A Social Rank Explanation of How Money Influences Health

OBJECTIVE Financial resources are a potent determinant of health, yet it remains unclear why this is the case. We aimed to identify whether the frequently observed association between absolute levels of monetary resources and health may occur because money acts an indirect proxy for a person's social rank. METHOD To address this question we examined over 230,000 observations on 40,400 adults drawn from two representative national panel studies; the British Household Panel Survey and the English Longitudinal Study of Ageing. We identified each person's absolute income/wealth and their objective ranked position of income/wealth within a social reference-group. Absolute and rank income/wealth variables were then used to predict a series of self-reported and objectively recorded health outcomes in cross-sectional and longitudinal analyses. RESULTS As anticipated, those with higher levels of absolute income/wealth were found to have better health than others, after adjustment for age, gender, education, marital status, and labor force status. When evaluated simultaneously the ranked position of income/wealth but not absolute income/wealth predicted all health outcomes examined including: objective measures of allostatic load and obesity, the presence of long-standing illness, and ratings of health, physical functioning, role limitations, and pain. The health benefits of high rank were consistent in cross-sectional and longitudinal analyses and did not depend on the reference-group used to rank participants. CONCLUSIONS This is the first study to demonstrate that social position rather than material conditions may explain the impact of money on human health.