Lay perceptions of health and environmental inequalities and their associations to mental health

Lima, Maria Luisa; Morais, Rita

doi:10.1590/0102-311X00105714

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Artigo • Cad. Saúde Pública 31 (11) • Nov 2015 • https://doi.org/10.1590/0102-311X00105714 copy

Lay perceptions of health and environmental inequalities and their associations to mental health

Percepções leigas sobre as desigualdades na saúde e no ambiente e suas associações com a saúde mental

Percepciones laicas sobre las desigualdades enla salud y medioambiente y su relación con la salud mental

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Health inequalities are very well documented in epidemiological research: rich people live longer and have fewer diseases than poor people. Recently, a growing amount of evidence from environmental sciences confirms that poor people are also more exposed to pollution and other environmental threats. However, research in the social sciences has shown a broad lack of awareness about health inequalities. In this paper, based on data collected in Portugal, we will analyze the consciousness of both health and environmental injustices and test one hypothesis for this social blindness. The results show, even more clearly than before, that public opinion tends to see rich and poor people as being equally susceptible to health and environmental events. Furthermore, those who have this equal view of the world present lower levels of depression and anxiety. Following cognitive adaptation theory, this “belief in an equal world” can be interpreted as a protective positive illusion about social justice, particularly relevant in one of the most unequal countries in Europe.

Health Inequalities; Social Inequity; Environment

Socio-demographic variables	%
Social class
High	14.9
Medium	33.8
Low	51.3
Education
University graduation	7.5
Middle school	11.4
9th grade	10.0
6th grade	11.7
Complete elementary school	48.3
Incomplete elementary school	6.3
No education	4.9
Occupation
Retired	41.3
Operator	13.8
Employed	11.2
Housewife	7.7
Technical job	7.0
Unskilled work	7.0
Unemployed	6.5
Higher technical jobs	4.0
Student	1.4
Other	0.2
Marital status
Married	68.3
Single	14.9
Widowed	13.1
Divorced	3.7
Income (Euros)
Up to 350	7.0
Between 351 and 600	15.2
Between 601 and 750	12.4
Between 751 and 1,200	13.1
Between 1,251 and 2,000	3.5
More than 2,000	0.9
Not given	48.0

		Are rich or poor people more likely to have the following experiences?
		Rich			Both equally			Poor			Total
	n		%	n		%	n		%	n		%
Cancer
High social class	1		1.6	62		96.9	1		1.6	64		100.0
Medium social class				141		97.2	4		2.8	145		100.0
Low social class				217		98.6	3		1.4	220		100.0
Total	1		0.2	420		97.9	8		1.9	429		100.0
% in Macintyre et al. ⁶6. Macintyre S, McKay L, Ellaway A. Are rich people or poor people more likely to be ill? Lay perceptions, by social class and neighbourhood, of inequalities in health. Soc Sci Med 2005; 60:313-7.			1.3			79.7			19.0
χ² = 6.68; d.f.= 4; p = 0.154
Fitter
High social class	8		12.5	56		87.5				64		100.0
Medium social class	9		6.2	134		92.4	2		1.4	145		100.0
Low social class	25		11.4	191		86.8	4		1.8	220		100.0
Total	42		9.8	381		88.8	6		1.4	429		100.0
% in Macintyre et al. ⁶6. Macintyre S, McKay L, Ellaway A. Are rich people or poor people more likely to be ill? Lay perceptions, by social class and neighbourhood, of inequalities in health. Soc Sci Med 2005; 60:313-7.			53.6			42.4			4.0
χ² = 4.43; d.f. = 4; p = 0.351 *
Heart disease
High social class	8		12.5	55		85.9	1		1.6	64		100.0
Medium social class	5		3.4	137		94.5	3		2.1	145		100.0
Low social class	10		4.5	198		90.0	12		5.5	220		100.0
Total	23		5.4	390		90.9	16		3.7	429		100.0
% in Macintyre et al. ⁶6. Macintyre S, McKay L, Ellaway A. Are rich people or poor people more likely to be ill? Lay perceptions, by social class and neighbourhood, of inequalities in health. Soc Sci Med 2005; 60:313-7.			6.6			48.8			44.5
χ² = 11.38; d.f. = 4; p = 0.023
Live longer
High social class	8		12.5	53		82.5	3		4.7	64		100.0
Medium social class	15		10.3	121		83.4	9		6.2	145		100.0
Low social class	41		18.6	168		76.4	11		5.0	220		100.0
Total	64		14.9	342		79.7	23		5.4	429		100.0
% in Macintyre et al. ⁶6. Macintyre S, McKay L, Ellaway A. Are rich people or poor people more likely to be ill? Lay perceptions, by social class and neighbourhood, of inequalities in health. Soc Sci Med 2005; 60:313-7.			67.6			30.5			1.9
χ² = 5.26; d.f. = 4; p = 0.261
Mental illness
High social class	3		4.7	60		93.6	1		1.6	64		100.0
Medium social class	1		0.7	138		95.2	6		4.1	145		100.0
Low social class	4		1.8	213		96.8	3		1.4	220		100.0
Total	8		1.9	411		95.8	10		2.3	429		100.0
% in Macintyre et al. ⁶6. Macintyre S, McKay L, Ellaway A. Are rich people or poor people more likely to be ill? Lay perceptions, by social class and neighbourhood, of inequalities in health. Soc Sci Med 2005; 60:313-7.			6.4			63.9			29.7
χ² = 6.95; d.f. = 4; p = 0.139 *

	Are rich or poor people more likely to have the following experiences?
	Rich		Both equally		Poor		Total
	n	%	n	%	n	%	n	%
Automobile accidents
High social class	5	7.8	56	87.5	3	4.7	64	100.0
Medium social class	14	9.7	126	86.9	5	3.4	145	100.0
Low social class	15	6.8	197	89.5	8	3.6	220	100.0
Total	34	7.9	379	88.3	16	3.7	429	100.0
χ² = 1.16; d.f. = 4; p = 0.885
Work-related accidents
High social class			30	46.9	34	53.1	64	100.0
Medium social class			92	63.4	53	36.6	145	100.0
Low social class	2	0.9	106	48.2	112	50.9	220	100.0
Total	2	0.5	228	53.1	199	46.4	429	100.0
χ² = 10.91; d.f. = 4; p = 0.028 *
Stress
High social class	8	12.5	50	78.1	6	9.4	64	100.0
Medium social class	12	8.3	125	86.2	8	5.5	145	100.0
Low social class	16	7.3	188	85.5	16	7.3	220	100.0
Total	36	8.4	363	84.6	30	7.0	429	100.0
χ² = 2.99; d.f. = 4; p = 0.559
Be happy
High social class	8	12.5	53	82.8	3	4.7	64	100.0
Medium social class	17	11.7	112	77.2	16	11.0	145	100.0
Low social class	28	12.7	166	75.5	26	11.8	220	100.0
Total	53	12.4	331	77.2	45	10.5	429	100.0
χ² = 2.89; d.f. = 4; p = 0.557

	Are rich or poor people more likely to have the following experiences?
	Rich		Both equally		Poor		Total
	n	%	n	%	n	%	n	%
Air pollution
High social class	2	3.1	57	89.1	5	7.8	64	100.0
Medium social class			140	96.9	5	3.4	145	100.0
Low social class			209	95.0	11	5.0	220	100.0
Total	2	0.5	406	94.6	21	4.9	429	100.0
χ² = 13.413; d.f. = 4; p = 0.009 *
Lack of water
High social class			49	76.6	15	23.4	64	100.0
Medium social class			125	86.2	20	13.8	145	100.0
Low social class			172	78.2	48	21.8	220	100.0
Total			346	80.3	83	19.3	429	100.0
χ² = 4.41; d.f. = 2; p = 0.110
Noise
High social class	1	1.6	50	78.1	13	20.3	64	100.0
Medium social class			129	89.0	16	11.0	145	100.0
Low social class			198	90.0	22	10.0	220	100.0
Total	1	0.2	377	87.9	51	11.9	429	100.0
χ² = 11.09; d.f. = 4; p = 0.025 *
Traffic jams
High social class	5	7.8	57	89.1	2	3.1	64	100.0
Medium social class	9	6.2	132	91.0	4	2.8	145	100.0
Low social class	21	9.5	194	88.2	5	2.3	220	100.0
Total	35	8.2	383	89.3	11	2.6	429	100.0
χ² = 1.49; d.f. = 4; p = 0.834

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[1] Correspondence M. L. Lima. Centro de Investigação e Intervenção Social, Instituto Universitário de Lisboa. Av. das Forças Armadas, Lisboa 1649-026, Portugal. luisa.lima@iscte.pt