Social Science and Medicine, 2003, vol. 57, 2
Tracing the social gradient in the health of Canadians: primary and secondary
determinants
Julie G. Kosteniuk, and Harley D. Dickinson
Department of Sociology, University of Saskatchewan, Saskatoon, Sask. S7N 5A5,
Canada
Available online 17 May 2003.
Abstract
The social gradient in heath refers to the fact that inequalities in population
health status are related to inequalities in social status. This study advances
and tests a model of the relationships between what we term primary and
secondary determinants of the social gradient in health. The primary
determinants of health include socioeconomic and demographic indicators.
Secondary determinants include stressors, control, self-esteem, social support,
and social involvement. Health status is indicated by measures of physical
health, self-reported health status, and mental distress. Data are taken from
the Canadian National Population Health (NPH) Survey (1994
?1995). The study
sample consists of 7720 men and 9269 women 15 to over 80 years of age. Using
path analysis, we found that higher household income, being retired and growing
older are significantly associated with lower stressor levels. Higher stressor
levels are associated with lower levels of control, self-esteem, and social
support. Higher income Canad ians experience greater levels of control and
social support, while older Canadians experience lower rates of social support
but higher rates of social involvement. Being employed and caring for one's
family are positively associated with better physical and self-reported health
status. Higher household income, being retired, and aging are associated with
better physical health and lower mental distress when accounting for their role
in lowering stressor levels and bolstering control, self-esteem, social support,
and social involvement. Replicating this study with future samples of the NPH
Survey should be of benefit in ascertaining whether the social gradient in
Canadians' health status shows signs of declining.
Author Keywords: Heath; Determinants; Social gradient; Stressors; NPHS; Canada
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