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Relative deprivation has previously been discussed as a possible mechanism underlying the income-health relation. The idea is that income matters to the individual’s health, over and above the increased command over resources, as the basis of social comparisons between a person and his or her reference group. The following study aimed to analyze the role of individual-level relative deprivation for all-cause mortality in the Swedish population. The Swedish context, characterized by relatively small income inequalities and promoting values as egalitarianism and equality, together with a large data material provide unique possibilities for analyzing the hypothesized mechanism.
The data used are prospective longitudinal data from the Swedish population and based on a linkage of registers. Restricting selection to individuals 25–64years, alive January 1st 1990, gave 4.7 million individuals, for whom a mortality follow-up was done over a 16-year period. The individual level relative deprivation was measured using the Yitzhaki index, calculating the accumulated shortfall between the individual’s income and the income of all other’s in the person’s reference group. All-cause mortality was used as the outcome measure.
Relative deprivation, generated through social comparisons, is one possible mechanism within the income and health relation. The present study analyzed different types of objectively defined reference groups, all based on the idea that people compare themselves to similar others. Results show relative deprivation, when measured by the Yitzhaki index, to be significantly associated with mortality. Also, we found a stronger effect among men than among women. Analyzing the association within different income strata, the effect was shown to be weak among the poorest. Revealing the importance of relative deprivation for premature mortality, over and above the effect of absolute income, these results resemble previous findings.
Relative deprivation, based on social comparisons of income, is significantly associated with premature mortality in Sweden, over and above the effect of absolute income. Also, it was found to be more important among men, but weak among the poorest.
Income enables people to purchase the goods and services they need to maintain health – e.g. food, clothing, shelter. Consequently, lack of income (or income poverty) is associated with worse health status . Beyond this direct relationship between income and command over resources, researchers have posed the question of whether an individual’s income relative to other people’s income might also influence his/her level of health. Broadly speaking, the relative income hypothesis has been empirically examined in two streams of research. One stream has sought to test the relationship between aggregate income distribution and health [2,3]. Researchers belonging to this school have been interested in answering the question of whether an individual with a given level of income would experience different health outcomes depending on the distribution of incomes of other people living in the same society. A meta-analysis of 28 multi-level studies suggests that there is a “contextual” effect of income inequality on poor health that is independent of an individual’s level of income. On average, a 0.05 unit increase in the Gini coefficient (a standard measure of income inequality) is associated with roughly an 8\% increase in the risk of mortality . However, how these studies should be interpreted continues to be debated, owing to the possibility of residual confounding by the unobserved characteristics of societies that have high or low income dispersion.
A second stream of research on the relative income hypothesis has sought to focus on the individual-level relationships between the concept of “relative deprivation” and health status. The theory of relative deprivation dates back to WG Runciman , who argued that having less income relative to some comparison (or reference) group can lead to feelings of f