Observing an association between socioeconomic status (SES) and health reliably leads to the question, “What are the pathways involved?” Despite enormous investment in research on the characteristics, behaviors, and traits of people disadvantaged with respect to health inequalities, the issue remains unresolved. We turn our attention to actions of more advantaged groups by asking people to self-report their exposure to disrespect, discrimination, exclusion, and shaming (DDES) from people above them in the SES hierarchy. We developed measures of these phenomena and administered them to a cross-sectional U.S. national probability sample (N = 1,209). Consistent with the possibility that DDES represents a pathway linking SES and health, the SES→health coefficient dropped substantially when DDES variables were controlled: 112.9% for anxiety, 43.8% for self-reported health, and 49.4% for cardiovascular-related conditions. These results illustrate a need for a relational approach emphasizing the actions of more advantaged groups in shaping health inequities.

中文翻译：

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基于社会经济地位的不尊重、歧视、排斥和羞辱：健康不平等的潜在根源？

观察社会经济地位（SES）与健康之间的关联可靠地引出了一个问题：“涉及的途径是什么？”尽管对健康不平等方面弱势群体的特征、行为和特征进行了大量研究，但该问题仍未得到解决。我们通过要求人们自我报告他们受到社会经济地位等级中高于其地位的人的不尊重、歧视、排斥和羞辱（DDES）的情况，将注意力转向更有利的群体的行为。我们制定了这些现象的衡量标准，并将其应用于美国国家横截面概率样本 (N = 1,209)。与 DDES 代表连接 SES 和健康的途径的可能性一致，当 DDES 变量受到控制时，SES→健康系数大幅下降：焦虑为 112.9%，自我报告的健康为 43.8%，心血管相关疾病为 49.4%。这些结果表明需要采取一种关系方法，强调更有利群体在塑造健康不平等方面的行动。