Nearly all of the empirical work, and for that matter theoretical discussion about this issue, has examined individual environmental risk factors. There is also a conceptual issue we wish to briefly discuss before overviewing some of the evidence for linkages among SES, environmental quality, and health. Given that there is also evidence that nonwhite individuals, at least in the United States, are more likely to be exposed to health threatening environmental conditions than are white individuals, it can be difficult to disentangle associations between income and environmental quality from racism.
The reader should also bear in mind that for several of the income-related environmental exposure results, the data are confounded with ethnicity. Furthermore, for certain salient environments, especially work and school settings, scant data are available on income-related differential exposures to hazardous, polluted, or inadequate building conditions. In addition to this fundamental shortcoming in the extant database, results on SES and environmental exposure tend to be restricted to income and, in several cases, are not continuous instead they compare individuals below and above the poverty line. What is necessary to verify the model shown in Figure 1 is that the SES health link is mediated by environmental quality. There are few if any data directly testing this proposition. This is not equivalent, however, to the conclusion that SES effects on health are caused by differential exposure to environmental quality. The implicit conceptual model under discussion is as follows ( Figure 1): As can be seen above, what we discuss is evidence for two necessary prerequisites for this model to be valid-namely that socioeconomic status (SES) is associated with environmental quality and, in turn, that environmental quality affects health. We also briefly cite evidence that each of these environmental factors, in turn, is linked to health. By environmental conditions we mean the physical properties of the ambient and immediate surroundings of children, youth, and families, including pollutants, toxins, noise, and crowding as well as exposure to settings such as housing, schools, work environments, and neighborhoods. In this paper we provide an overview of data indicating that income is inversely correlated with exposure to suboptimal environmental conditions. Satisfactory explanation for the ubiquitous socioeconomic status-health gradient remains elusive, suggesting, in part, that an adequate model of this relation is probably complex and multifaceted ( 1, 81). SOCIOECONOMIC STATUS AND HEALTH: THE POTENTIAL ROLE OF ENVIRONMENTAL RISK EXPOSURE
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