The future (history) of socioeconomic measurement and implications for improving health outcomes among African Americans

Socioeconomic status (SES) has powerful and complex impacts on health, and understanding the relationship between SES and health is essential for long-term improvements in the health of populations. In addition, in the United States, the impact of SES on health is inextricably intertwined with racial and ethnicity status and the historical development and maintenance of health disparities. Most of the literature documenting this relationship has focused on individual-level socioeconomic factors. There are sound theoretical reasons and some empirical support to suggest that socioeconomic resources at both individual and neighborhood levels have strong influences on health outcomes such as disease, disability, and mortality. However, these relationships have been inadequately examined to date. In this article, the term "ecological SES" will be used to denote SES at geographic group levels. As the United States attempts to achieve the goals of the Department of Health and Human Services' Healthy People 2010 program, understanding ecological SES and its impacts on health will be crucial. We review the theory, some of the empirical evidence, and likely future for the measurement and use of a broader approach to SES and offer a specific research paradigm for examining these issues. We focus in particular on one racial-ethnic group that experiences health disparity, that is, African Americans. We use our ongoing project investigating physical frailty in urban African Americans to illustrate the importance of a multilevel approach to understanding the impacts of socioeconomic resources oil health and the potential implications for efforts to prevent or reverse frailty.