Nber Working Paper Series the Ses Health Gradient on Both Sides of the Atlantic

Looking across many diseases, average health among mature men is much worse in America compared to England. Second, there exists a steep negative health gradient for men in both countries where men at the bottom of the economic hierarchy are in much worse health than those at the top. This health gradient exists whether education, income, or financial wealth is used as the marker of one's SES status. These conclusions are maintained even after controlling for a standard set of behavioral risk factors such as smoking, drinking, and obesity and are equally true using either biological measures of disease or individual self-reports. In contrast to these disease based measures, health of American men appears to be superior to the health of English men when self-reported general health status is used. The contradiction most likely stems instead from different thresholds used by Americans and English when evaluating health status on subjective scales. For the same "objective" health status, Americans are much more likely to say that their health is good than are the English. Finally, feedbacks from new health events to household income are one of the reasons that underlie the strength of the income gradient with health in England. James Banks Institute for Fiscal Studies 7 Ridgemount London, WC1 7AE U.K. [email protected] Michael Marmot University College London Department of Epidemiology and Public Health Royal Free and University College London Medical School 1-19 Torrington Place London WC1E6BT, UK [email protected] Zoe Oldfield The Institute for Fiscal Studies 7 Ridgemount London, WC1 7AE U.K. [email protected] James P. Smith RAND Corporation Labor and Pop Studies Program The RAND Corporation 1776 Main Street Santa Monica, CA 90406 [email protected]