This paper examines three interconnected dimensions of public health. First, it analyzes the inverse relationship between socioeconomic status (SES) and health outcomes, drawing on divergence theory and research linking higher SES to reduced morbidity and mortality across the lifespan. Second, it discusses racial, socioeconomic, and gender-based disparities in mental illness rates, with particular attention to how stress, stigma, and community factors shape these differences. Third, it compares the Health Belief Model and the Theory of Reasoned Action/Theory of Planned Behavior, ultimately arguing that the Health Belief Model is the more appropriate framework for a public health intervention aimed at decreasing diabetes in the African American community through health education.
The paper demonstrates the use of multiple frameworks — divergence theory, the Health Belief Model, and the Theory of Planned Behavior — to examine a single policy problem from several theoretical angles. This multi-framework approach allows the writer to evaluate competing models critically before selecting the most appropriate one for a specific intervention context, a technique central to applied public health scholarship.
The paper is organized around three discrete prompt questions. The first section establishes the SES–health gradient and introduces both objective and subjective dimensions of SES. The second section addresses mental health disparities across race, SES, and gender, with stress and stigma as unifying concepts. The third section compares two behavioral theories in detail before recommending one for a diabetes-reduction intervention targeting the African American community. Each section builds on shared themes of inequality, perception, and behavioral determinants.
Money may not buy happiness, but it does buy better health and therefore longer life. The multiple variables involved in this calculus include the fact that affluent people can afford healthier foods, visit healthcare providers for preventive checkups as well as whenever illness requires it, and enjoy a less stress- and depression-filled lifestyle due to fewer financial worries. They are also more able to participate in activities that provide physical fitness and joy. This is not to say that less affluent people never experience joy or a decent meal, but poor people may avoid visiting a healthcare provider or purchasing needed medicine due to a lack of funds, or go without meals so that their children can have enough to eat.
A growing body of scholarship confirms the positive relationship between higher socioeconomic status (SES) and better health and longevity. For example, a seminal study by Prus (2004) used divergence theory to test the hypothesis that higher SES levels serve to reduce morbidity and mortality rates over the lifespan. The key finding that emerged from this study was that, "while adults from all socio-economic status (SES) levels generally encounter a decline in health as they grow older, research shows that health status is tied to SES at all stages of life" (Prus, 2004, p. 145).
Furthermore, the strength of this positive relationship tends to increase as affluent people grow older. Prus (2004) also notes that, "multiple linear regression analyses show support for this assumption; that is, the relationship between SES (measured by years of education and annual household income) and health (measured by self-rated and functional health indexes) strengthens with age" (p. 145). These findings indicate that the reverse is also true: lower SES levels adversely affect morbidity and mortality rates over the lifespan, and this effect intensifies with age as individuals grow older and become more vulnerable to age-related disorders.
An interesting finding by Rarick et al. (2018) was that the subjective perception of affluence can also affect morbidity and mortality rates. In other words, individuals' views about their own SES relative to others can have many of the same effects as clear-cut differences in income levels. This is an especially noteworthy finding because, all else being equal, the subjects' actual income levels did not allow them to receive any additional or better healthcare, diet, or lifestyle — the subjective perception of being affluent was the only operative variable. This finding suggests that, irrespective of objective reality, people who believe they are financially well-off may enjoy more stress-free lives, which contributes to improved health and longevity (Rarick et al., 2018).
The subjective sense of life satisfaction's effect on health and longevity was also the focus of a study by Moreno-Agostino et al. (2021). Their findings shed light on how subjective perceptions of SES affect health and lifespan. As Moreno-Agostino et al. (2021) point out, "one of the predictors of life satisfaction in older adulthood is SES. While some SES indicators (e.g., education) may reflect socioeconomic experiences in earlier life stages, others (e.g., income) represent current socioeconomic conditions that are more susceptible to change with age" (p. 585). Although research has shown that the relationship between actual SES levels and health strengthens with age, the reverse is true of the subjective perception of SES and corresponding life satisfaction levels. Moreno-Agostino et al. (2021) conclude that, "life satisfaction (i.e., evaluative wellbeing) has shown a particularly strong association with health [but] life satisfaction exhibits a declining pattern with age in most countries worldwide" (p. 585).
Although everyone's response to stress manifests in unique ways, there are race-, SES-, and gender-related commonalities that warrant further attention. Researchers have shown that there is even an intergenerational effect from lower family SES on susceptibility to developing mental illness, with children from low-SES families tending to develop these disorders at higher rates compared to their more affluent counterparts (Silva et al., 2022). This outcome is attributed to children's experiences with, and perceptions of, their parents or caregivers suffering from mental illnesses (Silva et al., 2022).
Current views concerning the effects of SES on mental illness may, however, be skewed by the fact that people with higher SES levels may avoid seeking medical care for mental illness due to the powerful stigma involved, and are therefore underrepresented in the statistics. While there are some cross-cultural differences, this stigma appears salient in many nations today. Foster and O'Mealey (2022) report that, "prior research has suggested that higher levels of SES may be linked with heightened mental illness stigma. It has been posited that this link is due to the resource-rich environment high-SES individuals live in, which predisposes them to seeing certain phenomena as being more controllable in nature than low-SES individuals" (p. 58). In other words, the same affluent circumstances that may have exacerbated a mental disorder also operate to discourage sufferers from seeking assistance, since they feel they should have been able to resolve the issue on their own — potentially with the support of expensive private health care providers.
Racial differences have also been shown repeatedly to affect the likelihood of developing mental illness. A study by Hope et al. (2020) assessed how the psychological and physiological anticipation of encountering racism — and the corresponding race-related stress — affected mental health. Hope and colleagues (2020) determined that stress levels among younger Black men were more pronounced, but that the potential for developing mental health disorders in response to race-related stress was mitigated when community support from older Black males was available.
Delivering evidence-based strategies is an integral part of any public health intervention, and the Health Belief Model provides a useful framework for this purpose. Moradi et al. (2022) report that, "the health belief model is an effective framework for designing educational interventions and promoting preventive behaviors and considers behavior as a function of the individual's knowledge and attitude" (p. 2). The Health Belief Model is based on the premise that individuals weigh the perceived costs and benefits of engaging in different behaviors, including lifestyle choices that may be harmful to health. According to the model, "a person's behavior changes when he understands the level of danger that threatens him (perceived sensitivity and severity) and also has a proper assessment of health barriers and behaviors (perceived barriers and benefits)" (Moradi et al., 2022, p. 2). These attributes indicate that the Health Belief Model can be appropriately applied to a wide variety of public health interventions.
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