The SES Health Gradient on Both Sides of the Atlantic

In this paper we investigate the size of health differences that exist among men in England and the United States and how those differences vary by Socio Economic Status (SES) in both countries. Across a wide variety of diagnosed diseases, average health status among mature men is much worse in America compared to England. A steep negative health gradient exists for men in both countries. This social health gradient is present whether education, income, or financial wealth is used as the marker of SES and, in addition, appears to be steeper in the United States. These conclusions are maintained even after controlling for a standard set of behavioral risk factors such as smoking, drinking, and obesity and are equally true using either biological measures of disease or individual self reports. In contrast to these disease based measures of health, the health of American men appears to be superior to the health of English men when self reported subjective general health status is used as the measure of health status. This apparent contradiction does not result from differences in co morbidity, emotional health, or ability to function, all of which still point to mature American men being less healthy than their English counterparts. Finally, we present preliminary data that indicate that feedbacks from new health events to household income are also one of the reasons that underlie the strength of the income gradient in health.