Socioeconomic Status and Health: What is the role of Reserve Capacity?

Abstract

A robust, linear association between socioeconomic status (SES) and health has been identified across many populations and endpoints. This relationship is typically monotonic, so that each step down the SES hierarchy brings increased vulnerability to disease and premature mortality. Despite growing attention to health disparities, scientists and policy makers have made little progress toward confronting their causes and implementing effective solutions. Using the Reserve Capacity Model (Gallo & Matthews, 2003) as an organizing framework, the current article examines the contribution of resilient psychosocial resources to socioeconomic disparities in physical health. Findings suggest that deficient psychosocial resources, such as low perceptions of control and social support, may be one of many factors that connect low SES with poor health. Additional research is needed to test these relationships and their underlying mechanisms, to consider interventions to enhance reserve capacity, and to evaluate the efficacy of such efforts in fostering resilience to socioeconomic hardship.

Figure 1

The Reserve Capacity Model (adapted and modified from Gallo & Matthews, 2003) of the dynamic associations among socioeconomic status (SES), stress, psychosocial resources, emotions, and health. Dashed lines indicate possible reverse or reciprocal effects. Arrow A shows the direct influence of SES on positive and negative psychosocial experiences, or stress experiences and appraisals. Arrow B indicates the direct impact of stressful experiences on emotions/cognitions. Arrow C shows the association between stress and intermediate, behavioral and physiological pathways to health outcomes. Arrow D shows that socioeconomic contexts can shape and deplete resilient resources, leading to reduced reserve capacity. Arrow E shows that Reserve Capacity may moderate the association between stress and emotional responses (i.e., interaction effects). Arrow F shows the direct association between reserve capacity resources and emotions. Arrow G shows that resilient resources can also impact behavioral and physiological risk pathways. Arrows H and I (dashed lines) indicate the possible influence of emotions/cognitions on reserve capacity and stress experiences or appraisals, respectively. Arrow J (dashed, bi-directional line) shows that SES may affect emotions/cognitions independent of the association with stress, and that emotional factors (particularly, emotional disorders) can also influence SES. Arrow K (dashed, bi-directional line) shows that one’s level of resilient resources can shape experiences or appraisals of stress, and vice versa. Arrows L and M depict the associations from emotions/cognitions, to intermediate pathways, to health outcomes. SAM = sympathetic adrenal medullary axis. HPA = hypothalamic, pituitary, adrenal axis.

Figure 2

Reserve Capacity Model pathways examined in the current article. Arrows N, O, and P depict the indirect association of SES and physical health through personal and social resources (mediated pathway). Arrow Q indicates that psychosocial resources can modify the impact of SES on physical health (moderated pathway).