and poverty in Europe: an overview. Proc Nutr Soc 56:51–62PubMedCrossRefGoogle Scholar
  22. Drewnowski A, Specter SE (2004) Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr 79:6–16PubMedGoogle Scholar
  23. Farmer MM, Ferraro KF (1997) Distress and perceived health: mechanisms of health decline. J Health Soc Behav 39:298–311CrossRefGoogle Scholar
  24. Fuchs J (1995) Does the income influences health? Empirical analyses with data of the German Socio-Economic Panel. Das Gesundheitswesen 57:746–752 (in German)PubMedGoogle Scholar
  25. Grabka M (2002) The German Socio-Economic Panel (GSOEP): a forgotten data source for health reports? In: Robert Koch-Institut (ed) Health reports on working environment for Germany (in German). RKI, Berlin, pp 77–85Google Scholar
  26. Greene WH (2008) Econometrics analysis, 6th edn. Pearson, New JerseyGoogle Scholar
  27. Groh-Samberg O, Goebel J (2007) The measurement of poverty across time. Indirect and direct poverty indicators in comparison. Wirtschaftsdienst 6:397–403 (in German)CrossRefGoogle Scholar
  28. Guio AC (2009) What can be learned from deprivation indicators in Europe. Eurostat Methodologies and Working Paper, LuxembourgGoogle Scholar
  29. Gwatkin DR, Rutstein S, Johnson K, Suliman E, Wagstaff A, Amouzou A (2007) Socio-economic differences in health, nutrition, and population within developing countries. World Bank, WashingtonGoogle Scholar
  30. Hagenaars AJM, de Vos K, Zaidi M (1994) Poverty statistics in the late 1980s: research based on micro-data, theme 3, series C. Eurostat, LuxembourgGoogle Scholar
  31. Hahn RA, Eaker E, Barker ND, Teusch SM, Sosniak W, Krieger N (1995) Poverty and death in the United States—1973 and 1991. Epidemiology 6:490–497PubMedCrossRefGoogle Scholar
  32. Halleröd B (1994) A new approach to the direct consensual measurement of poverty. SPRC Discussion Paper No. 50. Social Policy Research Centre, WalesGoogle Scholar
  33. Halleröd B (1995) The truly poor: direct and indirect consensual measurement of poverty in Sweden. J Eur Soc Policy 5:111–129CrossRefGoogle Scholar
  34. Halleröd B (1996) Deprivation and poverty: a comparative analysis of Sweden and Great Britain. Acta Sociol 39:141–168CrossRefGoogle Scholar
  35. Halleröd B (2006) Sour grapes: relative deprivation, adaptive preferences and the measurement of poverty. J Soc Policy 35:371–390CrossRefGoogle Scholar
  36. Halleröd B, Larsson D (2008) Poverty, welfare problems and social exclusion. Int J Soc Welf 17:15–25Google Scholar
  37. Halleröd B, Larsson D, Ritakallio VM (2006) Relative deprivation: a comparative analysis of Britain, Finland and Sweden. J Eur Soc Policy 16:328–345CrossRefGoogle Scholar
  38. Heinzel-Gutenbrenner M (2001) Income, income poverty and health. In: Mielck A, Bloomfield K (eds) Social epidemiology. An introduction to basic principles, results and application possibilities. Juventa, Weinheim, pp 39–49 (in German)Google Scholar
  39. Helmert U, Mielck A, Shea S (1997a) Poverty, health, and nutrition in Germany. Rev Environ Health 12:159–170PubMedCrossRefGoogle Scholar
  40. Helmert U, Mielck A, Shea S (1997b) Poverty and health in West Germany. Soz Praventivmed 42:276–285PubMedCrossRefGoogle Scholar
  41. Idler EL, Benyamini Y (1997) Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 38:21–37PubMedCrossRefGoogle Scholar
  42. Jensen J, Krishnan V, Spittal M, Sathiyandra S (2003) New Zealand Living Standard: their measurement and variation, with an application to policy. Soc Policy J NZ 20:72–97Google Scholar
  43. Jensen J, Sathiyandra S, Matangi-Want M (2007) The 2004 New Zealand Living Standard Survey: what does it signal about the importance of multiple disadvantage? Soc Policy J NZ 30:110–143Google Scholar
  44. Jylhä M (2009) What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med 69:307–316PubMedCrossRefGoogle Scholar
  45. Kangas O, Ritakallio VM (1998) Different methods–different results? Approaches to multidimensional poverty. In: Andress HJ (ed) Empirical poverty research in a comparative perspective. Ashgate, Aldershot, pp 167–203Google Scholar
  46. Klocke A (2000) Poverty measurement methods. Approaches of Income, Undersupply, Deprivation and social Benefits in comparison. Z Soziol 29:313–329 (in German)Google Scholar
  47. Lampert T, Kroll LE (2006) Income differences in health and life expectancy—cross sectional and longitudinal findings of the German Socio-Economic Panel (GSOEP). Das Gesundheitswesen 68:219–230 (in German)PubMedCrossRefGoogle Scholar
  48. Layte R, Maitre B, Nolan B, Whelan CT (2001) Persistent and consistent poverty in the 1994 and 1995 waves of the European Community Household Panel Survey. Rev Income Wealth 47:427–449CrossRefGoogle Scholar
  49. Lipsmeier G (1999) The identification of a necessary living standard—appraisal differences and decision problems. Z Soziol 28:281–300 (in German)Google Scholar
  50. Lipsmeier G (2001) Potential and problems of the deprivation approach in poverty research. Arch Wiss Prax soz Arb 32:3–29 (in German)Google Scholar
  51. Lorant V, Croux CC, Weich S, Deliège D, Mackenbach J, Ansseau M (2007) Depression and socio-economic risk factors: 7-year longitudinal population study. Br J Psychiatry 190:293–298PubMedCrossRefGoogle Scholar
  52. Lynch JW, Kaplan GA, Shema SJ (1997) Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning. New Engl J Med 337:1889–1895PubMedCrossRefGoogle Scholar
  53. Mack J, Lansley S (1985) Poor Britain. Allan and Unwin, LondonGoogle Scholar
  54. Mayer SE (1993) Living conditions among the poor in four rich countries. J Popul Econ 6:261–286CrossRefGoogle Scholar
  55. Mayer SE, Jencks C (1989) Poverty and the distribution of material hardship. J Hum Resour 24:88–113CrossRefGoogle Scholar
  56. McDonough P, Berglund P (2003) Histories of poverty and self-rated health trajectories. J Health Soc Behav 44:198–214PubMedCrossRefGoogle Scholar
  57. McDonough P, Sacker A, Wiggins RD (2005) Time on my side? Life course trajectories of poverty and health. Soc Sci Med 61:1795–1808PubMedCrossRefGoogle Scholar
  58. McKay S (2004) Poverty or preferences: what do ‘consensual deprivation indicators’ really measure? Fisc Stud 25:201–223CrossRefGoogle Scholar
  59. Muffels RJA (1993) Deprivation standards and style of living indices. In: Bergham J, Cantillon B (eds) The European face of social security. Avebury, Aldershot, pp 43–59Google Scholar
  60. Muffels RJA, Bergham J, Dirven HJ (1992) A multi-method approach to monitor the evolution of poverty. J Eur Soc Policy 2:193–213CrossRefGoogle Scholar
  61. Murray S (2006) Poverty and health. Can Med Assoc J 174:923CrossRefGoogle Scholar
  62. Nielsen MJ, Juon HS, Ensminger M (2004) Preventing long-term welfare receipt: the theoretical relationship between health and poverty over the early life course. Soc Sci Med 59:2285–2301PubMedCrossRefGoogle Scholar
  63. Nolan B, Whelan CT (1996a) Resources, deprivation and poverty. Clarendon, OxfordGoogle Scholar
  64. Nolan B, Whelan CT (1996b) Measuring poverty using income and deprivation indicators: alternative approaches. J Eur Soc Policy 6:225–240CrossRefGoogle Scholar
  65. Nolan B, Whelan CT (2007) On the multidimensionality of poverty and social exclusion. In: Jenkins SP, Micklewright J (eds) Inequality and poverty re-examined. Oxford University Press, Oxford, pp 146–165Google Scholar
  66. Nolte E, McKee M (2004) Changing health inequalities in East and West Germany since unification. Soc Sci Med 58:119–136PubMedCrossRefGoogle Scholar
  67. Perry B (2002) The mismatch between income measures and direct outcome measures of poverty. Soc Policy J NZ 19:101–127Google Scholar
  68. Peters DH, Garg A, Bloom G, Walker DG, Brieger WR, Rahman MH (2008) Poverty and access to health care in developing countries. Ann NY Acad Sci 1136:161–171PubMedCrossRefGoogle Scholar
  69. Piachaud D (1987) Problems in the definition and measurement of poverty. J Soc Policy 16:147–164CrossRefGoogle Scholar
  70. Regidor E, Calle ME, Navarro P, Dominguez V (2003) Trend in the association between average income, poverty and income inequality and life expectancy in Spain. Soc Sci Med 56:961–971PubMedCrossRefGoogle Scholar
  71. Ringen S (1988) Direct and indirect measures of poverty. J Soc Policy 16:147–167Google Scholar
  72. Robine RM, Jagger C, Euro-REVES Group (2003) Creating a coherent set of indicators to monitor health across Europe—the Euro-REVES 2 project. Eur J Public Health 83:397–423Google Scholar
  73. Santana P (2002) Poverty, social exclusion and health in Portugal. Soc Sci Med 55:33–45PubMedCrossRefGoogle Scholar
  74. Shaw M, Dorling D, Davey Smith G (2006) Poverty, social exclusion, and minorities. In: Marmot M, Wilkinson RG (eds) Social determinants of health, 2nd edn. Oxford University Press, Oxford, pp 196–223Google Scholar
  75. Short KS (2005) Material and financial hardship and income-based poverty measures in the USA. J Soc Pol 34:21–38CrossRefGoogle Scholar
  76. SOEP Group (2001) The German Socio-Economic Panel (GSOEP). After more than 15 years—overview. Vierteljahresh Wirtsch 70:7–14CrossRefGoogle Scholar
  77. Stronks K, van de Mheen HD, Mackenbach JP (1998) A higher prevalence of health problems in low income groups: does it reflect relative deprivation. J Epidemiol Commun Health 52:548–557CrossRefGoogle Scholar
  78. Sturm R, Wells KB (2001) Does obesity contribute as much to morbidity as poverty or smoking? Public Health 115:229–235PubMedCrossRefGoogle Scholar
  79. Thiede M, Traub S (1997) Mutual influences of health and poverty. Evidence from German panel data. Soc Sci Med 45:867–877PubMedCrossRefGoogle Scholar
  80. Townsend P (1979) Poverty in the United Kingdom. A survey of household resources and standard of living. Penguin Books, HarmondsworthGoogle Scholar
  81. Townsend P (1987) Deprivation. J Soc Policy 16:125–146CrossRefGoogle Scholar
  82. Vetter S, Endrass J, Schweizer I, Teng HM, Rossler W, Gallo WT (2006) The effects of economic deprivation on psychological well-being among the working population of Switzerland. BMC Public Health 6:223PubMedCrossRefGoogle Scholar
  83. Wagner G, Frick JR, Schupp J (2007) The German Socio-Economic Panel Study (SOEP)—scope, evolution, and enhancements. Schmollers Jahrb 127:139–169Google Scholar
  84. Wagstaff A (2002) Poverty and health sector inequalities. Bull World Health Organ 80:97–105PubMedGoogle Scholar
  85. Walker R (1987) Consensual approaches to the definition of poverty: towards an alternative methodology. J Soc Policy 16:213–226CrossRefGoogle Scholar
  86. Whelan BJ (1993) Non-monetary indicators of poverty. In: Bergham J, Cantillon B (eds) The European face of social security. Ashgate, Avebury, Aldershot, pp 24–42Google Scholar
  87. Whelan CT, Maitre B (2006) Comparing poverty and deprivation dynamics: Issues of reliability and validity. J Econ Inequal 4:303–323CrossRefGoogle Scholar
  88. Whelan CT, Maitre B (2009) The ‘Europeanisation’ of reference groups. A reconsideration using EU-SILC. Eur Soc 11:283–309CrossRefGoogle Scholar
  89. Whelan CT, Layte R, Maitre B, Nolan B (2001) Income, deprivation, and economic strain. An analysis of the European Community Household Panel. Eur Sociol Rev 17:357–372CrossRefGoogle Scholar
  90. Whelan CT, Layte R, Maitre B (2002a) Multiple deprivation and persistent poverty in the European Union. J Eur Soc Policy 12:91–105CrossRefGoogle Scholar
  91. Whelan CT, Layte R, Maitre B (2002b) Persistent deprivation in the European Union. Schmollers Jahrb 122:31–54Google Scholar
  92. Whelan CT, Layte R, Maitre B (2003) Persistent income poverty and deprivation in the european union: an analysis of the first three waves of the European Community Household Panel. J Soc Policy 32:1–18CrossRefGoogle Scholar
  93. Whelan CT, Layte R, Maitre B (2004) Understanding the mismatch between income poverty and deprivation: a dynamic comparative analysis. Eur Soc Rev 20:287–302CrossRefGoogle Scholar
  94. Wooldridge JM (2003) Introductory econometrics. A modern approach, 2nd edn. Thomson South Western, MasonGoogle Scholar
  95. World Health Organization (1996) Health interview surveys: toward an international harmonization of methods and instruments. WHO Office for Europe, CopenhagenGoogle Scholar
  96. Zaidi SA (1988) Poverty and disease: need for structural change. Soc Sci Med 27:119–127PubMedCrossRefGoogle Scholar

Copyright information

© Swiss School of Public Health 2010

Authors and Affiliations

  • Timo-Kolja Pfoertner
    • 1
  • Hans-Juergen Andress
    • 1
  • Christian Janssen
    • 2
  1. 1.CologneGermany
  2. 2.Department of Applied Social Sciences, Hochschule MunicMunichGermany

Personalised recommendations