International Journal of Behavioral Medicine

, Volume 11, Issue 3, pp 143–151 | Cite as

Explaining the social gradient in health in canada: Using the national population health survey to examine the role of stressors



Understanding the mechanisms that explain the pervasive association between socioeconomic status and health has been identified as an important area of research. Using the 1994-1995 National Population Health Survey, this study examines whether exposure to psychosocial stressors may be one mediating mechanism of the social gradient in health. Data were obtained including indicators of socioeconomic status (SES); exposure to recent life events and chronic stressors; and self-rated health status. Results showed a clear gradient in poor self-rated health with decreasing SES. Higher exposure to stressors across several domains was also observed with decreasing SES. Exposure to stressors was further associated with poor self-rated health, above and beyond adjusting for SES. Across income adequacy groups, exposure to stressors accounted for 16% to 26% of the relationship between income group and poor self-rated health among men and for 6% to 15% among women, suggesting that exposure to psychosocial stressors may be one of the mediators underlying the higher prevalence of poor self-rated health within lower socioeconomic groups.

Key words

socioeconomic status social gradient stressors stress self-rated health 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Adler, N. E., Boyce, T., Chesney, M. A., Cohen, S., Folkman, S., Kahn, R. L., & Syme, S. L. (1994). Socioeconomic status and health: The challenge of the gradient. American Psychologist, 49(1), 15–24.PubMedCrossRefGoogle Scholar
  2. Adler, N. E., Epel, E. S., Castellazzo, G., & Ickovics, J. R. (2000). Relationship of subjective and objective social status with psychological and physiological functioning: Preliminary data in healthy white women. Health Psychology, 19(6), 586–592.PubMedCrossRefGoogle Scholar
  3. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.PubMedCrossRefGoogle Scholar
  4. Baum, A., Garofalo, J. P., & Yali, A. M. (1999). Socioeconomic status and chronic stress: Does stress account for SES effects on health? Annals of the New York Academy of Sciences, 896, 131–144.PubMedCrossRefGoogle Scholar
  5. Baum, A., & Posluszny, D. M. (1999). Health psychology: Mapping biobehavioral contributions to health and illness. Annual Review of Psychology, 50, 137–63.PubMedCrossRefGoogle Scholar
  6. Brown, G. W., & Harris, T. O. (1978). The social origins of depression. London: Tavistock.Google Scholar
  7. Brown, G. W., & Harris, T. O. (1989). Life events and illness. New York: Guilford.Google Scholar
  8. Brunner, E. (1997). Socioeconomic determinants of health: Stress and the biology of inequality. British Medical Journal, 314, 1472–1476.PubMedGoogle Scholar
  9. Cohen, S., Kaplan, G. A., & Salonen, J. T. (1999). The role of psychological characteristics in the relation between socioeconomic status and perceived health. Journal of Applied Social Psychology, 29(3), 445–468.CrossRefGoogle Scholar
  10. Davis, K. & Moore, W. E. (1945). Some principles of stratification. American Sociological Review, 10, 242–249.CrossRefGoogle Scholar
  11. Elstad, J. I. (2000). Social inequalities in health and their explanations. Oslo, Norway. Norweigian Social ResearchGoogle Scholar
  12. Evans, R. G., Barer, M. L., & Marmor, T. R. (1994). Why are some people healthy and others not? The determinants of health of populations. New York: A. de Gruyter.Google Scholar
  13. Fotinatos-Ventouratos, R., & Cooper, C. L. (1998). Social class differences and occupational stress. International Journal of Stress Management, 5(4), 211–222.CrossRefGoogle Scholar
  14. Gottlieb, N. H., & Green, L. W. (1984). Life events, social network, life-style, and health. Health Education Quarterly, 11(1), 91–105.PubMedGoogle Scholar
  15. Graham, H. (1994). When life’s a drag. London: Her Majesty’s Stationery Office.Google Scholar
  16. Hansen, M. S., Fink, P., Frydenberg, M., Oxhoj, M. (2002). Use of health services, mental illness, and self-rated disability and health in medical inpatients. Psychosomatic Medicine, 64, 668–675.PubMedCrossRefGoogle Scholar
  17. Hemingway, H., & Marmot, M. (1999). Psychosocial factors in the aetiology and prognosis of coronary heart disease. British Medical Journal, 318, 1460–1467.PubMedGoogle Scholar
  18. Holmbeck, G. N. (1997). Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: Examples from the child-clinical and pediatric psychology literatures. Journal of Clinical and Consulting Psychology, 65(4), 599–610.CrossRefGoogle Scholar
  19. Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: a review of twenty-seven community studies. Journal of Health and Social Behavior, 38(1), 21–37.PubMedCrossRefGoogle Scholar
  20. Karasek, R., & Theorell, T. (1990). Healthy work: Stress, productivity, and the reconstruction of working life. New York: Basic Books.Google Scholar
  21. Lynch, J. W., Kaplan, G. A., & Salonen, J. T. (1997). Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse. Social Science and Medicine, 44(6), 809–19.PubMedCrossRefGoogle Scholar
  22. Lynch, J. W., Davey Smith, G., Kaplan, G. A., & House, J. S. (2000). Income inequality and mortality: Importance to health of individual income, psychosocial environment, or material conditions. British Medical Journal, 320, 1200–1204.PubMedCrossRefGoogle Scholar
  23. MacFayden, A. J., MacFayden, H. J., & Prince, N. J. (1996). Economic stress and psychological well-being: An economic psychology framework. Journal of Economic Psychology, 17, 291–311.CrossRefGoogle Scholar
  24. MacKinnon, D. P., & Dwyer, J. H. (1993). Estimating mediated effectsin prevention studies. Evaluation Review, 17(2), 144–158.CrossRefGoogle Scholar
  25. Manor, O., Matthews, S., & Power, C. (2001). Self-rated health and limiting longstanding illness: Inter-relationships with morbidity in early adulthood. International Journal of Epidemiology, 30, 600–607.PubMedCrossRefGoogle Scholar
  26. Marmot, M. J., Shipley, M. J., & Rose, G. (1984). Inequalities in death: Specific explanations of a general pattern? Lancet, 1, 1003–1006.PubMedCrossRefGoogle Scholar
  27. McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171–179.PubMedCrossRefGoogle Scholar
  28. Menard, S. (2002). Applied Logistic Regression Analysis (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
  29. Pearlin, L. I. (1989). The sociological study of stress. Journal of Health and Social Behaviour, 30(3), 241–256.CrossRefGoogle Scholar
  30. Pincus, T., Callahan, L. F., & Burkhauser, R. V. (1987). Most chronic diseases are reported more frequently by individuals with fewer than 12 years of formal education in the age 18-64 United States population. Journal of Chronic Diseases, 40(9), 865–74.PubMedCrossRefGoogle Scholar
  31. Rothman, K. J., & Greenland, S. (1998). Precision and validity in epidemiologic studies. K. J. Rothman, & S. Greenland (Eds.), Modern Epidmiology (pp. 115-134). New York: Lippincott.Google Scholar
  32. Schnall, P. L., Landsbergis, P. A., & Baker, D. (1994). Job strain and cardiovascular disease. Annual Review of Public Health, 15, 381–411.PubMedCrossRefGoogle Scholar
  33. Spector, P., Zapf, D., Chen, P., & Frese, M. (2000). Why negative affectivity should not be controlled for in job stress research: Don’t throw the baby out with the bath water. Journal of Organizational Behavior, 21, 79–95.CrossRefGoogle Scholar
  34. Statistics Canada. (1996). 1994-1995 NPHS Public Use Microdata Documentation. [CD-ROM]. Ottawa: Minister of Supply and Services Canada.Google Scholar
  35. Stronks, K., van de Mheen, H., Looman, C. W., & Mackenbach, J. P. (1998). The importance of psychosocial stressors for socio-economic inequalitiesin perceived health. Social Science and Medicine, 46(4–5), 611–23.PubMedGoogle Scholar
  36. Susser, M., Hopper, K., & Watson, W. (1985). Sociology in medicine (3rd ed.). New York: Oxford University Press.Google Scholar
  37. Tambay, J.-L., & Caitlin, G. (1995). Sample design of the National Population Health Survey. Health Reports, 7(1), 29–38.PubMedGoogle Scholar
  38. Turner, R. J., Wheaton, B., & Lloyd, D. A. (1995). The epidemiology of social stress. American Sociological Review, 60(1), 104–125.CrossRefGoogle Scholar
  39. Watson, D., & Pennebaker, J. W. (1989). Health complaints, stress, and distress: Exploring the central role of negative affectivity. Psychological Review, 96(2), 234–54.PubMedCrossRefGoogle Scholar
  40. Wheaton, B. (1994). Sampling the stress universe. In W. R. Avison, & I. H. Gotlib (Eds.), Stress and mental health: Contemporary issues and prospects for the future. (pp. 77-114). New York: Plenum.Google Scholar

Copyright information

© International Society of Behavioral Medicine 2004

Authors and Affiliations

  1. 1.Institute of Population HealthUniversity of OttawaOttawa, OntarioCanada

Personalised recommendations