Comparing the socioeconomic status - Health gradient among adults 50 and older across rural and urban areas of Thailand in 1994 and 2007

This paper examines associations between three indicators of socioeconomic status, education, income and bank savings, as well as one composite of these three measures, and self-assessed health for adults aged 50+ across rural and urban Thailand, comparing 1994 and 2007. Between 1994 and 2007 Thailand experienced rapid social changes that could impact on health overall and across groups, including population aging, socioeconomic development and changes in health policy. This led us to test whether overall health has improved as a result and whether the SES health gradient has changed. The data come from comparable survey sources from over seventy-thousand respondents, collected by Thailand's National Statistical Office. Generalized proportional ordered logit models were run that include up to three-way interactions of SES by year by rural versus urban location of residence are run. The three-way interactions allow for testing and of whether changes over time are due to complex intertwined effects. Results indicate that a) there has been improvement in health among the population aged 50 years and older in Thailand; b) there has been a flattening in the SES - health gradient in rural areas, and c) there has been little change in the gradient in urban areas, and if anything, there has been a widening of the relationship between income and health in urban Thailand. Divergence in the way the gradient has changed across rural and urban Thailand may point to the impact of social policy that has been aimed at poorer rural residents. (C) 2012 Elsevier Ltd. All rights reserved.