Commentary: The place in life course research of validated measures of socioeconomic position

Abstract

Among the attractions of social epidemiology (or social medicine—call it what you will) is the opportunity for medicine and social science to collaborate. An inspiration in this respect is the example set in the mid-20th century by Richard Titmuss and Jerry Morris, 1 who arguably established this sub-discipline. Collaborations such as that between Titmuss and Morris are required if we wish to explain the social patterning of health and disease in terms of processes that are plausible both socially and biologically. The work is most creative when each half of the collaboration respects and acquires elementary knowledge of the other discipline; something that often is not achieved. A contemporary example of sub-optimal collaboration is the continued use by social epidemiologists of the term ‘socioeconomic status’—a thought prompted by the otherwise excellent paper by Ball and Mishra 2 published in this issue of the International Journal of Epidemiology. As first pointed out by Kreiger et al., 3 the term socioeconomic status (SES) often has been used in an inconsistent manner and to mean different things. Usually three dimensions of social inequality are being referred to by SES: social class; social status; and material circumstances (indexed as income or some other measure of living standards). In sociological theory, social class refers to the position of the individual’s occupation in the structure of employment relations and conditions. Thus, a selfemployed person belongs to a different class from that of an employee; and the employee’s social class, in turn, depends on whether the employee is a supervisor, a manager, or a routine worker. Social status, in contrast, refers to a hierarchy of prestige or the social honour accorded to an individual. This may be determined by the individual’s occupation but also may depend on a range of other factors, which reflect culture and history, such as gender, ancestry, race, or religion. Someone may be an employee with no managerial power yet have high status owing to membership of the clergy. In Hindu culture, a person belonging to a family descended from a priestly caste will be accorded high status, regardless of their present-day occupation; as may a person descended from a large land-owning family in several Christian cultures. Confusion between these different forms of social inequality may have arisen during the Cold War, when use of the term social class alarmed some academics, but the end of the Cold War hopefully has removed the need for such caution. Following Kreiger et al., the term ‘socioeconomic position’ has been adopted increasingly as the most general term, encompassing all the various dimensions of inequality, keeping the terms social status and social class to describe two specific forms. For some decades now, social scientists have advocated an approach to measuring social position that is theoretically grounded and capable of empirical validation; the former being a precondition of the latter. Particularly influential, in their different ways, have been two British groups: the Oxford group of Goldthorpe, Heath, and Marshall 4 ; and the Cambridge group of Stewart, Prandy, and Blackburn. 5 The work of the Oxford group has led to the new National Statistics SocioEconomic Classification (NS-SEC), 6,7 which in UK government statistics has replaced the Registrar General’s social classes; and that of the Cambridge group has given us the Cambridge Social Interaction and Stratification Scale (CAMSIS). 8 These measures are theoretically based, in the sense that each is explicit about which socioeconomic parameter they intend to measure—social class expressed through employment relations in the case of NSSEC; and general social and material advantage as expressed through shared lifestyle in the case of the Cambridge scale. As they have a clear conceptual basis, it is possible to carry out empirical validation of the measures. An occupation’s location within the NS-SEC, for example, predicts the availability of a career structure and the possibilities for promotion for those working in that occupation, autonomy over the pace and content of work and forms of pay such as an hourly wage or monthly salary. 6