Better health reports when the grass is greener on your side of the fence? A cross-sectional study in older persons

Dutch older men and women possessing many luxury goods feel in better physical and mental health compared with their worse-off counterparts. The benefit, however, only appears apparent for those in lower social classes with lower education, lower income levels, and only few basic goods. Hence, despite on average possessing fewer luxury goods, possession of many such goods substantially increase both physical and mental health outcomes in lower social classes.

For lower social classes, luxury goods might purposefully be used to compensate for their low standing in terms of educational and income levels. In their desire for status and prestige (De Botton 2004; Marmot 2004), some might tend to camouflage and mask their lower ranking by possessing luxury goods and showing them (off) to their neighbours and others in the outside world. Our findings thus seem to support the hypothesis that there is a health benefit of keeping up appearances and snobbism. The higher social classes apparently do not benefit from luxury goods. Possibly, their higher educational and income level (and related lifestyles, behaviours, and styles of communication) already provide sufficient outward manifestation of their higher status and social ranking, so there is no or less additional value of the possession of luxury goods. While Veblen initially described the conspicuous consumption as typical for the higher social classes (“leisure class”) (Veblen 2004), more recent scholars point to the possibly higher prevalence of such consumption in the poorer segments of society (Charles et al. 2007). Simultaneously, it is crude that some in lower social classes end up in poverty with severe debts, because—in their status anxiety—too many loans might be negotiated for essentially unnecessary expensive material products (European Federation of Food Banks 2009).

The results underline the importance of luxury goods for a further understanding of socioeconomic inequalities in health and how these develop. Psychosocial pathways might be important here, because the negative social comparison with others who possess more goods and who apparently better know the rules of the meritocratic rat race might result in people getting frustrated, ashamed, and depressed or hostile (Bosma 2006; De Botton 2004; Marmot 2004; Marmot and Wilkinson 2001). Some items in the luxurious goods list, such as a mobile phone and an internet connection, however, may also point to an alternative psychosocial interpretation in terms of the importance of social networks and support for health. Although the psychosocial explanation of socioeconomic inequalities in health has most often been discussed regarding the white-collar segments of society (where deprivation is uncommon, but where health inequalities are common) (Marmot and Wilkinson 2001), the current findings suggest the additional relevance of the psychosocial pathway for the lower social classes, in particular.

Several limitations need to be discussed. Firstly, all measures were self-reported and the design was cross-sectional. We should therefore acknowledge the possibility of overestimated associations and reverse causation. However, it seems somewhat awkward to assume that those with better health reports overestimated their possession of luxury goods and particularly that this happened in the lower social classes only. Another possibility that cannot be excluded is that of confounding by personality (e.g. optimism) or genetic predisposition resulting in spurious relations between luxury goods and health. But, here also, it is complicated to think about such causal (perhaps also interacting) pathways, given that these would have to be assumed to hold for the lower social classes only. As a final note, related to the self-reported health outcome, we should acknowledge the possibility that there might be a subjective health benefit only, not an “objective” health benefit. The latter possibility should be subject of further research, as is the causal pathways underlying the current cross-sectional, social class-specific findings.

Secondly, there was substantial non-response and non-respondents more often were of lower social classes and more often reported less luxury goods and worse health. For persons not participating in 2007, the mean physical and mental health outcome in 2003 was worse (mean 44.71 and 51.17, respectively) compared with the 2003 means of the persons participating in 2007 (mean 48.02 and 52.80, respectively) (P value for the difference in means: <0.001). Of the lower social classes, 42% participated in 2007, compared with 60% of the higher social classes (P value < 0.001). Furthermore, 16% of the persons with few luxury goods had missing scores on the health outcome compared with 4% of the persons with many luxury goods (P value < 0.001). It is unclear how this pattern of non-response might have affected our findings and particularly its social class-specificity. Furthermore, our 2007 means for physical (46.1; SD = 10.28) and mental functioning (51.81; SD = 9.61), when people were on average 74 years old, compares well to the mean of 50 and standard deviations of 10 in the general US population (Ware and Kosinski 2001). This further confirms the selectivity according to health and survival in our sample of elderly people. The findings can thus only be generalised to relatively healthy older survivors.

Thirdly, luxury goods and social class were of course related, but the Variance Inflation Factor (VIF) was smaller than 2 in the model with class and luxury goods included, which indicates the absence of bias due to multicollinearity (Kleinbaum et al. 1988). In both conceptual and empirical terms, the findings could still indicate that ranking of social class should include the dimension and measurement of luxury good possession, allowing further health differentiation at the bottom end of the socioeconomic spectrum (thereby avoiding floor effects). Similarly, as social class was measured between 2002 and 2004 and luxury goods were measured in 2007, the findings may also be interpreted in terms of a low social class-specific health benefit from upward social mobility. However, additionally controlling for income in 2006 (2007 data were not available) hardly affected the reported odds ratios (not tabulated) implying that social mobility is probably not the underlying mechanism. A final drawback of our measurement of social class concerns educational level which, as an ordinal level variable, was treated as an interval level one.

In conclusion, we may say that older men and women from lower social classes appear to benefit from possessing luxury goods. Despite lower chances of having the grass greener on their side of the fence, only lower social classes benefit from such possession. There might thus be a health benefit of keeping up appearances, snobbism, and “conspicuous consumption” in lower social classes. The higher social classes’ higher education and income level and related lifestyles (manifest for the outside world) are probably already sufficient to reflect their higher position in the pecking order and the resultant health benefits thereof. Simultaneously, lower social classes should probably be better informed about the financial risks of negotiating loans for spending on unnecessary material products, particularly in times of economic crisis. Further research in this field should try to further differentiate health consequences of status inconsistency and upward social mobility, to elaborate on the concept and measurement of socioeconomic ranking, and to exclude confounding and reverse causation as much as possible.