Inequalities in health related to social class in women. What is the effect of the measure used?

Abstract

Classical theories of social stratification share the assumption that the family is the unit of stratification, using the man's occupation as a measure of social class. These theories were criticized by feminism, which claimed that women were not visible in class analysis. The present article aims firstly to review measurement of women's social class, secondly to review studies on the impact of different measures of social class on inequalities in health among women, and thirdly to illustrate the differences among alternative measures, using data from the Barcelona Health Interview Survey 2000 as an example. There are few studies analyzing inequalities in health among women that take into account several measures of social class; most studies have been performed in the United Kingdom, although some studies have been conducted in other countries. Typically, these studies compare several social class indicators: the conventional social class measure, which uses the husband's occupation or that of the head of household (a household measure); the individual social class measure, which uses women's occupation, and the dominant social class measure, which allocates an individual the highest social class within a household (also a household measure). The impact of the various measures on inequalities in health varies according to the study performed, but is usually greater with the conventional and dominant approaches. Data from the Health Interview Survey of Barcelona 2000 show the existence of inequalities in health using these three approaches, with varied impact according to the health indicators used and women's characteristics.The dominant social class measure has several advantages: it is gender-blind and is not sexist. When the dominant social class is a less privileged class (i.e. manual laborer) it means that both partners have an occupation equal to or lower than this measure. Finally, this indicator is easily obtained.