Social Science & Medicine 55 (2002) 191–209 Social environment, life challenge, and health among the elderly in Taiwan Megan Beckett a, *, Noreen Goldman b , Maxine Weinstein c , I-Fen Lin d , Yi-Li Chuang e a RAND, 1700 Main Street, Santa Monica, CA 90401, USA b Office of Population Research, Princeton University, Wallace Hall, Princeton, NJ 08455-2091, USA c Graduate School of Arts and Sciences, Georgetown University, P.O. Box 571214, Washington DC 20057-1214, USA d Department of Sociology, Bowling Green State University, Bowling Green, OH 43403, USA e National Institute of Family Planning, Taichung, Taiwan Abstract We use an ongoing longitudinal survey of elderly Taiwanese to examine the linkages among health, the social environment, and exposure to life challenge. Data from three waves of the survey provide measures of social hierarchy, social connection, life challenge, and health outcomes. On the basis of multinomial and binomial logistic models, we explore the effects of social factors and challenge on being unhealthy or deceased at follow-up. The estimates indicate that poor health status at follow-up is associated with (1) low socioeconomic status, not having any living children, limited networks of friends, and low participation in social activities; and (2) three life challengesFchronic financial problems, excessive demands placed by close relatives and friends, and having a spouse in poor health. Respondents facing several challenges or having multiple negative attributes in their social environment are especially likely to be unhealthy at follow-up, although negative attributes appear to be counteracted by positive ones. Many findings from Western societies extend to this Taiwanese population. However, some aspects of social connection and challenge hypothesized to affect health fail to reveal a significant association. The analysis identifies differences between men and women in the effects of specific challenges on health, but sex differences in the effects of socioeconomic status and social connection on health are not significant. r 2002 Elsevier Science Ltd. All rights reserved. Keywords: Social environment; Gender; Elderly; Stress; Socioeconomic status; Taiwan Introduction The complex relationships among health, the social environment, and exposure to stressful experience have engaged the attention of researchers from a variety of disciplines. Two aspects of the social environmentFpo- sition in social hierarchies and integration in social networksFhave been studied extensively. With regard to the former, epidemiologists and social scientists have demonstrated that persons of lower socioeconomic status (SES)Ffor example, those with less income, fewer years of education, and lower occupational classFexperience higher death rates and poorer health than those of higher SES. These differences exist at every level of the social hierarchy (i.e., not simply between the poor and the non-poor) and affect every age group (e.g., Feinstein, 1993; Adler, Boyce, Chesney, Folkman, & Syme, 1993; Adler et al., 1994). With regard to social networks, researchers have shown that persons who are less socially integrated have poorer health and survival outcomes than those with more extensive and stronger social connections (e.g., House, Landis, & Umberson, 1988). Recent studies focusing on the elderly have confirmed the importance of social ties and social support on the health of this segment of the population *Corresponding author. Fax: +1-310-393-4818. E-mail address: beckett@rand.org (M. Beckett). 0277-9536/02/$-see front matter r 2002 Elsevier Science Ltd. All rights reserved. PII:S0277-9536(01)00161-7