Inequality, Wealth, and Health
Social inequality takes many forms across a society. Individuals and groups with lower socioeconomic status often have less access to education, health care, housing, safe and attractive neighborhoods, and many other resources. With less wealth, fewer resources, and less power, groups with lower socioeconomic status are at greater risk of experiencing negative impacts of social, economic, and political policies. For example, those in the lower classes are more likely to live in environments in which they are exposed to health risks. The water supply for Flint, Michigan, one of the poorest cities in the United States, was poisoned by lead contaminants after the city switched its water supply from Lake Huron to the Flint River in 2014 in order to lower costs. Although the government in Flint was aware of the issue, it did not seek a solution. The mostly lower-class citizens of Flint lacked power—such as access to lawyers and the ability to pay for lawyers—to battle decision makers higher up in the social structure. The lack of a robust response to the Flint crisis illustrates how groups and areas with less economic and social standing can experience greater negative impacts on both health and environment. Race is a factor in socioeconomic status in the United States, with white Americans and Asian Americans holding more wealth than other racial and ethnic groups. People and communities of color are more likely to be poor. Issues of race, wealth, and poverty impact people of color in multiple ways. However, poverty and low income affect people of all races and ethnicities. With less wealth, people have less social power.
Inequality can impact the health of individuals and groups and their ability to get medical care. People at the lower end of the class ladder have less access to good health care. Some people with low incomes have no access to health care. This is particularly true in the United States, where health care is mostly privatized and is based on employer-provided health insurance. Many Americans only have access to modest insurance policies that require them to pay high deductibles and copayments for doctors' visits. Often when people get sick, they simply go without care. When they require care, they go to a hospital emergency room (ER), where by law medical staff must stabilize them. This overcrowds emergency rooms, which become de facto clinics for people who lack insurance. On the other end of the spectrum, people at the higher end of the class ladder often have good health insurance policies. They are more likely to visit a doctor and receive care during the early stages of an illness. This raises the likelihood of a better health outcome. Behavior that influences health can also be linked to income inequality. Smoking, for example, is more prevalent among low-income individuals. There are complex reasons that motivate smoking, but one factor is that smoking helps people relax. Higher-income people may have more access to other forms of relaxation—they may have swimming pools or media rooms at home. They may have more time to relax than low-income people who have two or three jobs. For low-income people, smoking may be an accessible and relatively affordable form of relaxation.
Social status can impact people's health in multiple ways. American sociologists Bruce Link and Jo Phelan proposed a theory of fundamental causes of disease. The idea is that individuals of low socioeconomic status are exposed to more negative conditions, such as crime, crowded living conditions, and less healthful food. As a result, they are more likely to get chronic and acute illnesses. When they do get sick, they lack the resources those in higher SES groups possess as a means of getting better. For example, in the 1980s the Whitehall Study examined the health of British men and found a social gradient (slope) in health. With each move up the socioeconomic status scale, study subjects lived longer and experienced fewer chronic and acute illnesses. Sociologists explore the many overlapping ways that social class and SES influence physical health, mental health, and behavior that contributes to health and illness.
Class, Values, and Beliefs
In industrialized societies such as the United States, occupation is strongly associated with social standing, or social prestige. However, despite this link, sometimes people's perceived social standing does not match their income. This is known as status inconsistency, the condition of possessing some high-status and some low-status characteristics. Other factors associated with social class, besides income, are values, norms, beliefs, attitudes, and behaviors. Class traits, or markers, are the typical behaviors and norms associated with class. These may include what people choose to spend time and money on or what kinds of hobbies and avocations they enjoy. For example, NASCAR auto races tend to attract a more working-class audience, while attending a polo match is typically a more upper-class form of entertainment.
People's values do differ to some degree by class. For example, upper- and middle-class parents often cultivate their children's talents and skills by sending them to organized activities and closely monitoring their progress in school. These parents encourage individuality in their children and cater to their needs, which may encourage a sense of entitlement. A 2015 survey by the Pew Research Center shows that working-class parents often organize their children's time less and allow them more free play in unstructured environments with relatives and neighbors. Working-class parents are more likely to tell their children what to do instead of trying to reason with them. Researchers theorize that this may be linked in part to the safety of the environments where some working-class families live. In less safe environments, parents may reason that children should not question authority but rather should obey parents in order to stay safe. These children are more likely to grow up with a sense that the world has constraints that must be navigated.
While these values, norms, and beliefs begin to cross class lines, those in the upper classes will always set the norms for these characteristics of society. The power of the upper class goes beyond income and wealth, often controlling the narrative of a culture. For example, the upper classes generally decide what is considered art, or "high culture." Paintings and sculptures that are housed in museums frequented by members of the upper classes may be defined as art, while graffiti and tattoos may not qualify as art or may be considered "low culture."
Class, Wealth, and Political Affiliation
People's socioeconomic status affects the political choices they make and influence their political party affiliation to some degree. However, links between social class and political choices are complex. For example, in the United States political choices and affiliations are not neatly linked to social class. People with high levels of income and wealth often support policies that protect their wealth, such as lower taxes or fewer requirements around paying workers. This can lead them to vote for more conservative candidates, who generally promote such policies. However, wealthy Americans often also support less conservative (more liberal) social policies, such as abortion rights, same-sex marriage, and immigration. On the other end of the spectrum, people with lower incomes often favor social programs, such as Medicaid and unemployment benefits. These kinds of programs are generally supported by more liberal candidates. However, many lower-income Americans are conservative on social issues. Multiple factors, including education, income, wealth, class, race, gender, and religious beliefs, impact voting choices. Sociologists look closely at all the ways these factors can combine to influence voting patterns.
One example of the complexities of voting patterns is seen in the tendency of low-income white Americans to vote for conservative candidates. These candidates usually support business-friendly policies and oppose tax and social policies that support low-income individuals and workers. Thus the low-income white voters who support them may seem to vote against their own economic interest. Sociologists look at how various issues may play a role in these voters’ decisions. One factor is that these voters support candidates whose views on social issues align with their own. Some working-class white voters make decisions about political parties or candidates solely based on their perspective on abortion rights, for instance. This perspective is often informed by religious beliefs. Another important consideration is the extent to which these voters’ choices may stem from a desire to maintain their position in society. Many of the social issues that are important to low-income white voters are correlated with ensuring the continuation of racial hierarchies and the economic implications of these racial hierarchies. For example, conservative candidates tend to oppose affirmative action, which consists of policies designed to promote the social and economic advancement of groups who have historically been the target of discrimination, such as people of color. Conservative candidates also tend to oppose allowing increased immigration and extending rights to undocumented immigrants (immigrants who do not hold legal authorization to live and work in the country). Both affirmative action and immigration policies have the potential to change the access that different racial and ethnic groups have to education and employment. Low-income white Americans who see liberal positions on affirmative action and immigration as threatening to their economic interest are thus not voting against their own interest when they support conservative candidates. Rather, their voting patterns can be understood as a way to preserve their place in an economic hierarchy in which they hold a higher position than members of racial and ethnic groups who could benefit from expanded affirmative action or immigration policies. Some sociologists attribute this to a lack of class consciousness, or a sense of solidarity with other members of the same social class. Instead, these voters feel solidarity with others of the same religion, race, or heritage.
Another issue to consider in American voting patterns is the high percentage of eligible voters who do not vote. A 2014 survey showed that 60 percent of eligible voters did not go to the polls that year. This reflects a consistent trend in the United States. The survey also found that nonvoters have weaker party affiliation (the tendency to identify with or support a particular political party) than those who do vote. Class, education, and income levels are linked to nonvoting. In the 2014 survey, 46 percent of nonvoters were low income and 54 percent held a high school diploma or less. Younger people are also less likely to vote. The survey found that 70 percent of nonvoters in 2014 were under the age of 50 and 34 percent were under the age of 30. Socioeconomic status is clearly an important factor in not voting. However, other factors, including age, also play a role.