Pathways from status attainment to adult health: The contribution of health insurance to socioeconomic inequities in health in the United States

This dissertation contributes to the study of SES and health by exploring the dynamics of the cumulative impact of income in early and mid-adulthood on health in the United States, and by examining the institutional impact of health insurance coverage on health and on the pathways leading from status attainment to adult health. Using data from the 1979 National Longitudinal Survey of Youth, the analyses included ordinal logits of self-rated health, OLS, and models with sibling clusters (sibling fixed effects models and structural equation models of sibling resemblance).;The results point to cumulative effects of average financial resources in young and mid-adulthood, whereby returns in adult health decline as financial resources increase. While there did not appear to be effects of mobility, resources in the late twenties had a more substantial impact on health than in other life course periods, which suggests homogeneity in the growth of financial resources in this sample in early and mid-adulthood.;In turn, analyses of the pathway effects of status attainment on adult health cast serious doubts on the causal nature of the negative effects of public insurance on health, and also suggested that these cumulative effects of income were partially mediated by the effects of health insurance. More specifically, these analyses indicated that health insurance and the source of coverage contributed to social inequities in health through very different pathways: first, the number of years privately insured was found to compound the positive sibling-specific effects of status attainment on health when contrasted with the lack of insurance; second, public insurance was not found to differ in its effects on health from private insurance; and third, public insurance may have the potential to reduce socioeconomic inequities from the family of origin when lack of insurance is the alternative.;Thus, these findings add to a growing body of evidence documenting the deleterious effects on individual health of the lack of insurance that culminated most recently with the recommendation by the Institute of Medicine that health insurance coverage should be universal in the United States.