COD E R E D

Income is related to economic hardship: That is the difficulty of paying the bills and buying thingsthe household needs. Economic hardship affects health in large part because of the stress associated withthe endless struggle to get by. As Mirowsky and Ross (2003) point out “People exposed to economichardship probably experience frequent, intense and prolonged activation of the physiological stressresponse, with consequences for their health” (Mirowsky & Ross, 2003, p. 86). The negative effects ofchronic or prolonged stress on health have been extensively documented (Cohen et al., 1999; Fremont &Bird, 2000; Glaser et al., 1999; Sapolsky, 1997). The stress of economic hardship leads to a sense ofpowerlessness, helplessness, failure and shame that make individuals feel at the mercy of external factorsand lowers their sense of personal control with negative influences on health behaviors and outcomes(Wilkinson, 2001).The relationship between education and health which is mediated by income has two components(Mirowsky & Ross, 2003). As we have seen, education reduces the risk of low income. But, if a householdsuffers from low-income, education can lower the risk of low income on health by aiding people to useincome effectively. According to Mirowsky and Ross (2003) people can use education as an effectivesubstitute for income. “The well-educated achieve economic well-being and physical health through higherincome, but they can and do achieve the same ends just as well through other means” (Mirowsky & Ross,2003, p. 98). Mirowsky and Ross (2003) show that, even among households with the same income andhousehold composition, education reduces the economic hardship associated with low income and that, atany given level of income, health tends to be better at higher levels of education.Mirowsky and Ross (2003) models indicate that the positive effect of income on health can beattributed to lower economic hardship measured by less trouble paying bills and buying householdnecessities (which account for 40% to 60% of income’s effect on health), lower exposure to poorneighborhoods (which accounts for about 5%), and increased sense of control that encourages healthybehaviors and reduces stress (which accounts for the remainder 35% to 55%). They also report that thedifferences in health by income decrease as education increases.Use of Medical Care. It is often believed that access to medical care explains the relationship betweenincome and health. However, much research doubts the effectiveness of medical care in accounting fordifferences in population health. Epidemiological studies have shown that the rise in life expectancy in the20th century cannot be explained by improvement in medical treatment of disease (Evans R. G. et al.,1994; McKeown, 1979; McKinlay & McKinlay, 1977). Furthermore, the contribution of medical resourcesand expenditures to differences in mortality across U.S. states and counties have been questioned (Austeret al., 1969; Miller M. K. & Stokes, 1978). Countries like the U.K. who introduced universal access tomedical care saw a reversal in the social gradient in the use of service, but did not see the socioeconomicgradient in health and survival reduce (Macintyre, 1997; Marmot M. et al., 1987; Wagstaff et al., 1991).In the U.S., low-income individuals use more medical services (Aday et al., 1980; Pincus, 1998).This is because they have more medical problems and because they have a more favorable attitudetowards the medical system (Sharp et al., 1983). Health can not be bought by buying medical services; itis produced chiefly through the benefits of education. While access to high quality medical care improvesoutcomes for a diseased individual, (Mirowsky & Ross, 2003, p. 90) conclude “Clearly, differential accessto medical care can not explain the differences in health and survival across levels of education andincome”.Employment, Occupation, and Work. Employment, occupation and work have been posited as linksbetween education and health. Better-educated people are more likely to be employed, to have jobs thatare better paid and that are more satisfying because they allow autonomy and reward creativity. Bettereducated people are more likely to be in full-time employment and less likely to be in part-timeemployment or unemployed. Education brings people into the labor force and keeps them at the highestlevel of participation: full-time employment. Mirowsky and Ross (2003) estimate that, on average, eachadditional year of education increases the odds of full-time employment by 11%, decreases the odds ofbeing unemployed by 10%, and decreases the odds of being unable to work because of disability by 23%.E-32