1 The SEP Gradient, Race, or the SEP Gradient and Race: Understanding Disparities in Child Health and Functioning Lisa Dubay, PhD, ScM The Urban Institute Academy Health Annual Research Meeting June 25, 2006

2 Gaps in Knowledge US policy and research focus is on children in poverty and not on the gradient No consistent measure of SEP Child health is usually narrowly defined Policy focus on eliminating race/ethnicity disparities

3 New Research Use a life-course developmental approach to conceptualizing child health and functioning Construct and validate a measure of SEP based on Britain's new National Statistics – Social Classification System (NS-SEC) Examine the association between SEP and child health and functioning in the context of race and ethnic disparities

4 Lifecourse Developmental Approach to Conceptualizing Child Health Elements of the human condition necessary for successful functioning and development in childhood and over the lifecourse are considered key components of child health including: Overall health status and disorders Psychological and social functioning Cognitive functioning

5 Primary Data Source Child Development Supplement to the Panel Survey of Income Dynamics Family units with children under 13 drawn from the 1997 PSID 3563 children interviewed in eligible to participate in CDS-II in participating with valid data for age, race, and SEP

6 Measuring Socio-economic Position Classification scheme adapts for use in the US Britain's newly designed and implemented National Statistics – Socio-economic Classification System (NS-SEC) Use information on employment status and occupation of the head and spouse to group households into five classes

7 Classification Scheme Class 1 - Higher managerial and professional occupations and incorporated business owners (22%) Class 2 - Lower managerial and professional occupations (23%) Class 3 - Intermediate occupations and small business owners (20%) Class 4 - Lower technical, craft, semi-routine and routine occupations (28%) Class 5 - Long term unemployed and disabled (5%)

8 Validation of SEP Measure

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10 Validation of SEP Measure

11 Distribution of SEP by Race

12 Estimation Strategy Continuous variables: Binary variables: Where: Outcome j represents each child health and functioning measure; Class c is a vector of indicator variables measuring the SEP of the child; Race r is a vector of indicator variables measuring the race of the child; Age a is a vector of indicator variables measuring the age of the individual child; and Sex is an indicator that the child is female..

13 Overall Health Status and Disorders – Excellent Health

14 Overall Health Status – Excellent Health

15 Psychological Functioning – Behavioral Problems Index

16 Cognitive Functioning – Woodcock-Johnson Tests of Achievement

17 Cognitive Functioning – Woodcock-Johnson Tests of Achievement

18 Effect of Eliminating Disparities on Population Health – General Health Status Parent ReportChild Report

19 Effect of Eliminating Disparities on Population Health – Psychological and Social Functioning

20 Effect of Eliminating Disparities on Population Health – Cognitive Functioning Woodcock-Johnson Tests of Achievement

21 Conclusions Clear evidence of an association between SEP and overall child health and disorders Particularly strong evidence of a gradient in behavioral and cognitive functioning Addressing both SEP gradients and racial/ethnic disparities is necessary to achieve an equitable distribution of population health

22 A Life-course Developmental Theory of Health Disparities SEP is causally related to general health status and psychosocial and cognitive abilities SEP directly and indirectly influences health behaviors, educational attainment, social relationships and the formal transition into the labor market The transition into the labor market is also influenced by cognitive functioning and educational attainment This transition determines additional exposures to health promoting and threatening environments that accumulate over the lifecourse SEP remains the fundamental cause of the gradient in health

23 Implications for Policy Addressing SEP and race/ethnic disparities will require a fundamental political and policy shift towards major social, educational, and economic policies as mechanisms for eliminating disparities Understanding the pathways through which SEP and race/ethnic disparities are produced is critical to their elimination