Social Class Inequalities In Health Research Articles

Retrenched Welfare Regimes Still Lessen Social Class Inequalities in Health

This article builds on recent work that has explored how welfare regimes moderate social class inequalities in health. It extends research to date by using longitudinal data from the EU-SILC (2003-2010) and examines how the relationship between social class and self-reported health and chronic conditions varies across 23 countries, which are split into five welfare regimes (Nordic, Anglo-Saxon, Eastern, Southern, and Continental). Our analysis finds that health across all classes was only worse in Eastern Europe (compared with the Nordic countries). In contrast, we find evidence that the social class gradient in both measures of health was significantly wider in the Anglo-Saxon and Southern regimes. We suggest that this evidence supports the notion that welfare regimes continue to explain differences in health according to social class location. We therefore argue that although downward pressures from globalization and neoliberalism have blurred welfare regime typologies, the Nordic model may continue to have an important mediating effect on class-based inequalities in health.

Neo-Marxian social class inequalities in self-rated health among the employed in South Korea: the role of material, behavioral, psychosocial, and workplace environmental factors

BackgroundThe aim of this study was to examine the pattern of social inequality in self-rated health among the employed using the Wright’s social class location indicator, and to assess the roles of material, behavioral, psychosocial, and workplace environmental factors as mediating factors in explaining the social class inequality in self-rated health in South Korea.MethodsThis study used data from the 4th Korea National Health and Nutrition Examination Survey from 2007 to 2009. Study subjects included the employed population of 4392 men and 3309 women aged 19–64 years. Subjects were classified into twelve social class positions based on the Wright’s social class map. The health outcome was self-rated health. Material, psychosocial, behavioral, and workplace environmental factors were considered as potential mediators in explaining social class health inequality. We calculated prevalence ratios of poor self-rated health according to social class, adjusted for age and mediating factors using Poisson regression models.ResultsNonskilled workers and petty bourgeoisie reported worse self-rated health than other social classes among men. The age-adjusted prevalence of petty bourgeoisie and nonskilled workers were about four-fold greater than that of managers. Expert supervisors in the contradictory class location had a greater prevalence of poor self-rated health than experts in men. In women, the prevalence of poor self-rated health was greater in most social classes than their male counterparts, while the differences among social classes within women were not statistically significant. Workplace environmental factors explained the social class inequality by from 24 to 31% in nonskilled and skilled workers and nonskilled supervisors, respectively, and material factors showed an explanatory ability of about 8% for both nonskilled workers and petty bourgeoisie in men.ConclusionsWe showed the inequality in self-rated health according to the Wright’s social class in an industrialized Asian country. Policy efforts to improve workplace environments in nonskilled and skilled workers and nonskilled supervisors would have a moderate effect on reducing the magnitude of social class inequality in self-rated health. Furthermore, the means to improve power relations in the workplace should be devised to further reduce the social class inequalities in health.

Social class inequalities in health among occupational cohorts from Finland, Britain and Japan: A follow up study

We examined whether relative occupational social class inequalities in physical health functioning widen, narrow or remain stable among white collar employees from three affluent countries. Health functioning was assessed twice in occupational cohorts from Britain (1997–1999 and 2003–2004), Finland (2000–2002 and 2007) and Japan (1998–1999 and 2003). Widening inequalities were seen for British and Finnish men, whereas inequalities among British and Finnish women remained relatively stable. Japanese women showed reverse inequalities at follow up, but no health inequalities were seen among Japanese men. Health behaviours and social relations explained 4–37% of the magnitude in health inequalities, but not their widening.

Evolución de las desigualdades sociales en salud en Cataluña

The aim of this work is to analyze the evolution of social class inequalities in men and women in health status, health related behaviours and utilization of health services in Catalonia between 1994 and 2006. This is a study of trends based on the analysis of the Encuesta de Salud de Cataluña. To examine the association between 12 dependent variables and social class in each survey, robust Poisson regression models were fitted. People belonging to manual class showed the worst indicators. Over the period, social class inequalities in health status and health services utilisation tended to remain constant or to decrease (performing breast cancer screening). Conversely, inequalities in smoking increased.In Catalonia there are social class inequalities in health, among men and women, that tend to remain stable over the years.

Social Class Differentials in Health and Mortality: Patterns and Explanations in Comparative Perspective

Social class inequalities in health and mortality have become an increasingly prominent topic of study among sociologists, demographers, economists, and social epidemiologists. Considerable progress has been made in documenting such inequalities in a wide variety of settings using multiple measures of health and all-cause and cause-specific mortality. That social class inequalities are pervasive is now well established, but factors that underlie them are less clearly understood. This review discusses various measures used to define social class in studies of health inequalities. It then reviews the literature on patterns of these inequalities in developed countries as well as their potential explanations. Promising new research approaches include those that employ a life course perspective in the study of health inequalities and those that integrate multiple levels of analysis, including biological pathways that are likely to be involved in translating cumulative adversity to poor health.

Trends in obesity among adults in England from 1993 to 2004 by age and social class and projections of prevalence to 2012

Background:This study aims to project the prevalence of adult obesity to 2012 by age groups and social class, by extrapolating the prevalence trends from 1993 to 2004. Repeated cross-sectional surveys...

Inequalities in health by social class dimensions in European countries of different political traditions

To compare inequalities in self-perceived health in the population older than 50 years, in 2004, using Wright's social class dimensions, in nine European countries grouped in three political traditions (Social democracy, Christian democracy and Late democracies). Cross-sectional design, including data of the Survey of Health, Ageing and Retirement in Europe (Sweden, Denmark, Austria, France, Germany, The Netherlands, Spain, Italy and Greece). The population aged from 50 to 74 years was included. Absolute and relative social class dimension inequalities in poor self-reported health and long-term illness were determined for each sex and political tradition. Relative inequalities were assessed by fitting Poisson regression models with robust variance estimators. Absolute and relative health inequalities by social class dimensions are found in the three political traditions, but these differences are more marked in Late democracies and mainly among women. For example the prevalence ratio of poor self-perceived health comparing poorly educated women with highly educated women, was 1.75 (95% CI: 1.39-2.21) in Late democracies and 1.36 (95% CI: 1.21-1.52) in Social democracies. The prevalence differences were 24.2 and 13.7%, respectively. This study is one of the first to show the impact of different political traditions on social class inequalities in health. These results emphasize the need to evaluate the impact of the implementation of public policies.

Reducing Racial And Social-Class Inequalities In Health: The Need For A New Approach

It is well known that people in racial and ethnic minority groups and in lower social-class positions have higher morbidity and mortality rates from virtually every disease. To effectively deal with the problem, we will need to adopt a more appropriate conceptual model that focuses on the fundamental determinants of health, we will need to understand how important this is for all Americans as a society, and we will need to better deal with the issues people care about: their children, homes, jobs, safety, education, families, retirement, and future prospects.

Does survey non-response bias the association between occupational social class and health?

A non-response rate of 20-40%is typical in questionnaire studies. The authors evaluate non-response bias and its impact on analyses of social class inequalities in health. Set in the context of a health survey carried out among the employees of the City of Helsinki (non-response 33%) in 2000-02. Survey response and non-response records were linked with a personnel register to provide information on occupational social class and long sickness absence spells as an indicator of health status. Women and employees in higher occupational social classes were more likely to respond. Non-respondents had about 20-30% higher sickness absence rates. Relative social class differences in sickness absence in the total population were similar to those among either respondents or non-respondents. In working populations survey non-response does not seriously bias analyses of social class inequalities in sickness absence and possibly health inequalities more generally.

A conversation with Jerry Morris. Interview by George Davey Smith.

erry Morris was born on May 6, 1910, in Liverpool, England. He studied medicine at University of Glasgow, qualifying in 1934 and obtaining his membership in the Royal College of Physicians in 1939. He served in the Royal Army Medical Corps from 1941 to 1946, mainly in India and Burma. During the war, Morris published a series of influential papers on the epidemiology of juvenile rheumatism and peptic ulcer together with the sociologist Richard Titmuss, which took a then-novel social view of disease causation. He received his first formal training in epidemiology at the London School of Hygiene and Tropical Medicine, where he won the Chadwick prize in 1947. In 1948, he became Director of a new Medical Research Council Social Medicine Unit, where he remained until his official retirement in 1975. There he established a series of cohort studies on physical activity and coronary heart disease. In 1957, he published his widely read textbook Uses of Epidemiology, one of the first books on non-infectious disease epidemiology. In the late 1970s, Morris served on the influential Black committee, established by the Labor government to investigate the persistent social class inequalities in health. His work on both exercise and social inequalities continues unabated. Further details on his life and work are available in a symposium held to celebrate his 90th birthday. 1-3

Is there a north-south divide in social class inequalities in health in Great Britain? Cross sectional study using data from the 2001 census

Objective To examine individual social class inequalities in self rated general health within and between the constituent countries of Great Britain and the regions of England.Design Cross sectional study using...

Intelligence: is it the epidemiologists' elusive "fundamental cause" of social class inequalities in health?

Virtually all indicators of physical health and mental competence favor persons of higher socioeconomic status (SES). Conventional theories in the social sciences assume that the material disadvantages of lower SES are primarily responsible for these inequalities, either directly or by inducing psychosocial harm. These theories cannot explain, however, why the relation between SES and health outcomes (knowledge, behavior, morbidity, and mortality) is not only remarkably general across time, place, disease, and kind of health system but also so finely graded up the entire SES continuum. Epidemiologists have therefore posited, but not yet identified, a more general "fundamental cause" of health inequalities. This article concatenates various bodies of evidence to demonstrate that differences in general intelligence (g) may be that fundamental cause.

Social class and self-reported health status among men and women: what is the role of work organisation, household material standards and household labour?

Social class understood as social relations of ownership and control over productive assets taps into parts of the social variation in health that are not captured by conventional measures of social stratification. The objectives of this study are to analyse the association between self-reported health status and social class and to examine the role of work organisation, material standards and household labour as potential mediating factors in explaining this association. We used the Barcelona Health Interview Survey, a cross-sectional survey of 10,000 residents of the city's non-institutionalised population in 2000. This was a stratified sample, strata being the 10 districts of the city. The present study was conducted on the working population, aged 16–64 years (2345 men and 1874 women). Social class position was measured with Erik Olin Wright's indicators according to ownership and control over productive assets. The dependent variable was self-reported health status. The independent variables were social class, age, psychosocial and physical working conditions, job insecurity, type of labour contract, number of hours worked per week, possession of appliances at home, as well as household labour (number of hours per week, doing the housework alone and having children, elderly or disabled at home). Several hierarchical logistic regression models were performed by adding different blocks of independent variables. Among men the prevalence of poor reported health was higher among small employers and petit bourgeois, supervisors, semi-skilled (adjusted odds ratio—aOR: 4.92; 95% CI: 1.88–12.88) and unskilled workers (aOR: 7.69; 95%CI: 3.01–19.64). Work organisation and household material standards were associated with poor health status with the exception of number of hours worked per week. Work organisation variables were the main explanatory variables of social class inequalities in health, although material standards also contributed. Among women, only unskilled workers had poorer health status than the referent category of manager and skilled supervisors (aOR: 3.25; 95%CI: 1.37–7.74). All indicators of work organisation and household material standards reached statistical significance, excepting the number of hours worked per week. In contrast to men, among women the number of hours per week of household labour was associated with poor health status (aOR: 1.02; 95% CI: 1.01–1.03). Showing a different pattern from men in the full model, household material deprivation and hours of household labour per week were associated with poor health status among women. Our findings suggest that among men, part of the association between social class positions and poor health can be accounted for psychosocial and physical working conditions and job insecurity. Among women, the association between the worker (non-owner, non-managerial, and un-credentiated) class positions and health is substantially explained by working conditions, material well being at home and amount of household labour.

A multivariate analysis of the association between social class of origin and current social class with self-rated general health and psychological health among 16-year-old Australians.

A recent review of international literature concludes that there is a relative absence of social class differentials in health in early youth. There is an absence of Australian studies on the effect of social class on the health of this age group. To examine the association between social class and health among 16-year-old Australians. The data on 1048 16-year-olds came from the fifth wave (1993) of the Australian Youth Survey conducted by the former Department of Employment, Education and Training. Outcome measures were self-rated general health and psychological health (GHQ-12). Binary logistic regression was used to analyse data. Neither social class of origin nor current social class was associated with self-rated general health or psychological health. The argument that social class inequalities in health exist in childhood, disappear during early youth, and reappear later appears to hold ground within the Australian context.

Health and inequalities among the oldest old.

The elderly, and especially the oldest old, have generally been overlooked in research on social class inequalities in health. On the basis of nationally representative data from Sweden for the age group 77 to 98 (N=537), we have been able to demonstrate clear differences in health between social classes. These inequalities were found both for men and women. It should be noticed, however, that the patterns of class differences varied depending on the health indicator used. The often employed global measure of self-rated health showed the smallest class gradient when controlling for age and sex, whereas larger differences were found with more concrete and descriptive measures such as peak flow rate.

Social Class: The Missing Link in U.S. Health Data

National vital statistics in the United States are unique among those of advanced capitalist countries in reporting data only by race, sex, and age--not by class and income. This article reviews the limited U.S. data resources that may be used to document social class inequalities in health. Summarizing the strengths and weaknesses of the British approach to gathering data on social class and health, the authors discuss possible approaches to collecting data that could be feasible in the U.S. context. They argue that educational level is an insufficient marker for socioeconomic position and contend that appropriate measures must take into account not only individual but also household and neighborhood markers of social class. These additional types of social class data are especially important for accurately describing and understanding social class inequalities in health among women and across diverse racial/ethnic groups.

A question of balance: health behaviour and work context among male Glaswegians

AbstractDiscussion of the persistence of social class inequalities in health has led to greater interest being paid to differences between the classes in lay health beliefs. Recent work on lay health beliefs, however, has mainly viewed social class as a proxy for wider aspects of lifestyle and paid less attention to its occupational component. Part of this can be explained by its predominant focus on the health beliefs of women. This paper remedies this imbalance by focusing on male Glaswegians' perceptions of the health effects of their occupations. It shows that not only were respondents very aware of the influence their jobs had on their health but that they also took action to redress the balance, either by compensating for such effects or controlling their work environment to minimise their influence. Respondents' degree of commitment to their work also had a direct bearing on their coping styles. Although traditional occupational class measures were found to obscure much of how occupation influences health, unskilled and semi‐skilled workers did suffer the greatest limitations in coping with the health effects of work.

Causal explanations for class inequality in health—An empirical analysis

One of the most important issues for research on social class inequalities in health are the causes behind such differences. So far, the debate on class inequalities in health has mainly been centred around hypotheses on artefactual and selectional processes. Although most contributors to this branch of research have argued in favour of causal explanations, these have gained very little systematic scrutiny. In this article, several possible causal factors are singled out for empirical testing. The effect of these factors on class differences in physical and mental illness is studied by means of logit regressions. On the basis of these analyses, it is shown that physical working conditions are the prime source of class inequality in physical illness, although economic hardship during upbringing and health related behaviours also contribute. For class inequality in mental illness these three factors plus weak social network are important. In sum, a large part of the class differences in physical as well as mental illness can be understood as a result of systematic differences between classes in living conditions, primarily differences in working conditions.

Health in Childhood and Social Inequalities in Health in Young Adults

The role of childhood and adolescent health and development has been assessed as a potential explanation for later social class inequalities in health using longitudinal data from the 1958 cohort study. In early adulthood, general health (as self‐rated by respondents) and emotional health (as measured by the malaise inventory) were generally poorer in lower social classes. Adjustment for a wide range of childhood health characteristics did not reduce class differences in health evident in early adulthood and were therefore considered to be relatively unimportant influences. Some reduction in the class differences did occur, however, when allowance was made for ill‐health in adolescence. For example, odds of ‘poor’ or ‘fair’ rating of health at age 23 years in classes IV and V relative to classes I and II decreased from 2.52 to 2.26 in men and 3.39 to 3.08 in women after adjusting for school absence through ill‐health at age 16. Adolescent health may contribute to class inequalities in health but preliminary consideration of other potential influences (socioeconomic circumstances and health‐related behaviour) suggests that other factors may be relatively more important.

Social class and health in youth: Findings from the west of Scotland twenty-07 study

The assumption that social class inequalities in health are a persistent feature of the life-course has been questioned in a recent issue of this journal. On the evidence of mortality and chronic illness, the pattern in youth in Britain appears to be characterised by the lack of class differentials, a striking contrast to early adulthood where the familiar picture of health inequalities is observed. The possibility that this finding of relative equality in youth is a consequence of the limited, and potentially inappropriate, health indicators used has now been tested on a cohort of 15-year-olds in the West of Scotland. On a range of indicators, from subjective assessments to objective physical measures, very little evidence of class variation in health is found. The possible transience of the youth pattern is, however, indicated by findings from a cohort of 35-year-olds in the same study, among whom marked class gradients in health are apparent. Possible explanations for the transformation of a pattern of relative class equality in youth into one of inequalities in adulthood are discussed.