Социальные неравенства в здоровье: посредническая роль материальных лишений и психологических ресурсов

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SOCIAL INEQUALITIES IN HEALTH: THE MEDIATING ROLE OF MATERIAL DEPRIVATION AND PSYCHOLOGICAL RESOURCES

The article deals with the problem of socio-structural inequalities in health. Numerous studies confirm the social structuring of health -- its deterioration with the decline of socio-economic status, i.e. level of education, income, and professional status. The main theoretical approaches to the explanation of structural inequalities in health are associated with materialistic, psychosocial and behavioral interpretations. This review presents the current state of research in which these approaches have been tested. It is empirically established that the poor health of low status individuals is linked not only to an increased prevalence of risky behavior patterns, such as smoking and alcohol abuse, but is also generated to a large extent by their unfavorable material circumstances. Psychosocial explanations have also been convincingly confirmed in empirical studies devoted to the study of the mediation effects associated with stressful influences and a person's psychological resources. Recently, these findings have been questioned, due to the fact that when taking into account the joint mediating influence of material, psychosocial and behavioral factors, the severity of individual mediations turned out to be less distinct -- the psychosocial and behavioral effects were not so clearly manifested as in separate analysis, being much weaker than material mediation. But this conclusion also requires clarification, given that the mediation effects may depend on the public macrocontext. It is possible that material and psychological mediators will be less pronounced in countries with a strong economy and social guarantees, as people from vulnerable strata can count on protection from the state and maintain their self-efficacy, with optimism looking to the future.

In less developed countries, not capable of providing social guarantees at a high level, not only material deprivation will serve as a mediator of structural inequalities, but also psychological resources which people with low social standing lose due to life's hardships.

Key words: social inequalities in health, materialistic, psychosocial and behavioral explanations, material deprivation, psychological resources, direct and indirect mediating effects, state of the art.

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