Socioeconomic Status and HealthSocioeconomic Status and Health

Thomas A. LaVeist, Ph.D.Thomas A. LaVeist, Ph.D.

Associate ProfessorAssociate Professor

The Johns Hopkins School of Public HealthThe Johns Hopkins School of Public Health

““[Further research on poverty and health [Further research on poverty and health is] a waste of time, money and effort, is] a waste of time, money and effort,

because the gross relationship has been because the gross relationship has been established conclusively enough.”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 GoalsLearning Goals

Terminology (Socioeconomic Status vs. Terminology (Socioeconomic Status vs. Social Class)Social Class)

Multiple Levels of AnalysisMultiple Levels of Analysis MeasurementMeasurement Conceptual Problems Conceptual Problems

What is Social Class?What is Social Class?

What is Socioeconomic Status?What is Socioeconomic Status?

Karl Marx’s Theory of Social ClassKarl Marx’s Theory of Social Class

Social status is tied to one’s relationship to Social status is tied to one’s relationship to the economythe economy

Everyone belongs to a classEveryone belongs to a class One’s class status determines one’s One’s class status determines one’s

interests, life chances and quality of lifeinterests, life chances and quality of life

Marx’s Theory of Social ClassMarx’s Theory of Social Class

BourgeoisieBourgeoisie (owners of the means of (owners of the means of production)production)

Proletariat Proletariat (workers)(workers)

Modifications to MarxModifications to Marx

Petit BourgeoisiePetit Bourgeoisie Lumpen ProletariatLumpen Proletariat

The Neo-Marxist HierarchyThe Neo-Marxist Hierarchy

BourgeoisieBourgeoisie Petit BourgeoisiePetit Bourgeoisie ProletariatProletariat Lumpen ProletariatLumpen Proletariat

Large Business OwnersLarge Business Owners ManagersManagers EmployeesEmployees Unemployed (underclass)Unemployed (underclass)

Max Weber Max Weber

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

Modernization of WeberModernization of Weber

Response to needs of quantitative analysisResponse to needs of quantitative analysis Multiple dimensionsMultiple dimensions Socioeconomic StatusSocioeconomic Status

Socioeconomic StatusSocioeconomic Status

IncomeIncome EducationEducation Occupational PrestigeOccupational Prestige

Occupational Prestige ScalingOccupational Prestige Scaling

Rank orders occupations according to Rank orders occupations according to subjective assessments of prestigesubjective assessments of prestige

Ranges from 0 to 100Ranges from 0 to 100 Score obtain by surveysScore obtain by surveys Classifies thousands of occupationsClassifies thousands of occupations

Sample Prestige ScoresSample Prestige Scores

DentistDentist LawyerLawyer SociologistSociologist Computer ProgrammerComputer Programmer Registered NurseRegistered Nurse SecretarySecretary Postal ClerkPostal Clerk GardenerGardener

96.096.0 93.093.0 74.574.5 65.065.0 60.160.1 46.546.5 44.744.7 10.910.9

Status InconsistencyStatus Inconsistency

Occupation Income Education Prestige

Teacher Low High High

Auto Worker High Low Low

Clergy (White) Low Medium Medium

Clergy (Black) Low Medium High

Nurse (Female) Medium High High

Nurse (Male) Medium High Low

Social MobilitySocial Mobility

Upward MobilityUpward Mobility Downward MobilityDownward Mobility

Social Mobility and HealthSocial Mobility and Health

28.00%

29.00%

30.00%

31.00%

32.00%

33.00%

34.00%

Downward Upward

Percent Reporting >1 Chronic Conditions

CAUSATIONCAUSATION

sesses HEALTHHEALTH

sesses HEALTHHEALTH

sesses HEALTHHEALTH

Three Categories of Theories of Three Categories of Theories of Social Mobility and HealthSocial Mobility and Health

Selection TheorySelection Theory Exposure TheoryExposure Theory Material Conditions TheoryMaterial Conditions Theory

Other ConsiderationsOther Considerations

Quality of HousingQuality of Housing Poor NutritionPoor Nutrition

IncomeIncome EducationEducation OccupationOccupation Health KnowledgeHealth Knowledge

Characteristics of ConditionsCharacteristics of Conditions Characteristic of IndividualsCharacteristic of Individuals

The SES/Health Status AssociationThe SES/Health Status Association

0

20

40

60

80

100

120

LOW MEDIUM HIGH

Multiple Levels of Analysis in Multiple Levels of Analysis in the study of Economic Statusthe study of Economic Status

Individual (Micro) LevelIndividual (Micro) Level Aggregate (Macro) Level Aggregate (Macro) Level

[group/contextual][group/contextual]

Individual (Micro) Level Individual (Micro) Level MeasuresMeasures

Income (family, individual) [missing data]Income (family, individual) [missing data] Educational Attainment [continuous and Educational Attainment [continuous and

categorical]categorical] Employment StatusEmployment Status Occupation CategoryOccupation Category Occupational PrestigeOccupational Prestige Wealth (Assets)Wealth (Assets) Housing QualityHousing Quality

Aggregate (Macro) Level Aggregate (Macro) Level MeasuresMeasures

Percent PovertyPercent Poverty Percent Educational AttainmentPercent Educational Attainment Median IncomeMedian Income Mean IncomeMean Income Housing ValuesHousing Values Unemployment ratesUnemployment rates Gross National/Domestic ProductGross National/Domestic Product LiteracyLiteracy Income Distribution (Gini, Robin Hood)Income Distribution (Gini, Robin Hood)

Income Inequality and HealthIncome Inequality and Health

Relationship between income distribution Relationship between income distribution and life expectancyand life expectancy

Population (group) level of analysis rather Population (group) level of analysis rather than individual analysisthan individual analysis

greater gap in income between rich and greater gap in income between rich and poor in a given society the low is life poor in a given society the low is life expectancyexpectancy

Income inequality and Mortality Income inequality and Mortality Rates for 50 States, 1990Rates for 50 States, 1990

650

700

750

800

850

900

950

1000

0.17 0.19 0.21 0.23

Source: Kaplan, et al (1996) BMJ 312:999-1003

Black/White Differences in SES Black/White Differences in SES and Health Statusand Health Status

0

10

20

30

40

50

60

70

80

Low High

Socioeconomic Status

Black

White

Summary and ConclusionsSummary and Conclusions

Social class status refers to relationship to the Social class status refers to relationship to the economyeconomy

Socioeconomic status refers to quantitative Socioeconomic status refers to quantitative measure of both social and economic standingmeasure of both social and economic standing

Socioeconomic status can be properly Socioeconomic status can be properly measures only by the combination of: income, measures only by the combination of: income, education and occupational prestige education and occupational prestige

Summary and ConclusionsSummary and Conclusions

The SES-health status relationship is The SES-health status relationship is complexcomplex

Status inconsistencyStatus inconsistency Social mobilitySocial mobility Income inequalityIncome inequality Much research on SES and health remains Much research on SES and health remains

to be doneto be done

Socioeconomic Status and HealthSocioeconomic Status and Health

Thomas A. LaVeist, Ph.D.Thomas A. LaVeist, Ph.D.

Associate ProfessorAssociate Professor

The Johns Hopkins School of Public HealthThe Johns Hopkins School of Public Health