Abstract
Quantitative studies have drawn attention to the patterning of health inequalities in relation to subjective social status (SSS). There is currently little insight into the complexities of the social and biographical aspects that lie behind these findings. Narrative accounts were gathered in a mixed-methods study involving a population of people with coronary heart disease (CHD) and/or diabetes in a region of the United Kingdom with above average levels of socio-economic deprivation. The aim of this secondary qualitative analysis was to examine the accounts of interviewees with low socio-economic status (SES) who ranked themselves either low or high in terms of SSS. The results highlight the multiplicity of adverse circumstances leading to subjective assessments of low SSS. Loss of employment status contributed more to a feeling of being “at the bottom of the ladder” than the symptoms of chronic illness did, perhaps because having somewhere to go is central to the accrual of social, economic, and cultural capital. The narratives of those who ranked themselves highly (in spite of low SES) appeared to have more family and community connections. The findings contribute to theories of socio-economic biographies or trajectories, subjective social status, and engagement with the self-management aspects of chronic illness.
Highlights
Previous quantitative studies have pointed to the possible role of subjective social status (SSS) in inequalities in health (e.g., Demakakos, Nazroo, Breeze, & Marmot, 2008), little is known about the mechanisms by which people choose to rank themselves notionally above or below others in society
The program involved a number of studies that incorporated a mixed-methods social networks survey, and previously published articles have reported on the statistical findings of the main survey data (Vassilev et al, 2013), the development of a telephone and web-based toolkit to link people with chronic illness to local community resources and activities (Blickem et al, 2013), and qualitative analyses focused on the importance of pets (Brooks et al, 2012) and “weak tie” social network members in supporting condition self-management (Rogers et al, 2014)
The bulk of findings were derived from the former group, who had an average age of 62 years and were mostly males (37/50, 74%)
Summary
Previous quantitative studies have pointed to the possible role of subjective social status (SSS) in inequalities in health (e.g., Demakakos, Nazroo, Breeze, & Marmot, 2008), little is known about the mechanisms by which people choose to rank themselves notionally above or below others in society. We adopt primarily a narrative approach that incorporates notions of biographical disruption (Bury, 1982) and a concern with how structural dimensions and forms of “capital” emerge in accounts of managing, or coping with, a chronic illness (after Townsend, 2012) The latter dimension is typically associated with a theoretical approach that derives from the work of Pierre Bourdieu, applied to the sociological study of class, health, and lifestyle (Williams, 1995). The data used in this article derived from interviews conducted with 68 people with diabetes or coronary heart disease (CHD) recruited in primary care settings These interviews were conducted as part of a broader program of mixed-methods research concerned primarily with investigating the role of social networks and social assets or resources in long-term condition self-management in 300 survey participants (Vassilev et al, 2013). In the context of this article, we are mostly concerned with the notion of the various resources that are available to people with a long-term condition and the extent to which different
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
