Socioeconomic Status

September 28, 2011

Socioeconomic status (SES) is a concept intended to describe one’s position in society. While Socioeconomic status is one of the terms most often used to describe this concept in the literature, Socioeconomic status has also been called social class, social status, socioeconomic position, and social inequality (although some of these terms are also used to represent distinct concepts). Socioeconomic status was originally described by Karl Marx as a group’s relation to the means of production, but has been more recently described by Weber to include three dimensions: class, status, and party or power. Since these factors describe one’s relationship to their work and others, these factors are not an inherent property of an individual, but rather are created by society. Consequently these social relationships exist prior to the factors by which Socioeconomic status is operationally measured (i.e., income, education, and occupation).

Socioeconomic status is a strong and consistent predictor of morbidity and premature mortality. This relationship has been observed for centuries. Even with the relatively recent improvements in standards of living and medical care across the globe, this relationship still holds. Furthermore, this relationship between Socioeconomic status and health is seen across the span of Socioeconomic status levels. This is often referred to as the Socioeconomic status gradient. For example, the upper class has better health outcomes than the upper-middle class, the upper-middle class has better health outcomes than the middle class, and so on.

often the relationship between Socioeconomic status and disease is so strong that it does not matter which measure of Socioeconomic status is used. However, for some diseases, the effect of Socioeconomic status and disease differs depending on the measure of social class.
The mixed results may be a result of methodological differences across studies or may signify that the different measures of Socioeconomic status are distinct but related components. Furthermore, as will be described, each measure of Socioeconomic status has its own limitations.

Education is the most popular single indicator of Socioeconomic status, likely due to the simplicity of measurement, its ability to categorize the nonactive labor force, and because of its association with many lifestyle characteristics. For most adults, this measure is more stable than either occupation or income. However, one limitation is that education levels vary by the age cohort of the individual. Many more people have graduated from high school and college in the past 20 years compared to the years prior. Furthermore, the earning potential of someone who was a high school graduate in the 1950s is different than a person graduating with a high school degree in the 1990s. Mandatory minimum age requirements for leaving school and increased opportunities for greater education are resulting in homogeneity of the population’s years of education. A further complication with using education is deciding how to categorize education. Often “years of schooling” is used, however, some have argued that academic degrees are more relevant. Furthermore, types of degrees earned and area of education may also be relevant.

The income measure of Socioeconomic status can be used as a quantitative measure but is often grouped into categories due to people’s reluctance and/or inability to report their exact income. The sensitivity of this information is often problematic since many are unwilling to give out their income level, even in broad categories. Further complications with this measure include that it is relatively unstable over time and is age-dependent since income tends to rise throughout one’s career and then drop after retirement. Furthermore, income does not necessarily equate to purchasing power or available money and household size, and regional differences in costs of living can also affect income.

Occupation is the most complex of the three single Socioeconomic status measures. There are several standard scales by which Socioeconomic status occupational status can be measured. However, many of these scales are based on data that were collected over 20 years ago and the categories were based on the judgments of persons with various degrees of familiarity with each occupation.

In addition to measurement problems with single indicators of Socioeconomic status, there are also problems with defining Socioeconomic status for special groups. For example, woman’s social class is often determined on the basis of her husband (if married) and sometimes by her father if unmarried. Furthermore, many of the scales developed for measuring occupation were created based exclusively on the male workforce. Occupational scales have been deemed less useful for assessing occupation status for African Americans, since it has been suggested that African Americans assign social class on a different scale than whites. Furthermore, the financial rewards for the same level of education are greater for white males compared to African American males. Finally, measuring the occupation and income for the elderly can be difficult, since many are in retirement. One must decide whether they will use their last job, the job they held for the longest period of time, or some other measure.

The strong relationship between Socioeconomic status and health has prompted many to consider how Socioeconomic status affects health. Research has shown that no one factor can be shown to account exclusively or entirely for the effects between Socioeconomic status and health, although several factors have been described repeatedly. Many have attributed the health gradient that exists among levels of Socioeconomic status to differential access to medical care. Research has shown that those with lower Socioeconomic status are more likely to have less access to care. However, lack of access to care is not sufficient to explain the entire relationship between Socioeconomic status and health since countries that have universal access to health care, such as England, still experience the Socioeconomic status gradient. Furthermore, since there are differences in health all along the Socioeconomic status spectrum, and those at the medium and high levels of Socioeconomic status are all likely to have access to care, it is unlikely that access to health care explains the difference entirely. Of course, access to care means more than just insurance coverage and those with lower Socioeconomic status may have more difficulty finding available doctors and may have more problems getting to the doctor (due to transportation or job conflicts). In addition, some have proposed that the quality of doctors may be different in areas of low-Socioeconomic status residents.

Poor health behaviors, such as smoking, poor diet, and lack of exercise, have an inverse linear relationship with Socioeconomic status. For example, smoking rate for those with less than a high school education is 45%, compared to 19% for those with advanced degrees. Similarly, the risk factors that go along with these behaviors, such as high cholesterol levels, obesity, and high blood pressure, are associated with lower Socioeconomic status. Recently, researchers have investigated the reasons why those with lower Socioeconomic status engage in unhealthy risk behavior more often than those with higher Socioeconomic status. Some proposed reasons include increased advertising and access to cigarettes and

alcohol in the neighborhood in which they live as well as decreased availability of healthy foods.

Physical environment has also been proposed as a factor related to the relationship between Socioeconomic status and health. The lower an individual is in the Socioeconomic status hierarchy, the more likely that that they will be exposed to adverse environmental conditions at work or at home, such as exposures to carcinogens or pathogens, and sanitation problems.

There is increasing evidence that stress plays an important role in the development of disease, in particular, heart disease and susceptibility to infection. Studies have shown that those with lower Socioeconomic status status are more likely to report being exposed to stressful events. Furthermore, the perception of the stressfulness of these events may be directly related to Socioeconomic status since those with higher education levels or more income may have more resources to resolve or reduce the impact of these events.

Many adolescents who grow up poor are thought to discount the future, perhaps because they do not feel that they will live into adulthood. This theory, called Fuch’s time preference theory, can explain both lower educational attainment and poor health behaviors, since both would require an investment in the future.

Many studies have reported health disparities across different racial and ethnic groups. Many have attributed these differences to Socioeconomic status since, in general, minorities are disproportionately represented in lower Socioeconomic status groups. To substantiate this, many studies have found no racial or ethnic differences after controlling for Socioeconomic status. However, other studies have found that controlling for Socioeconomic status does reduce the racial and ethnic differences but does not eliminate it completely. Many have attributed these residual differences in part to racial discrimination.

Some researchers have argued that even if you would consider all these factors that are related to Socioeconomic status and would control for them, studies would still find an association of Socioeconomic status and health because Socioeconomic status is a fundamental cause of disease. In general, studies focus on a single disease and a single cause at a single point in time. However, risk factors and the potential social factors that affect health are dynamic and change over time. As new risk factors emerge, those with higher Socioeconomic status are in a more favorable position to know about the risks and have the means to protect themselves against these new risks.

Socioeconomic status is clearly an important factor in health outcomes. Given the various ways to measure Socioeconomic status along with the multitude of factors that are associated with Socioeconomic status, researchers have argued for further research into Socioeconomic status, specifically its theoretical conception as well as standardized or at least consistent measurement of Socioeconomic status in all public health databases. Other suggestions include considering various time periods to measure one’s Socioeconomic status, for example, childhood Socioeconomic status versus adult Socioeconomic status. Another important avenue of investigation is determining the relevant level of Socioeconomic status, meaning individual, household, and/or neighborhood, since it has been found that an individual’s Socioeconomic status and their neighborhood’s Socioeconomic status can have independent effects on their health.

Additional research is also needed to examine whether and how the effects of Socioeconomic status may be different for women compared to men. Most of the research up until the late 1980s focused exclusively on men and how their occupation affected health. However, there are many economic issues that are specific to women. Single mothers and women who live alone are vulnerable to living in poverty. There are a growing number of single-parent households, of which the majority are headed by females. Female-headed households have median incomes below those of male-headed households or married households. Consequently, these women face the same stressors from assuming various roles (i.e., childcare, household management, paid work), but have less monetary resources to combat these stressors. The increase in single-parent households is a function of increased childbearing outside of marriage and, more often, because of divorce. Further research is needed to examine how changes in Socioeconomic status after a divorce affect women’s health relative to men, particularly, since a decline in the standards of living is often seen in the first year after a divorce for women.

There are still inequalities in pay for women in the same positions as men and women are more likely to carry out unpaid work. Presently, it is not clear the degree to which the dual role of paid and unpaid (i.e., household duties) work affects women’s health. Finally, there are important cohort effects in the Socioeconomic status of women. Women across generations have experienced very different social and economic environments and it is important to incorporate a life course perspective when examining the association between women and Socioeconomic status.

Given the increasing disparity in health outcomes and increasing income inequality, understanding Socioeconomic status is an important goal for public health practitioners. It is only through understanding the mechanism through which Socioeconomic status exerts its effects that we will be able to address these growing health disparities.

See Also: Disparities in Women’s Health and Health Care

Suggested Reading

  • Adler, N. E., Boyce, T., Chesney, M. A., Cohen, S., Folkman, S., Kahn, R. L., et al. (1994). Socioeconomic status and health. The challenge of the gradient. American Psychologist, 49(1), 15-24.
  • Adler, N. E., Boyce, W. T., Chesney, M. A., Folkman, S., & Syme, S. L. (1993). Socioeconomic inequalities in health. No easy solution. Journal of the American Medical Association, 269(24), 3140-3145.
  • Arber, S., & Khlat, M. (2002). Introduction to “social and economic patterning of women’s health in a changing world.” Social Science and Medicine, 54, 643-647.
  • Feinstein, J. S. (1993). The relationship between socioeconomic status and health: A review of the literature. Milbank Quarterly, 71(2), 279-322.
  • Krieger, N., Williams, D. R., & Moss, N. E. (1997). Measuring social class in US public health research: Concepts, methodologies, and guidelines. Annual Review of Public Health, 18, 341-378.
  • Liberatos, P., Link, B. G., & Kelsey, J. L. (1988). The measurement of social class in epidemiology. Epidemiologic Reviews, 10, 87-121.
  • Link, B. G., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, Spec. No, 80-94.
  • Lynch, J., & Kaplan, G. (2000). Socioeconomic position. In L. F. Berkman & I. Kawachi (Eds.), Social epidemiology. New York: Oxford University Press.
  • Marmot, M. G., Fuhrer, R., Ettner, S. L., Marks, N. F., Bumpass, L. L., & Ryff, C. D. (1998). Contribution of psychosocial factors to socioeconomic differences in health. Milbank Quarterly, 76(3), 403-448.
  • Strobino, D. M., Grason, H., & Minkovitz, C. (2002). Charting a course for the future of women’s health in the United States: Concepts, findings and recommendations. Social Science and Medicine, 54, 839-848.


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