Social causation versus health selection in the life course : does their relative importance differ by dimension of SES?

Abstract

A person’s socioeconomic status (SES) can affect health (social causation) and health can affect SES (health selection). The findings for each of these pathways may depend on how SES is measured. We study (1) whether social causation or health selection is more important for overall health inequalities, (2) whether this differs between stages of the life course, and (3) between measures of SES. Using retrospective survey data from 10 European countries (SHARELIFE, n = 18,734), and structural equation models in a cross-lagged panel design, we determine the relative explanatory power of social causation and health selection through childhood, adulthood, and old age. We use three ways to measure SES: First, as a latent variable capturing different aspects of SES, second as material wealth, and third as occupational skill level. Between childhood and adulthood, social causation and health selection are equally important. In the transition from adulthood to old age, social causation becomes more important than health selection, making it the dominant mechanism in old age. The three measures of SES produce similar results. Only material wealth shows a stronger effect on health (between childhood and adulthood); it is also more affected by health (between adulthood and old age) than the other measures.