There are several potential explanations for why post-industrial conditions may exacerbate wealth/SES effects on health. In other words, while social gradients in health have deep roots in primate and human evolution, the nature and magnitude of SES-health gradients have potentially changed as a function of modern lifeways. In particular, it has been hypothesized that the steep wealth-based gradients in health observed in HICs are recent byproducts of environmental changes precipitated by urbanization, globalized markets, capitalism and other modern advancements. This disparity has made it difficult to comprehensively assess whether the relationship between SES and health is universal and consistent or instead varies as a function of resource availability and distribution, the nature of social relationships and hierarchies, or other socioecological features of a population (as has been shown for other species ). There is strong appreciation that we need to study the social determinants of health across a wider variety of contexts, and while research in other contexts is rapidly expanding, this body of literature still lags behind what exists for HICs. While there is clear support for the idea that higher SES (operationalized as greater absolute material wealth) is associated with better health in humans, most evidence to date comes from studies of high-income countries (HICs). In particular, animal studies have found that low ordinal dominance rank, a commonly used approximation for low SES in human societies, leads to stress-induced health issues by fundamentally altering hypothalamic-pituitary-adrenal (HPA) axis function. However, studies in social mammals, where such confounds can be avoided, support the hypothesis that some portion of the SES–health relationship is driven by direct and causal effects of social status on physiology. These socioeconomic status (SES) gradients in disease risk and survival are to some degree explained by differences in health care, health habits and access to resources that are also socially stratified. In the USA, individuals in the lowest socioeconomic class (defined by absolute material wealth in the form of income) are at greater risk for major health issues such as heart disease, cancer and diabetes and are predicted to die over a decade earlier than individuals in the highest socioeconomic class. Mounting research has shown that these social environmental effects can be profound. A major goal in evolutionary biology and human health research is to understand the social determinants of health, defined as the ‘distribution of money, power and resources’ that shape health outcomes.
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