Subjective relative deprivation is associated with poorer physical and mental health

Highlights

• Epidemiological research has linked inequality to poorer mental/physical health.

• Personal relative deprivation (PRD) is a psychological consequence of inequality.

• Little work has examined if subjective PRD is associated with health.

• We demonstrate that subjective PRD is linked with poorer individual-level health.

Abstract

Substantial epidemiological evidence has shown that income inequality and objective measures of relative deprivation are associated with poorer health outcomes. However, surprisingly little research has examined whether subjective feelings of relative deprivation are similarly linked with poorer health outcomes. The relative deprivation hypothesis suggests that inequality affects health at the individual level through negative consequences of social comparison. We directly examined the relationship between subjective feelings of personal relative deprivation and self-reported physical and mental health in a diverse community sample (n = 328). Results demonstrated that subjective feelings of personal relative deprivation are associated with significantly poorer physical and mental health. These relationships held even when accounting for covariates that have been previously associated with both relative deprivation and health. These results further support the link between relative deprivation and health outcomes and suggest that addressing root causes of relative deprivation may lead to greater individual health.

Introduction

Income inequality is an issue of great concern to citizens and governments worldwide for good reason: Income inequality has been associated with nearly every measurable social, health, and well-being issue (reviewed in Pickett and Wilkinson, 2015, Wilkinson and Pickett, 2006, Wilkinson and Pickett, 2007, Wilkinson and Pickett, 2009). Here, we (a) briefly review epidemiological evidence linking inequality, mental health, and physical health; (b) describe the relative deprivation hypothesis, which may account for an individual-level association between inequality and health; and (c) present research directly examining whether subjective feelings of relative deprivation are associated with self-reported physical and mental health at the individual level.

Substantial epidemiological evidence indicates that aggregate-level income inequality (i.e., income inequality measured at the society, nation, state/province, and community/census tract levels) affects diverse health outcomes (reviewed in Subramanian and Kawachi, 2004, Pickett and Wilkinson, 2015, Wilkinson and Pickett, 2006, Wilkinson and Pickett, 2007, Wilkinson and Pickett, 2009). Income inequality has been linked with increased obesity, mental illness, and general mortality, as well as decreased cardiovascular health and life expectancy, among other negative physical and mental health outcomes (e.g., Crepaz and Crepaz, 2004, Khan et al., 1998, Pickett and Wilkinson, 2010; reviewed in Pickett and Wilkinson, 2015, Wilkinson and Pickett, 2006, Wilkinson and Pickett, 2007, Wilkinson and Pickett, 2009). These effects have been demonstrated even when controlling for individual-level socioeconomic status and such aggregate economic measures as gross domestic product (e.g., Kawachi et al., 1997, Kennedy et al., 1998, Kawachi et al., 2002, Wilkinson, 1996; reviewed in Pickett and Wilkinson, 2015, Wilkinson and Pickett, 2009). A recent review by Pickett and Wilkinson (2015) provides evidence that the aggregate-level income inequality/health relationship meets all major criteria for causality (i.e., temporal precedence, non-spuriousness, covariation, and biological plausibility). Together, the extant evidence clearly indicates that income inequality has an important influence on physical and mental health.

The relative deprivation hypothesis (also known as the relative income hypothesis or the income inequality hypothesis) offers an explanation of the individual-level mechanisms underlying the relationship between inequality and negative outcomes at the aggregate level (e.g., Adjaye-Gbewonyo and Kawachi, 2012, Subramanian and Kawachi, 2004, Wilkinson, 1996, Wilkinson and Pickett, 2006, Wilkinson and Pickett, 2007, Wilkinson and Pickett, 2009). This hypothesis states that inequality manifests through various forms of socioeconomic comparison (especially income inequality). These various forms of socioeconomic comparison in turn undermine social cohesion, social capital, trust, and well-being more generally, eventually leading to negative psychosocial and physical outcomes (Walker and Smith, 2001, Wilkinson, 1996).

Substantial research evidence suggests that relative deprivation, as defined by individual-level socioeconomic comparison, is associated with poorer health (reviewed in Adjaye-Gbewonyo and Kawachi, 2012, Smith et al., 2012). In these studies, relative deprivation is almost always quantified through a relative statistical comparison of an individual's objective outcomes, experiences, or socioeconomic status relative to those in the population who score higher on such measures (using such indices as the Yitzhaki Index; Yitzhaki, 1979). That is, these studies involve the computation of an objective level of relative deprivation for each individual in a given sample relative to more privileged others (e.g., Eibner and Evans, 2005, Lhila and Simon, 2010). These indices of individual-level objective relative deprivation have been associated with poorer health outcomes in a number of domains, including increased mortality (Eames et al., 1993, McLoone and Boddy, 1994), suicide (McLoone, 1996), heart disease (Lawlor et al., 2005), and poorer mental health (Eibner et al., 2004, Walters et al., 2004; reviewed in Adjaye-Gbewonyo and Kawachi, 2012, Smith et al., 2012). However, no studies, to our knowledge, have examined whether the individual-level subjective experience of relative deprivation is associated with poorer physical and mental health.

Relative deprivation must necessarily manifest at the psychological level in order to influence individual level outcomes (Smith and Huo, 2014, Smith et al., 2012). Psychological relative deprivation describes subjective feelings of resentment, dissatisfaction, and anger associated with perceived deprivation of a deserved outcome relative to other persons (Bernstein and Crosby, 1980; Runciman, 1966; Smith and Huo, 2014). Surprisingly, very little research has examined whether directly measured whether subjective feelings of psychological relative deprivation are associated with health outcomes. Some individual-level studies have examined relationships between health outcomes and such non-subjective inputs as relative social status (e.g., Adler et al., 2000). Although variables like relative social status probably represent important inputs into subjective feelings of personal relative deprivation, they remain both non-subjective and domain-specific. None of the available research presents a direct test of the hypothesis that subjective personal feelings of relative deprivation are linked with individual-level physical and mental health.

The present research examined whether subjective feelings of personal relative deprivation are associated with poorer individual-level health. This research extends previous results in three important ways by: (1) directly measuring whether subjective feelings of personal relative deprivation are associated with physical and mental health in a diverse community sample, (2) using a general, non-domain specific psychological measure to assess individual differences in feelings of personal relative deprivation, and (3) examining whether individual differences in feelings of personal relative deprivation account for variance in physical and mental health above and beyond other variables that have been commonly associated with socioeconomic relative deprivation and health. We predicted that subjective feelings of personal relative deprivation would be significantly associated with self-reported physical and mental health, and would account for variance above and beyond other variables that have been previously associated with socioeconomic relative deprivation.