Socioeconomic Status and Health Thomas A. LaVeist, Ph.D. Associate Professor Associate Professor The Johns Hopkins School of Public Health

“[Further research on poverty and health is] a waste of time, money and effort, because the gross relationship has been established conclusively enough.” O.W. Anderson (1958) Infant Mortality and Social and Cultural Factors: Historical Trends and Current Patterns. In Patients, Physicians and Illness, ed. E.G. Jaco. Glenco, Ill.: Free Press

Learning Goals n Terminology (Socioeconomic Status vs. Social Class) n Multiple Levels of Analysis n Measurement n Conceptual Problems

What is Social Class? What is Socioeconomic Status?

Karl Marx’s Theory of Social Class n Social status is tied to one’s relationship to the economy n Everyone belongs to a class n One’s class status determines one’s interests, life chances and quality of life

Marx’s Theory of Social Class n Bourgeoisie (owners of the means of production) n Proletariat (workers)

Modifications to Marx n Petit Bourgeoisie n Lumpen Proletariat

The Neo-Marxist Hierarchy n Bourgeoisie n Petit Bourgeoisie n Proletariat n Lumpen Proletariat n Large Business Owners n Managers n Employees n Unemployed (underclass)

Max Weber n Social status is not necessarily tied to the economy (e.g. aristocracy, clergy, literate/illiterate)

Modernization of Weber n Response to needs of quantitative analysis n Multiple dimensions n Socioeconomic Status

Socioeconomic Status n Income n Education n Occupational Prestige

Occupational Prestige Scaling n Rank orders occupations according to subjective assessments of prestige n Ranges from 0 to 100 n Score obtain by surveys n Classifies thousands of occupations

Sample Prestige Scores n Dentist n Lawyer n Sociologist n Computer Programmer n Registered Nurse n Secretary n Postal Clerk n Gardener n 96.0 n 93.0 n 74.5 n 65.0 n 60.1 n 46.5 n 44.7 n 10.9

Status Inconsistency

Social Mobility n Upward Mobility n Downward Mobility

Social Mobility and Health

CAUSATIONsesHEALTH sesHEALTH sesHEALTH

Three Categories of Theories of Social Mobility and Health n Selection Theory n Exposure Theory n Material Conditions Theory

Other Considerations n Quality of Housing n Poor Nutrition n Income n Education n Occupation n Health Knowledge Characteristics of Conditions Characteristic of Individuals

The SES/Health Status Association

Multiple Levels of Analysis in the study of Economic Status n Individual (Micro) Level n Aggregate (Macro) Level [group/contextual]

Individual (Micro) Level Measures n Income (family, individual) [missing data] n Educational Attainment [continuous and categorical] n Employment Status n Occupation Category n Occupational Prestige n Wealth (Assets) n Housing Quality

Aggregate (Macro) Level Measures n Percent Poverty n Percent Educational Attainment n Median Income n Mean Income n Housing Values n Unemployment rates n Gross National/Domestic Product n Literacy n Income Distribution (Gini, Robin Hood)

Income Inequality and Health n Relationship between income distribution and life expectancy n Population (group) level of analysis rather than individual analysis n greater gap in income between rich and poor in a given society the low is life expectancy

Income inequality and Mortality Rates for 50 States, 1990 Source: Kaplan, et al (1996) BMJ 312:

Black/White Differences in SES and Health Status

Summary and Conclusions n Social class status refers to relationship to the economy n Socioeconomic status refers to quantitative measure of both social and economic standing n Socioeconomic status can be properly measures only by the combination of: income, education and occupational prestige

Summary and Conclusions n The SES-health status relationship is complex n Status inconsistency n Social mobility n Income inequality n Much research on SES and health remains to be done

Socioeconomic Status and Health Thomas A. LaVeist, Ph.D. Associate Professor Associate Professor The Johns Hopkins School of Public Health