Improving the Epidemiological Understanding of the Dynamic Relationship Between Life Course Financial Well-Being and Health
- 80 Downloads
Purpose of Review
We posit that there are many different measures of financial well-being such as income, debt, assets, and wealth, which may have different consequences for health at different times in the life course. We frame our discussion of financial well-being within existing theories and mechanisms by which financial well-being may influence health.
We contrast the influences of “snap shot” or one point in time measures of financial well-being with those of repeated measures of financial well-being across the life course. Reviewing recent research, we show the importance of measures apart from income in understanding how financial well-being influences health.
We argue that because financial well-being is multidimensional, the salient effect of financial well-being on health may not be captured by only focusing on singular aspects of this construct. We believe that there is an impetus on epidemiologists to embrace the multidimensionality of financial well-being, which will, in turn, improve public health practice and inform health policy in a more consequentialist manner.
KeywordsEpidemiological methods Financial well-being Income Social determinants of health
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Baird S, De Hoop J, Özler B. Income shocks and adolescent mental health. J Hum Resour. 2013;48(2):370–403.Google Scholar
- 3.Feinglass J, Lin S, Thompson J, Sudano J, Dunlop D, Song J, et al. Baseline health, socioeconomic status, and 10-year mortality among older middle-aged Americans: findings from the health and retirement study, 1992–2002. J Gerontol Ser B Psychol Sci Soc Sci. 2007;62(4):S209–17.CrossRefGoogle Scholar
- 4.Knapp EA, Dean LT. Consumer credit scores as a novel tool for identifying health in urban U.S. neighborhoods. Ann Epidemiol. 2018;28(10)724–29.Google Scholar
- 5.• Golberstein E. The effects of income on mental health: evidence from the social security notch. J Ment Health Policy Econ. 2015;18(1):27 Using an instrument variable approach, this analysis examines the influence of a large increase in financial well-being in the form of a larger pension in later life. In this analysis, the author examined increases in pensions due to a change in Social Security Policy in the USA and the influence of this change on late life mental health outcomes. This analysis provides a good example of how exogenous variations in measures of financial wellbeing cold be leveraged, allowing researchers to make stronger causal inferences. PubMedPubMedCentralGoogle Scholar
- 7.Glymour MM, Avendano M, Kawachi I. Socioeconomic status and health. Soc Epidemiol. 2014;2:17–63.Google Scholar
- 10.Wolff EN. Recent trends in household wealth, 1983–2009: the irresistible rise of household debt. Rev Econ Inst. 2010;2(1).Google Scholar
- 11.Bricker J, Dettling LJ, Henriques A, et al. Changes in US family finances from 2013 to 2016: evidence from the survey of consumer finances. Fed Reserv Bull. 2017;103:1.Google Scholar
- 12.Dynan K, Elmendorf D, Sichel D. The evolution of household income volatility. BE J Econ Anal Policy. 2012;12(2).Google Scholar
- 13.Halpern-Meekin S, Greene SS, Levin E, Edin K. The rainy day earned income tax credit: a reform to boost financial security by helping low-wage workers build emergency savings. RSF. 2018.Google Scholar
- 14.DeSilver D. For most workers, real wages have barely budged for decades: Pew Research Center; 2014. p. 9.Google Scholar
- 15.• Chetty R, Grusky D, Hell M, Hendren N, Manduca R, Narang J. The fading American dream: trends in absolute income mobility since 1940. Science. 2017;356(6336):398–406 The authors show that despite an increasing Gross Domestic Product within the USA, intergenerational mobility has declined steadily since the 1940s. This trend has implications for the worsening of health outcomes related to lower financial well-being status. CrossRefPubMedGoogle Scholar
- 16.Kahn K. Reconecting work and wealth: a report from the 2017: Aspen Institute Economic Security Summit. Aspen Institute; 2018.Google Scholar
- 21.Berkman LF, Kawachi I, Glymour MM. Social epidemiology: Oxford University Press; 2014.Google Scholar
- 24.Tali E, Swift SL, Maria Glymour M, Calonico S, Jacobs DR, Jr, Mayeda ER, Kershaw KN, Kiefe C, Al Hazzouri AZ. Associations of Income Volatility with Incident Cardiovascular Disease and All-cause Mortality in a US cohort: 1990 to 2015. Circulation 2019.Google Scholar
- 25.Brody GH, Yu T, Chen E, Miller GE, Kogan SM, Beach SRH. Is resilience only skin deep? Rural African Americans’ preadolescent socioeconomic status-related risk and competence and age 19 psychological adjustment and allostatic load. Psychol Sci. 2013;24(7):1285–93.CrossRefPubMedPubMedCentralGoogle Scholar
- 29.• Willson AE, Shuey KM. Life course pathways of economic hardship and mobility and midlife trajectories of health. J Health Soc Behav. 2016;57(3):407–22 The authors examined trajectories of financial well-being and their relationship with self-rated health later in life. They found that leaving situations of economic hardship in earlier life was associated with better self-rated health in midlife than staying in economic hardship across the life course, supporting a cumulative advantage hypothesis for financial well-being and health. CrossRefPubMedGoogle Scholar
- 36.•• Marden JR, Tchetgen Tchetgen EJ, Kawachi I, Glymour MM. Contribution of socioeconomic status at 3 life-course periods to late-life memory function and decline: early and late predictors of dementia risk. Am J Epidemiol. 2017;186(7):805–14 This research examines the association between measures of socioeconomic status and financial well-being at different times in the life course and late life memory function and decline. This analysis illustrates a potential strategy for examining the relationship between financial well-being and health within the life course context using marginal structural models to account for time-dependent confounding related to the longitudinal nature of these exposures. CrossRefPubMedPubMedCentralGoogle Scholar
- 37.• Dean LT, Schmitz KH, Frick KD, et al. Consumer credit as a novel marker for economic burden and health after cancer in a diverse population of breast cancer survivors in the USA. J Cancer Surviv. 2018;12(3):306–15 Shows the relationship between consumer credit scores and self-rated health among cancer patients post diagnosis while adjusting for other measures of financial well-being. The authors found that increases in consumer credit scores were associated with increases in self-rated health, showing the utility of the consumer credit score, which tracks a different aspect of financial wellbeing than income. CrossRefPubMedPubMedCentralGoogle Scholar