in recent years the world health organization ( who ) has increasingly drawn attention to the importance of the relationship between health and social conditions in determining the health of individuals and populations . social determinants ( conditions in which people are born , live , grow , work and age as well as the health system available to them ) produce inequalities in health , and need to be considered in health development . addressing social determinants and health policy now forms the basis for political action both nationally and internationally . human poverty is defined as more than income poverty ; it is the denial of choices and opportunities for living a tolerable life . poverty as described above in the caribbean has been predominantly a rural phenomenon ; however , rising levels of urban poverty have also been seen . in 1996 the world bank estimated 38% of the total population ( or 25% including haiti ) in the caribbean , or more than seven million people , to be poor . one study found that rural poverty in argentina , barbados , boliva , brazil , colombia , jamaica , suriname , trinidad and tobago , and uruguay was at least twice more than urban poverty . according to the jamaica survey of living conditions ( jslc ) , in 2003 , the poverty rate stood at 19.1% , and in 2007 it fell to 9.9% . the jslc for 2001 indicates that the wealthiest 20% of the population accounted for 45.9% of national consumption , while the poorest 20% accounted for only 6.1% of national consumption . on average , the wealthiest 10% of the population consumed approximately 12.5 times more than the poorest 10% . this is a mean per capita annual consumption expenditure of us$ 3,963.53 compared to us$ 314.48 . gafar found that in some latin american and caribbean countries , between 2 to 8 percentage of income is estimated to be received by those in the poorest 20% compared to between 42 and 58% that is received by those in the wealthiest 20% which indicates that income inequalities are vast between the poor and the wealthy within those societies , and does account for some of the health disparities between the social hierarchies . according to the who 's definition , health is not merely the absence of disease but the highest possible state of physical , social and mental wellbeing . at both a societal and individual level , the aim is to extend healthy life expectancy , as well as productivity and quality of life at older ages for as long as possible . understanding how the social determinants influence health and social wellbeing is an area of considerable research interest . that the unequal distribution of variables such as income , unemployment and education produce health inequalities , has been documented[810 ] . studies have established a statistical relationship between health status and poverty[1113 ] , between standard of living and health conditions , health status owing to a particular natural disaster , and income and health . it is recognized that more information is needed at the social level , and that knowledge needs to be translated into action . people with lower socioeconomic status have worse health in all adult age groups , including older ages . reduced capacity to generate income , and the growing risk of illness increase the vulnerability of the elderly to poverty ; regardless of their original economic status in developing and industrialized countries . many studies that have examined those in the poor and wealthy income groups have used a piecemeal approach , and in the caribbean this is also the case . studies that have examined social determinants of health[12817 ] have made their investigations in the population , but have not reviewed them from the perspective of particular social hierarchies within a nation , in order to establish if the factors are the same , and if not , what the disparities are . it is within this framework that the present study examined factors determining self - reported health among men in the two poorest and the two richest quintiles in jamaica , in order to provide public health specialists and policy makers with research findings on these cohorts . the current study extracted a sample of 6,474 men ; ( 2,704 from the two poorest quintiles and 3,770 from the two wealthiest quintiles ) from the dataset of the jamaica survey of living conditions ( jslc ) . the inclusion / exclusion criteria were ( 1 ) being males , and ( 2 ) being classified in the poor or wealthy social strata . the survey ( jslc ) was a nationally representative probability sample in which self - administered questionnaires were used to collect data from the populace . it is a modification of the world bank 's living standards measurement study ( lsms ) household survey . the design was a two - stage stratified random sampling design where there was a primary sampling unit ( psu ) and a selection of dwellings from the primary units . the psu is an enumeration district ( ed ) , which constitutes a minimum of 100 residences in rural areas and 150 in urban areas . self - reported health conditions : this is a dummy variable , where 1 = self - reported ailment , injury or illness in the last four weeks , which was the survey period , 0 = otherwise . thus , self - reported health is a binary variable , where 1 = not reporting an illness , and 0 = reporting an ailment . , where hi represents each person in the household , and r is the number of rooms excluding kitchen , bathroom and verandah . psychological conditions are the psychological state of an individual , and this is subdivided into positive and negative affective psychological conditions . positive affective psychological condition is the number of responses with regard to being hopeful and optimistic about the future and life generally . negative affective psychological condition is the number of responses from a person on having lost a breadwinner and/or family member , having lost property , having been made redundant , or failing to meet household and other obligations . natural disaster : this is the number of responses from people who indicated suffering landslides ; property damage due to rains , flooding and soil erosion . where ki represents the frequency with which an individual witnessed or experienced a crime , where i denote 0 , 1 and 2 , in which 0 indicates not witnessing or experiencing a crime , 1 means witnessing 1 to 2 , and 2 symbolizes seeing 3 or more crimes . tj denotes the degree of the different typologies of crime witnessed or experienced by an individual ( where j = 1  4 , which 1 = valuables stolen , 2 = attacked with or without a weapon , 3 = threatened with a gun , and 4 = sexually assaulted or raped . the summation of the frequency of crime by the degree of the incident ranges from 0 to a maximum of 51 . consumption : the total sum which is spent by an individual on durable and non - durable good during a 12-month period . statistical analyses were performed using statistical packages for the social sciences ( spss ) 16.0 software for windows ( spss inc , chicago il ) . logistic regression analyses were used to establish the model to ascertain parameters , and determine the strength of each statistically significant variable ( p < 0.05 ) . the predictive power of the model was tested using the omnibus test of model and hosmer and lemeshow was used to examine goodness of fit of the model . the correlation matrix was examined in order to ascertain whether autocorrelation ( or multi - collinearity ) existed between variables . cohen and holliday stated that correlation can be low / weak ( 0 to 0.39 ) ; moderate ( 0.4 - 0.69 ) , or strong ( 0.7 - 1.0 ) . this was used to assist in the exclusion ( or retention ) of a variable in the model . in support of this , where collinearity existed ( r > 0.7 ) , variables were entered independently into the model to assist in determining which one should be retained during the final model construction . the decision to retain ( or exclude ) was based on the variables contribution to the predictive power of the model and its goodness of fit . to derive accurate tests of statistical significance , we used suddan statistical software ( research triangle institute , research triangle park , nc ) , and this adjusted for the survey 's complex sampling design . the multivariate model used in this study to examine the sub - sample is a modification of that of grossman and smith & kington which captures the multi - dimensional concept of health status and conditions . the present study further refined the two aforementioned works and in the process added some new factors , such as psychological conditions , crowding , house tenure , and the number of people in the household . using econometric analysis the study sought to model the self - reported health of men in the two wealthiest and poorest quintiles from a general set of social determinants identified in the literature , as seen in the equation below ( equation ) . f(li , ri , lnc , eni , ari , ssi , cri , ( 1npippi),lnei , hhi , ai , hii , mi , fi , mri , edi , lnmei )  . hi is a function of the 17 variables . li is living alone of person i , 1 if living alone , 0 if not living alone ; ri is retirement income of person i , 1 if receiving private and/or government pension , 0 if otherwise ; lnc is the average consumption expenditure of person i , in dollars ; en is the natural disaster , 1 if in the lived milieu there has been flooding , soil erosion , landslide , 0 if not ; ari is the area of residence , other towns , kma with the reference group being rural areas ; ssi is social support , 1 if yes , 0 if no ; cr is crowding in the household of person i ; lnei is the average total expenditure of the person i in dollars , which is the proxy for income ; hhi is household head of person , 1 if yes , 0 if no ; ai is age of person i , in years ; hii is health insurance coverage , 1 if person has a health insurance policy , 0 if otherwise ; m is number of males in household of person i ; f is number of females in household of person i ; mri is marital status of person i ; edi is educational level of person i ; lnmei is medical expenditure of person i ; ( i=1npi , ppi ) npi is the summation of all negative affective psychological conditions and pp is the summation of all positive affective psychological conditions . the final model consisted of only those variables which are statistically significant ( p < 0.05 ) . equation represents those factors that explain the health conditions of those in the poorest 20% and equation denotes variables which are correlated with the health conditions of those in the wealthiest 20% : hi = f(li , ppi , ai , hii , edi )      hi = f(lnci , npi , ai , hii , lnmei ) self - reported health conditions : this is a dummy variable , where 1 = self - reported ailment , injury or illness in the last four weeks , which was the survey period , 0 = otherwise . thus , self - reported health is a binary variable , where 1 = not reporting an illness , and 0 = reporting an ailment . , where hi represents each person in the household , and r is the number of rooms excluding kitchen , bathroom and verandah . psychological conditions are the psychological state of an individual , and this is subdivided into positive and negative affective psychological conditions . positive affective psychological condition is the number of responses with regard to being hopeful and optimistic about the future and life generally . negative affective psychological condition is the number of responses from a person on having lost a breadwinner and/or family member , having lost property , having been made redundant , or failing to meet household and other obligations . natural disaster : this is the number of responses from people who indicated suffering landslides ; property damage due to rains , flooding and soil erosion . where ki represents the frequency with which an individual witnessed or experienced a crime , where i denote 0 , 1 and 2 , in which 0 indicates not witnessing or experiencing a crime , 1 means witnessing 1 to 2 , and 2 symbolizes seeing 3 or more crimes . tj denotes the degree of the different typologies of crime witnessed or experienced by an individual ( where j = 1  4 , which 1 = valuables stolen , 2 = attacked with or without a weapon , 3 = threatened with a gun , and 4 = sexually assaulted or raped . the summation of the frequency of crime by the degree of the incident ranges from 0 to a maximum of 51 . consumption : the total sum which is spent by an individual on durable and non - durable good during a 12-month period . statistical analyses were performed using statistical packages for the social sciences ( spss ) 16.0 software for windows ( spss inc , chicago il ) . logistic regression analyses were used to establish the model to ascertain parameters , and determine the strength of each statistically significant variable ( p < 0.05 ) . the predictive power of the model was tested using the omnibus test of model and hosmer and lemeshow was used to examine goodness of fit of the model . the correlation matrix was examined in order to ascertain whether autocorrelation ( or multi - collinearity ) existed between variables . cohen and holliday stated that correlation can be low / weak ( 0 to 0.39 ) ; moderate ( 0.4 - 0.69 ) , or strong ( 0.7 - 1.0 ) . this was used to assist in the exclusion ( or retention ) of a variable in the model . in support of this , where collinearity existed ( r > 0.7 ) , variables were entered independently into the model to assist in determining which one should be retained during the final model construction . the decision to retain ( or exclude ) was based on the variables contribution to the predictive power of the model and its goodness of fit . to derive accurate tests of statistical significance , we used suddan statistical software ( research triangle institute , research triangle park , nc ) , and this adjusted for the survey 's complex sampling design . the multivariate model used in this study to examine the sub - sample is a modification of that of grossman and smith & kington which captures the multi - dimensional concept of health status and conditions . the present study further refined the two aforementioned works and in the process added some new factors , such as psychological conditions , crowding , house tenure , and the number of people in the household . using econometric analysis the study sought to model the self - reported health of men in the two wealthiest and poorest quintiles from a general set of social determinants identified in the literature , as seen in the equation below ( equation ) . f(li , ri , lnc , eni , ari , ssi , cri , ( 1npippi),lnei , hhi , ai , hii , mi , fi , mri , edi , lnmei )  . hi is a function of the 17 variables . li is living alone of person i , 1 if living alone , 0 if not living alone ; ri is retirement income of person i , 1 if receiving private and/or government pension , 0 if otherwise ; lnc is the average consumption expenditure of person i , in dollars ; en is the natural disaster , 1 if in the lived milieu there has been flooding , soil erosion , landslide , 0 if not ; ari is the area of residence , other towns , kma with the reference group being rural areas ; ssi is social support , 1 if yes , 0 if no ; cr is crowding in the household of person i ; lnei is the average total expenditure of the person i in dollars , which is the proxy for income ; hhi is household head of person , 1 if yes , 0 if no ; ai is age of person i , in years ; hii is health insurance coverage , 1 if person has a health insurance policy , 0 if otherwise ; m is number of males in household of person i ; f is number of females in household of person i ; mri is marital status of person i ; edi is educational level of person i ; lnmei is medical expenditure of person i ; ( i=1npi , ppi ) npi is the summation of all negative affective psychological conditions and pp is the summation of all positive affective psychological conditions . the final model consisted of only those variables which are statistically significant ( p < 0.05 ) . equation represents those factors that explain the health conditions of those in the poorest 20% and equation denotes variables which are correlated with the health conditions of those in the wealthiest 20% : hi = f(li , ppi , ai , hii , edi ) self - reported health conditions : this is a dummy variable , where 1 = self - reported ailment , injury or illness in the last four weeks , which was the survey period , 0 = otherwise . thus , self - reported health is a binary variable , where 1 = not reporting an illness , and 0 = reporting an ailment . , where hi represents each person in the household , and r is the number of rooms excluding kitchen , bathroom and verandah . psychological conditions are the psychological state of an individual , and this is subdivided into positive and negative affective psychological conditions . positive affective psychological condition is the number of responses with regard to being hopeful and optimistic about the future and life generally . negative affective psychological condition is the number of responses from a person on having lost a breadwinner and/or family member , having lost property , having been made redundant , or failing to meet household and other obligations . natural disaster : this is the number of responses from people who indicated suffering landslides ; property damage due to rains , flooding and soil erosion . where ki represents the frequency with which an individual witnessed or experienced a crime , where i denote 0 , 1 and 2 , in which 0 indicates not witnessing or experiencing a crime , 1 means witnessing 1 to 2 , and 2 symbolizes seeing 3 or more crimes . tj denotes the degree of the different typologies of crime witnessed or experienced by an individual ( where j = 1  4 , which 1 = valuables stolen , 2 = attacked with or without a weapon , 3 = threatened with a gun , and 4 = sexually assaulted or raped . the summation of the frequency of crime by the degree of the incident ranges from 0 to a maximum of 51 . consumption : the total sum which is spent by an individual on durable and non - durable good during a 12-month period . statistical analyses were performed using statistical packages for the social sciences ( spss ) 16.0 software for windows ( spss inc , chicago il ) . logistic regression analyses were used to establish the model to ascertain parameters , and determine the strength of each statistically significant variable ( p < 0.05 ) . the predictive power of the model was tested using the omnibus test of model and hosmer and lemeshow was used to examine goodness of fit of the model . the correlation matrix was examined in order to ascertain whether autocorrelation ( or multi - collinearity ) existed between variables . cohen and holliday stated that correlation can be low / weak ( 0 to 0.39 ) ; moderate ( 0.4 - 0.69 ) , or strong ( 0.7 - 1.0 ) . this was used to assist in the exclusion ( or retention ) of a variable in the model . in support of this , where collinearity existed ( r > 0.7 ) , variables were entered independently into the model to assist in determining which one should be retained during the final model construction . the decision to retain ( or exclude ) was based on the variables contribution to the predictive power of the model and its goodness of fit . to derive accurate tests of statistical significance , we used suddan statistical software ( research triangle institute , research triangle park , nc ) , and this adjusted for the survey 's complex sampling design . the multivariate model used in this study to examine the sub - sample is a modification of that of grossman and smith & kington which captures the multi - dimensional concept of health status and conditions . the present study further refined the two aforementioned works and in the process added some new factors , such as psychological conditions , crowding , house tenure , and the number of people in the household . using econometric analysis the study sought to model the self - reported health of men in the two wealthiest and poorest quintiles from a general set of social determinants identified in the literature , as seen in the equation below ( equation ) . f(li , ri , lnc , eni , ari , ssi , cri , ( 1npippi),lnei , hhi , ai , hii , mi , fi , mri , edi , lnmei )  . li is living alone of person i , 1 if living alone , 0 if not living alone ; ri is retirement income of person i , 1 if receiving private and/or government pension , 0 if otherwise ; lnc is the average consumption expenditure of person i , in dollars ; en is the natural disaster , 1 if in the lived milieu there has been flooding , soil erosion , landslide , 0 if not ; ari is the area of residence , other towns , kma with the reference group being rural areas ; ssi is social support , 1 if yes , 0 if no ; cr is crowding in the household of person i ; lnei is the average total expenditure of the person i in dollars , which is the proxy for income ; hhi is household head of person , 1 if yes , 0 if no ; ai is age of person i , in years ; hii is health insurance coverage , 1 if person has a health insurance policy , 0 if otherwise ; m is number of males in household of person i ; f is number of females in household of person i ; mri is marital status of person i ; edi is educational level of person i ; lnmei is medical expenditure of person i ; ( i=1npi , ppi ) npi is the summation of all negative affective psychological conditions and pp is the summation of all positive affective psychological conditions . the final model consisted of only those variables which are statistically significant ( p < 0.05 ) . equation represents those factors that explain the health conditions of those in the poorest 20% and equation denotes variables which are correlated with the health conditions of those in the wealthiest 20% : hi = f(li , ppi , ai , hii , edi )      hi = f(lnci , npi , ai , hii , lnmei ) there are diverse dissimilarities between the demographic characteristics of men in the two poorest quintiles and those in the two wealthiest quintiles . the average consumption per head for the poor was us$301.79 ( sd = us$96.16 ) , which represented 22.1% of the average consumption expenditure per head of those in the two wealthiest quintiles . similarly , the crowding for men in the two wealthiest quintiles was 1 person ( sd = 0.798 person ) compared to 2.3 persons ( sd = 1.4 persons ) for those in the two poorest quintiles . furthermore , 4.6 times more men in the two wealthiest quintiles resided alone , compared to those in the poorest quintiles . there was a remarkable difference in the level of tertiary education of the two sampled groups , as for every 1 man in the two poorest quintiles with tertiary level education there were 88 men in the two wealthiest quintiles . in addition to the aforementioned differences , there are 4 times more men in the two wealthiest quintiles who are receiving retirement income compared to those men in the two poorest quintiles ( table 1 ) . moreover , those in the two wealthiest quintiles are more vulnerable to crime ( 2.5  8.5 ; range = 88 , 0 ) compared to those in the poorest quintiles ( 1.7  7.3 ; range = 88 , 0 ) . demographic characteristics of sample the disparity was narrower for self - reported health conditions , as for every 100 men in the two poorest quintiles who indicated a health condition there were 109 men in the two wealthiest quintiles . predicting the health conditions of men in the two poorest quintiles : in the investigation of the factors which predict the health conditions of men in the two poorest quintiles , it was found that the data was a good fit for the model as 89.1% ( n = 1,755 ) of the data were correctly classified ; 98.5% of those who indicated no health condition were correctly classified , with 28.7% reporting that they had at least one dysfunction ( table 2 ) . moreover , the 5 factors accounted for 30.6% of the variability in health conditions of this group : -2 log likelihood = 1195.541 ; nagelkerke r = 0.306 ;  ( 21 ) = 360.02 , p < 0.001 . logistic regression : health conditions of men in the two poorest quintiles by some explanatory variables . predicting health conditions of men in the two wealthiest quintiles : in investigating the self - reported health of men in the two wealthiest quintiles , it was found that the data was a good fit for the model , as 87.6% ( n = 2,533 ) were correctly classified ; 99.0% ( n = 2,396 ) of those who indicated no health condition were correctly classified , with 29.0% ( n = 76 ) of those mentioning that they had at least one dysfunction ( table 3 ) . logistic regression : health conditions of men in the two wealthiest quintiles by some explanatory variables . there are diverse dissimilarities between the demographic characteristics of men in the two poorest quintiles and those in the two wealthiest quintiles . the average consumption per head for the poor was us$301.79 ( sd = us$96.16 ) , which represented 22.1% of the average consumption expenditure per head of those in the two wealthiest quintiles . similarly , the crowding for men in the two wealthiest quintiles was 1 person ( sd = 0.798 person ) compared to 2.3 persons ( sd = 1.4 persons ) for those in the two poorest quintiles . furthermore , 4.6 times more men in the two wealthiest quintiles resided alone , compared to those in the poorest quintiles . there was a remarkable difference in the level of tertiary education of the two sampled groups , as for every 1 man in the two poorest quintiles with tertiary level education there were 88 men in the two wealthiest quintiles . in addition to the aforementioned differences , there are 4 times more men in the two wealthiest quintiles who are receiving retirement income compared to those men in the two poorest quintiles ( table 1 ) . moreover , those in the two wealthiest quintiles are more vulnerable to crime ( 2.5  8.5 ; range = 88 , 0 ) compared to those in the poorest quintiles ( 1.7  7.3 ; range = 88 , 0 ) . demographic characteristics of sample the disparity was narrower for self - reported health conditions , as for every 100 men in the two poorest quintiles who indicated a health condition there were 109 men in the two wealthiest quintiles . predicting the health conditions of men in the two poorest quintiles : in the investigation of the factors which predict the health conditions of men in the two poorest quintiles , it was found that the data was a good fit for the model as 89.1% ( n = 1,755 ) of the data were correctly classified ; 98.5% of those who indicated no health condition were correctly classified , with 28.7% reporting that they had at least one dysfunction ( table 2 ) . moreover , the 5 factors accounted for 30.6% of the variability in health conditions of this group : -2 log likelihood = 1195.541 ; nagelkerke r = 0.306 ;  ( 21 ) = 360.02 , p < 0.001 . logistic regression : health conditions of men in the two poorest quintiles by some explanatory variables . predicting health conditions of men in the two wealthiest quintiles : in investigating the self - reported health of men in the two wealthiest quintiles , it was found that the data was a good fit for the model , as 87.6% ( n = 2,533 ) were correctly classified ; 99.0% ( n = 2,396 ) of those who indicated no health condition were correctly classified , with 29.0% ( n = 76 ) of those mentioning that they had at least one dysfunction ( table 3 ) . logistic regression : health conditions of men in the two wealthiest quintiles by some explanatory variables . there are diverse dissimilarities between the demographic characteristics of men in the two poorest quintiles and those in the two wealthiest quintiles . the average consumption per head for the poor was us$301.79 ( sd = us$96.16 ) , which represented 22.1% of the average consumption expenditure per head of those in the two wealthiest quintiles . similarly , the crowding for men in the two wealthiest quintiles was 1 person ( sd = 0.798 person ) compared to 2.3 persons ( sd = 1.4 persons ) for those in the two poorest quintiles . furthermore , 4.6 times more men in the two wealthiest quintiles resided alone , compared to those in the poorest quintiles . there was a remarkable difference in the level of tertiary education of the two sampled groups , as for every 1 man in the two poorest quintiles with tertiary level education there were 88 men in the two wealthiest quintiles . in addition to the aforementioned differences , there are 4 times more men in the two wealthiest quintiles who are receiving retirement income compared to those men in the two poorest quintiles ( table 1 ) . moreover , those in the two wealthiest quintiles are more vulnerable to crime ( 2.5  8.5 ; range = 88 , 0 ) compared to those in the poorest quintiles ( 1.7  7.3 ; range = 88 , 0 ) . demographic characteristics of sample the disparity was narrower for self - reported health conditions , as for every 100 men in the two poorest quintiles who indicated a health condition there were 109 men in the two wealthiest quintiles . predicting the health conditions of men in the two poorest quintiles : in the investigation of the factors which predict the health conditions of men in the two poorest quintiles , it was found that the data was a good fit for the model as 89.1% ( n = 1,755 ) of the data were correctly classified ; 98.5% of those who indicated no health condition were correctly classified , with 28.7% reporting that they had at least one dysfunction ( table 2 ) . moreover , the 5 factors accounted for 30.6% of the variability in health conditions of this group : -2 log likelihood = 1195.541 ; nagelkerke r = 0.306 ;  ( 21 ) = 360.02 , p < 0.001 . logistic regression : health conditions of men in the two poorest quintiles by some explanatory variables . predicting health conditions of men in the two wealthiest quintiles : in investigating the self - reported health of men in the two wealthiest quintiles , it was found that the data was a good fit for the model , as 87.6% ( n = 2,533 ) were correctly classified ; 99.0% ( n = 2,396 ) of those who indicated no health condition were correctly classified , with 29.0% ( n = 76 ) of those mentioning that they had at least one dysfunction ( table 3 ) . logistic regression : health conditions of men in the two wealthiest quintiles by some explanatory variables . this study makes an important contribution to understanding self - reported health in jamaican men in two ways . it provides both an econometric model which can be used on sub- samples of data sets for routine data collection , and it identifies the variables involved in determining the self - reported health of the poorest and wealthiest jamaican groups . the study is timely , given the increasing recognition of the contribution of social determinants to health . the findings of this study suggest that age , average consumption , private health insurance coverage , level of education , whether or not the person lived alone , medical expenditure and positive or negative affective psychological conditions were determinants of the self - reported health of the wealthiest and poorest men in jamaica . age , health insurance and psychological conditions are common to both groups , while consumption and medical expenditure are significant for the wealthiest , and education and living arrangements for the poorest quintiles . these findings are contrary to those of other studies , and therefore contribute to the local understanding of the relationship between self - rated health status and the socio - economic status of men in jamaica . age was the second most significant predictor of self - reported health for both groups . the jamaican healthy lifestyle survey report 2000 noted a prevalence of hypertension of 19.9% among males , which increased with age in both rural and urban populations and in both sexes . the most common chronic diseases identified among elderly males and females were hypertension , arthritis , diabetes , cardiovascular arrest , stroke and cancer . patients in the 60-and - over age groups accounted for 37.2% and 41.1% respectively , of new hypertensive and diabetic cases . diabetes is one of the leading causes of morbidity and mortality among persons aged 65 and older . access to services also depends on the capacity to pay , which can exclude men in the poorest quintile and who might have lived all their lives in poverty . the high cost of consultations , diagnostic services and particularly medicines are among the most formidable barriers to appropriate and timely care . deprivation earlier in the life cycle , in terms of education and paid employment , means that older men in the two poorest quintiles are less likely than their counterparts in the two wealthiest quintiles to be literate , to have participated in the formal labour force , or to receive retirement pensions or benefits , such as health insurance coverage . even when they do receive a retirement pension , this is likely to be lower than that of their wealthier counterparts because of the lower average wages that they earned when employed . thus , many lack the means to meet their needs . in this study 4.8% of men in the two poorest quintiles possessed medical insurance , compared with 3.3% of men in the two wealthiest quintiles , and this was lower than the 7.6% reported in a previous study . this finding suggests that the cost of health care is the individual 's responsibility and for the poorer quintiles emphasizes the reliance on public services . being in fair or poor health , or having a chronic health condition , is strongly associated with being underinsured . compared to those in better health , individuals who rate their health as fair or poor are almost three times as likely to be underinsured ( 19% versus 7% ) . while this is true regardless of residence , rural non - adjacent residents in poorer health have the highest underinsured rate . studies have also shown that the lack of health insurance coverage is a significant barrier to treatment , and rural areas have disproportionate populations of uninsured and underinsured . as a result of a large percentage of rural men being employed in small businesses or being self - employed , they are more likely to be uninsured . bennett and colleagues postulated that rural residents were more likely to be uninsured than urban residents ( 17.8% versus 15.3% ) , and that rural respondents were more likely than urban counterparts to report having deferred health care because of cost ( 15.1% versus 13.1% ) . the current study found that a positive affective psychological condition was a predictor of self - reported health for those in the two poorest quintiles , while a negative affective condition was a predictive factor for those in the two wealthiest quintiles . this means that the more a wealthy individual experiences negative affective conditions , he / she is 1.074 times ( or 7.4% ) more likely to report health conditions , suggesting that increased negative conditions result in more hypertension , diabetes mellitus and other types of illnesses . positive affective psychological conditions , on the other hand , were inversely correlated with health conditions for those in the two poorest quintiles . there , those in the two poorest quintiles who experienced more positive conditions were 8.3% less likely to report health conditions . embedded in this finding is the role negative and positive affective conditions play in determining the health conditions of different sub - groups in the jamaican population . psychological wellbeing is dependent on a host of factors , including genetic traits , social support systems , personality types , and the presence of positive and negative psychological constructs such as happiness , optimism , morale , depression , anxiety , self - esteem , self - efficacy , and vigour . psychological wellbeing is particularly important for the prevention or management of cardiovascular disease , but it also has important implications for the prevention and management of other chronic diseases such as diabetes , osteoporosis , hypertension , obesity , cancer and depression , which have been identified as significant in the jamaican population . people 's cognitive responses to ordinary and extraordinary situational events in life are associated with a different typology of wellbeing . it is found that happier people are more optimistic , and as such they conceptualize life 's experiences in a positive manner . a study by diener and colleagues found that self - reported wellbeing ( personal happiness ) of the wealthy - affluent ( those earning in excess of us 10 million annually ) was marginally more than that of the lower wealthy , suggesting that high incomes do not increase happiness by the same proportion . the distinction between the importance of the positive and negative affective conditions of the poor and rich respectively , underlines the importance of the state of mind in perceived health . according to harris and colleagues and kashdan , negative psychological conditions affect subjective wellbeing in a negative manner ( i.e. guilt , fear , anger , disgust ) , and positive factors influence self - reported wellbeing in a direct way . this concurs with findings in studies conducted by fromson as well as by other scholars . furthermore , the poor may become more optimistic , even with a decline in their health status . the rich , on the other hand , report that a negative affective psychological condition , such as the loss of a family member , is associated with their decline in health . education was another of the five predictors of self - reported health for those in poor quintiles . for every eighty - eight men in the two wealthiest quintiles attaining a tertiary level of education , there was only one man in the two poorest quintiles . education is closely associated with an individual 's health status , and high average educational levels are closely associated with higher average life expectancy . research has shown that higher levels of education usually translate into better health status , higher incomes , and consequently higher standards of living and better cognitive functioning in older age . men with less education and who are poorer are more likely to experience earlier onset of disease , loss of functioning , and physical impairment . hayward and colleagues reported onset of diseases and death 510 years earlier for persons with lower socioeconomic status . the average number of biological risk factors indicating physiological dysregulation is also higher for poorer people and people with less education . education further affects health because well - educated people may be more aware of the benefits and disadvantages of certain types of behaviours associated with personal health . importantly , marital status did not appear to be a proxy for who a person lives with , as it was not a significant determinant of self - reported health conditions . smith and waitzman 's work noted that men 's gains from marriage were greater than those of women . smith and waitzman offered the explanation that wives dissuaded their husbands from particular risky behaviours , such as the use of alcohol and drugs , and would ensure that they maintain a strict medical regimen coupled with proper eating habits which accounts for them having greater wellbeing than their non - married counterparts . older men are likely to live alone and be unconnected to any family unit because of irresponsible patterns of sexual behaviour and parenting or unstable relations during their younger years . the wealthiest in the society experience better health , due to their knowledge of health risks and their access to the resources necessary to avoid such risks , and to treat health conditions . but with increasing wealth and development there has been an increase in chronic diseases , as lifestyle changes have had a negative impact . this study found that there was a large gap between the consumption of the groups , with the poorest only consuming 22% of the proportional consumption of the wealthiest . among the demographic correlates of health the current study concurs with the literature that the cost of medical care is associated with health status ; but this is only for wealthy jamaicans . medical care expenditure was not associated with self - reported health for the poor to poorest in jamaica . the key finding which emerged from this is that social determinants of health are not always the same across different social hierarchies . the similarities in social determinants across the two social strata are age of respondents , health insurance coverage , and negative affective psychological conditions . educational levels and living arrangements are not associated with health for men in the upper social strata , and consumption and medical expenditure are not for those in the lower social strata . this study adds to the literature by showing that social determinants of health are not the same in a particular cohort , or between different social strata .
background : studies that have examined social determinants of health have made their investigations on the population , but none have reviewed them from the perspective of particular social hierarchies.aim:the study examined the factors determining the self - reported health of men of different socioeconomic status , by using models derived through econometric analyses.materials & methods : the study used a sample of 6,474 respondents : 2,704 from the two poor quintiles and 3,770 from the two wealthy quintiles . 
 the survey used a random stratified probability sampling technique and involved the use of self - administered questionnaires . 
 multiple logistic regression technique was used to identify variables which are associated with health conditions of men in the two social hierarchies.results:the findings revealed that the self - reported health of men in the two wealthiest quintiles were substantially influenced by private health insurance coverage ( odds ratio ( or ) = 32.9 , 95%ci : 20.64 , 52.45 ) and age of respondents ( or = 1.03 , 95%ci : 1.02 , 1.04 ) this was similar for men in the two poorest income quintiles ; private health insurance coverage ( or = 16.97 , 95%ci : 10.18 , 28.27 ) and age ( or=1.05 , 95%ci : 1.03 , 1.06 ) . 
 negative affective psychological conditions , consumption and medical expenditure affected the self - reported health of those in the two wealthiest quintiles , while positive affective , secondary levels of education and living alone influenced those in the two poorest quintiles.conclusion:this research serves as a foundation for further work relating to the determinants of self - reported health conditions , inequity across socio - economic strata for men , and how patient care should be addressed .