Social Inequality and Mental Health in Chile, Ecuador, and Colombia

• Author: Pamela Vaccari Jiménez,Loreto Villagrán,Luz Dary Gallardo,Yanet Quijada,Carlos Reyes
• Published date: 01 November 2019
• Date: 01 November 2019
• DOI: 10.1177/0094582X18803682
• Subject Matter: Articles

LATIN AMERICAN PERSPECTIVES, Issue 229, Vol. 46 No. 6, November 2019, 92–108

DOI: 10.1177/0094582X18803682

© 2018 Latin American Perspectives

92

Social Inequality and Mental Health in Chile,

Ecuador, and Colombia

by

Yanet Quijada, Loreto Villagrán, Pamela Vaccari Jiménez,

Carlos Reyes, and Luz Dary Gallardo

Translated by

Victoria J. Furio

The results of a comparative study of social inequality and mental health show that

Chile and Colombia, which have enormous social gaps despite their economic growth, are

characterized by poor mental health indicators and social discontent, while the better

equity indicators in Ecuador are not clearly linked to mental health. The concept of social

defeat is suggested as a mediator between social inequality and individual and collective

mental health, and participation and empowerment are suggested as ways of improving

social well-being.

Los resultados de un estudio comparativo de desigualdad social y salud mental muestran

que Chile y Colombia, que tienen enormes brechas sociales a pesar de su crecimiento

económico, se caracterizan por indicadores de salud mental deficientes y descontento social,

mientras que los mejores indicadores de equidad en Ecuador no están claramente vincula-

dos a la salud mental. El concepto de derrota social se sugiere como un mediador entre la

desigualdad social y la salud mental individual y colectiva, y la participación y el empodera-

miento se sugieren como formas de mejorar el bienestar social.

Keywords: Mental health, Social well-being, Social inequality, Social defeat, Public

policy

It is recognized worldwide that social variables influence people’s health

(WHO, 2008). In Latin America, however, an increase in macroeconomic indi-

cators has not always translated into improved individual health and/or

well-being, and this may be related to inequality. Most studies of the relation-

ship between health and inequality focus on epidemiological variables

(Kaufman and Mezones-Holguín, 2013; Muntaner etal., 2003) or on power

relations and the control of capital (Domingo-Salvany etal., 2013; Rocha etal.,

2013) rather than on the way people construct and represent the sociopolitical

context in which they live. For this reason, the guiding question for this essay

is what psychosocial processes make it possible for social inequality to affect

mental health.

Yanet Quijada is an associate professor of psychology at the Universidad San Sebastián, Chile.

Pamela Vaccari Jiménez and Loreto Villagrán are professors of psychology at the Universidad de

Concepción. Carlos Reyes is a professor at the Universidad Andina Simón Bolívar, Ecuador and

Luz Dary Gallardo is a professor at the Universidad San Buenaventura, Colombia. Victoria J. Furio

is a translator living in New York City.

803682LAPXXX10.1177/0094582X18803682Latin American PerspectivesQuijada et al. / SOCIAL INEQUALITY AND MENTAL HEALTH

research-article2018

Quijada et al. / SOCIAL INEQUALITY AND MENTAL HEALTH 93

Studies emphasize the social dimension, including aspects such as empa-

thy, the ability to establish interpersonal relations (Jahoda, 1958), satisfying the

need for bonds (Ryan and Deci, 2000) and establishing positive relations with

others (Ryff, 1989), as a basic component of health. The WHO (2002: 2) defines

health as “a state of complete physical, mental, and social well-being and not

merely the absence of disease or infirmity,” incorporating the concept of social

well-being originally proposed by Corey Keyes (1998) and including self-

esteem, satisfaction with life, sense of well-being, social sensitivity, and posi-

tive affect (Keyes, 2005; Shapiro etal., 2008). From this we infer that the

inequality and discontent that characterize Latin American countries make it

highly likely that their health will be affected. This is not an assertion of social

determinism but a relational view in which people cannot be separated from

their physical and mental features or from the social and cultural contexts in

which they are imbedded.

The effects of inequality can be explained in terms of the inability of

lower-income groups to acquire the material conditions necessary for good

health (Lynch, Smith, and House, 2000). Another approach suggests that

physical and psychological discomfort develops when people evaluate

themselves as having lower status than a reference group (Hounkpatin

etal., 2015). Empirical studies such as that of Daly, Boyce, and Wood (2015)

show that a low social position based on gross income compared with var-

ious reference groups (gender, age, education, and place of residence) is a

better determinant of various indicators of physical health problems than

gross income per se. The same occurs in predicting psychological distress

(Wood etal., 2012). Low social position has been found a better predictor

than gross income of symptoms of depression (Hounkpatin etal., 2015),

low overall satisfaction (Boyce, Brown, and Moore, 2010), and even sui-

cidal ideation and attempts (Wetherall etal., 2015). These studies use data-

bases with macroeconomic and social indicators, leading some writers to

point to the need for more research into the psychological mechanisms that

link social context with individual malady, with social comparison being

fundamental to their understanding (Hounkpatin etal., 2016; Wilkinson

and Pickett, 2006).

Developmental models of social functioning show that subjects with low or

subordinate social positions will display physiological and behavioral reac-

tions that make them more vulnerable to health problems (Mendelson,

Thurston, and Kubzansky, 2008). When applying this to mental health, the term

“social defeat” surfaces. This concept involves negative behavioral and cogni-

tive reactions to failure to attain status or goals in comparison with others

(Gilbert, 2006). This mechanism, which assumes social comparison, has been

studied empirically only in relation to individual clinical variables. Therefore,

its association with social variables is still unexplored, and we suggest that it

could be useful in understanding mental health in Latin America. Accordingly,

this essay will analyze figures on inequality and studies that relate it to mental

health and well-being in the past 20 years in Latin America and examine the

concept of social defeat as a possibility for explaining the impact of inequality

on mental health.