Examining the relation between the subjective and objective social status with health reported needs and health-seeking behaviour in Dande, Angola

Edite Vila Nova Rosário,Milton Severo,Miguel Brito,Diogo Francisco,Diogo Costa

doi:10.1186/s12889-021-11003-4

Abstract

BackgroundAssessing subjective social status (SSS) may be easily accommodated in the context of a Health and Demographic Surveillance System (HDSS). To our knowledge, no prior studies have examined the association of SSS and health in Angola. Subjective socioeconomic measures may provide a rapid assessment of a relevant social status construct, important for studying health inequalities. In this study, we addressed social determinants of health by examining the relationship between the subjective and objective social status, reported health and healthcare-seeking behaviour.MethodsThis research results from a cross-sectional study performed during 2015 in the Dande HDSS, in Angola. We tested the application of the MacArthur scale as a measure of SSS in a developing setting, in a sample of 12,246 households. First, we investigated its relation to objective socioeconomic indicators, and then we explored how subjective and objective social status associate with health reported needs and health-seeking behaviour of the surveyed population.Chi-square, ANOVA tests, and Receiver Operating Characteristics (ROC) Curves analysis were computed for testing relationships between subjective status ladder quartiles, sociodemographic and household characteristics. Logistic regression was used to examine the influence of subjective perception of status in self-reported health and health-seeking behaviour.ResultsOur findings suggest that the SSS follows a gradient distribution obtained with more objective socioeconomic indicators. Additionally, we found that subjective perception of status influence health needs reporting and health-seeking behaviour and its significant effect remained after controlling for the objective socioeconomic markers. Individuals standing in the second quartile of the social ladder have more odds of reporting illness and those in the highest quartiles of the ladder were twice more likely (OR = 2.23, 95% CI = 1.52–3.26) to seek help from formal health services than those at the bottom of the ladder.ConclusionsThe MacArthur Scale is a valuable tool to measure SSS in the Dande HDSS, relevant for studying socioeconomic disparities and health inequalities. It is also an easier alternative to traditional measures such as income, usually difficult to measure in developing settings. The social perception of status should be considered as a complement with objective indicators when exploring social determinants of health.

Highlights

Assessing subjective social status (SSS) may be accommodated in the context of a Health and Demographic Surveillance System (HDSS)
It is an easier alternative to traditional measures such as income, usually difficult to measure in developing settings
The social perception of status should be considered as a complement with objective indicators when exploring social determinants of health

Summary

Introduction

Assessing subjective social status (SSS) may be accommodated in the context of a Health and Demographic Surveillance System (HDSS). Unequal distribution of resources and social goods leads to different degrees of economic, political, social, and cultural advantage among groups, which may affect individuals’ health [3]. Among those factors, socioeconomic status (SES), a central feature of all societies’ social structure [4], has received remarkable attention on public health and epidemiological research [5, 6]. Socioeconomic status is a theoretical construct encompassing individual, household, and/or community access to resources [7] It measures an individual’s economic (e.g., material goods and assets) and sociological (prestige within a community) standing [8], and has been commonly considered an important predictor of health. In health science literature, it is well established that SES is a compelling determinant of morbidity, mortality, and self-rated health [9,10,11,12]

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