How Social Status Permeates Inequalities in Health: Three Studies on Experiences of Social Disadvantage

Thumbnail Image



Journal Title

Journal ISSN

Volume Title

Repository Usage Stats



The social gradient of health is pervasive and unrelenting. Across nearly any layer of society – race, religion, economic standing, or others – the populations worst off in terms health are also the most socially disadvantaged. Over three studies, this dissertation examines some of the experiences that underlie the connection between social disadvantage and health, namely internalized perceptions of status, interpersonal interactions, and institutional actions. The first study examines the link between adolescents’ perceived social status and their mental health at a range of ages, identifying at what age mental health problems begin to track perceptions of status, as well as contextual factors that do (or do not) relate to perceptions of status. In the second study, data from a nationally representative survey in France are used to document rates of reporting discrimination within the healthcare setting by gender, immigrant status, race/ethnicity, and religion. Rates of foregoing medical care are also documented across the same groups, and the potential explanatory role of discrimination toward disparities in foregone care is then investigated. The third and final study looks at the role of institutional stigma, using state bans of Sharia law in the USA as an exemplary case of stigmatizing policies with minimal material consequences. National birth record data for the USA is used, and the variation in policy enactment over time and space is leveraged to examine birth outcomes for Muslim women who were pregnant at the time their state passed a ban. Findings reveal a decrease in the secondary sex ratio to targeted women, suggesting the stigmatizing policy acts as a population-level stressor with consequences for maternal health.






Rivenbark, Joshua (2020). How Social Status Permeates Inequalities in Health: Three Studies on Experiences of Social Disadvantage. Dissertation, Duke University. Retrieved from


Dukes student scholarship is made available to the public using a Creative Commons Attribution / Non-commercial / No derivative (CC-BY-NC-ND) license.