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Socioeconomic status (SES) – a marker of an individual’s or a group’s position in the societal structure – exerts a profound influence on all dimensions of health and mortality. Health is a measure of the quality of life, whereas mortality defines the risk of death and can be used to measure length of life. High mortality captures the extreme consequences of socioeconomic disadvantage and in some cases reflects the ultimate state of poor health. The examination of health and mortality outcomes is a useful way to understand the negative effects of socioeconomic disadvantage.
SES is measured in a variety of ways, depending on data availability and the specific research questions posed. Typically, SES includes measures of education, income, and occupation. Education is often regarded as the most important dimension of SES because it usually occurs prior to employment, may be a prerequisite for occupational advancement, engenders a broader world perspective, contributes to a sense of personal control, and provides the requisite knowledge and skills to obtain and apply health information. Education has a graded effect on health and mortality, with higher educational levels contributing to better health and survival prospects.
Overwhelming evidence supports the strong and persistent effects of income on health. Low income increases the likelihood of poor health and contributes to higher risks of death. Methods of measuring income include per capita income, poverty rates, income-to-needs ratios, and various consumption thresholds. Income can also be measured through relative comparisons. Whereas incomes can directly affect health through access to health care and opportunities for healthy lifestyles, income inequality can indirectly affect health outcomes and mortality through underinvestment in social spending, erosion of social cohesion, and stress.
Occupational research shows that mortality and morbidity decrease with increases in employment, occupational status, and occupational prestige. Compared to individuals who are not in the labor force, employed individuals are generally healthier, in part because they have access to income, workplace camaraderie, workplace health factors such as gyms and exercise programs, and health insurance. Occupations can be further classified by occupational status and occupational prestige using measures such as the Nam-Powers Occupational SES Scores (OSS), Duncan’s Socioeconomic Index (SEI), and innovative measurements of job desirability and physical and mental demands.
Occupational status and prestige can affect health through differential experiences with workplace hazards, physical risks, and demands, toxic exposures, or through detrimental stress related behaviors.
SES is associated with health behaviors and structural conditions that have lasting impacts on health throughout the life course. For instance, researchers have made a persuasive case that higher levels of SES include access to resources that translate into behaviors that minimize the risks associated with morbidity and mortality. Compared to individuals with lower SES, individuals with higher SES are more likely to live in areas characterized by health promoting resources and low crime and they are more likely to engage in healthy behaviors – exercise, abstention from smoking, more nutritious diets, avoidance of drug use or excessive alcohol consumption – which translate into lower risks of death from such causes as cardiovascular disease, many forms of cancer, diabetes, accidents, and homicide.
SES is usually conceptualized to include multiple dimensions (knowledge, employment, and economic status) and is often indexed by educational and occupational attainment and income. Individuals who are situated in elevated positions in the social hierarchy tend to experience superior levels of health and survival. Individuals who are employed, with higher levels of education, and with greater incomes tend to enjoy better health and lower mortality than socioeconomically disadvantaged individuals.
- Link, B. G. & Phelan, J. (1995) Social conditions as fundamental causes of disease. Journal of Health and Social Behavior (extra issue): 80-94.
- Mirowsky, J. & Ross, C. E. (2003) Education, Social Status, and Health. Aldine de Gruyter, New York.
- Rogers, R. G., Hummer, R. A., & Nam, C. B. (2000) Living and Dying in the USA: Behavioral, Health, and Social Differentials of Adult Mortality. Academic Press, New York.
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