Hi Benny

Well I’m getting from your answer a qualified ‘no’. Interesting, the report on the Lancet-Oslo University Commission that you reference states quite bluntly that ‘the fact that people’s life chances differ so widely is not simply a problem of poverty, but one of socioeconomic inequality’ (2014: 631).

What worries me (oh, that’s not quite right: what frustrates me slightly) about the Savage et al. model is that it seems to obscure some of this socioeconomic inequality, by focusing in on things like cultural capital: defining a person’s class in part by whether they prefer Country and Western music or the opera. I can sort of accept that social capital (provided by the people with whom one associates) has some purchase, though it seems a rather circular argument to define a person’s class in terms of the people to whom she or he is similar.

But what does really worry me about this model of class, in terms of its utility to predict life chances and health, illness and mortality, is that it seems quite possible to shift easily from one class to another over a lifetime. Indeed I reckon I’ve been a member of at least four of the seven classes over my adult life! Which one now predicts my health expectations: the one I end up within, or the one I was in when in my 20s or 30s?

Nick

One would have to revisit the data and see the fit. However, there have been critiques of this system as there were of NS-SEC. One could get involved the nuances of classificatory systems and yes in a heuristic way this system could be used to illustrate the social gradient. Sandra Carlisle's paper : Critical Public Health, Volume 11, Number 3, 1 September 2001 , pp. 267-281(15) http://www.ingentaconnect.com/content/routledg/ccph/2001/00000011/00000003/art00006

is a useful start on the contested nature of health inequalities and of course the Wilkinson and Pickett's social comparison thesis in' the Spirit Level' adds to material deprivation theories. The recent Lancet-Oslo University Commission (2014) paper on the political determinants of health (see: http://www.thelancet.com/commissions/global-governance-for-health) is also a useful addition clarifying the political dimension to health inequalities but stops short of identifying the growth dynamic of capitalism ( a cause if the cause) as a key driving force in politics and hence in health.

Hi Benny

Well I’m getting from your answer a qualified ‘no’. Interesting, the report on the Lancet-Oslo University Commission that you reference states quite bluntly that ‘the fact that people’s life chances differ so widely is not simply a problem of poverty, but one of socioeconomic inequality’ (2014: 631).

What worries me (oh, that’s not quite right: what frustrates me slightly) about the Savage et al. model is that it seems to obscure some of this socioeconomic inequality, by focusing in on things like cultural capital: defining a person’s class in part by whether they prefer Country and Western music or the opera. I can sort of accept that social capital (provided by the people with whom one associates) has some purchase, though it seems a rather circular argument to define a person’s class in terms of the people to whom she or he is similar.

But what does really worry me about this model of class, in terms of its utility to predict life chances and health, illness and mortality, is that it seems quite possible to shift easily from one class to another over a lifetime. Indeed I reckon I’ve been a member of at least four of the seven classes over my adult life! Which one now predicts my health expectations: the one I end up within, or the one I was in when in my 20s or 30s?

Nick

University of Athens

NIck,

As far as the "circular argumeht" is concerned, you may at least consider the psycho-social mechanisms through which one's position in the social ladder has a bearing on his/hers health. Ranking low may produce negative emotions that worsen health via neuro-endocrine mechanisms and stress-induced behaviors.

I think that intra-generational mobility should not worry you. It is quite acceptable that one may change class through his life-time, and with that also his/hers capability to be healthy. Its the specific SES that somewhat determines one's health at the specific time point that are both measured. I believe that your main concern lies with the possibility that past SES may influence current health. I don't think that anyone can oppose the impulse effect of a past life event or even a time period with a different SES, especially the one in childhood, on health. However, we have to assume, and there are studies indicating so, that the association somewhat fades with time, leaving current SES to be more significant. As far as the prediction of future health is concerned, we should vest it with the uncertainty of a possible class shift.

All in all, there are many determinants of the SES. I reckon that whether Savage's model is appropriate to explain health inequalities depends on his classification, and the range of determinants that he included into his model.

Nick, Thanos,

Yes the focus seems to on inequality (and the psycho - social mechanisms) now as a key determinant, regardless of how you classify 'class'. I agree Nick the cultural capital element (i like opera but was born in a council house) can mislead but also overplay the amount of social mobility in more unequal societies. Have Wilkinson and Pickett clearly demonstrated that more equal societies, allied to greater social mobility, result in better outcomes for all. Maybe the search for a macro theory that explains health inequalities has to accept that although the direction might be found towards an answer, the road map to get us there is complex. By that I mean structural changes say, in employment, as well as psycho-socal comparison, as well as gender, ethnicity etc all intersect in various ways. The theory with the most traction for explanation, might change at the level of analysis: individual, community, populations; with some factors coming into play at these levels. Savage's model is a useful hueristic and teaching tool to get students to develop thier sociological imaginations.

Http://www.jrf.org.uk/publications/how-does-money-influence-health

You should check out recent work on this by my colleague, Jason Houle, Dept. Sociology, Dartmouth College, USA.

Of course social class theory explains (part of) health inequalities!

For a primer, see Elizabeth McGibbon's recent book, Oppression: A Social Determinant of Health. Also check out some of the work being done at the Dalla Lana School of Public Health at the University of Toronto, where I was pleased to conduct a workshop at its conference on Health, Austerity and Affluence. Blake Poland would be an excellent contact.

Hi everyone

This question has attracted some interest on Researchgate, so I think it’s worth reviewing the discussion so far, and also clarify some of the issues.

First, some context. As Howard notes, classical social class theory has identified statistical associations between socio-economic status (SES) and health status. This class gradient was most famously set out in the ‘Black Report’ of 1979. This finding has been replicated many times, in different groups and countries. This gradient operates for deaths, for many illnesses, and even suicide.

The Black Report suggested three mechanisms for this association. First, SES is a proxy for level of poverty/deprivation, and it is lack of income that leads to poorer health. Second, SES is a proxy for level of education, and hence with health behaviour (e.g. diet). Third, poor health leads to limited occupational opportunities, so those with chronic illnesses or disabilities tend to be in ‘lower’ social classes. The authors favoured the first ‘materialist’ explanation, arguing that poor diet, overcrowded, damp housing, and general lack of resources impact health.

Some of the answers in this Q&A have addressed and augmented these aspects of the class gradient: the link that Benny supplies summarises these mechanisms, and adds a fourth, psychosocial one. Thanos also mentions the latter, suggesting that low self esteem may mediate a neurochemical effect that affects health. John makes reference to Jason Houle’s work, which examines personal debt, and suggests this may reproduce and exacerbate existing socioeconomic inequalities across generations, and also affect well-being and mental health.

Now to the Savage et al model, which was the focus of my question. The citation is: Savage, M. et al (2013) A new model of social class? Findings from the BBC’s Great British Class Survey Experiment. Sociology, 47: 219-250, and incidentally it’s available online at:

http://ctinobar.webs.ull.es/1docencia/Poltsociale/BBC.pdf

In this model, the ordinal SES scale has now been replaced with a nominal one. OK, so there is an ‘elite’ group (high income and other material resources, exclusive tastes and associates from the same social bracket) and a ‘precariat’ with few resources, few contacts and lowbrow tastes. But the other classes do not fit into a neat hierarchy: for example the ‘technical middle class and the ‘new affluent workers’ are only qualitatively different. This is partly because of the focus on social and cultural capitals in the model. People may move through many of these classes during a lifetime, as their education, work, material and social resources alter.

My concern is that this detracts from the explanatory power of the original model when it comes to health, by diluting the clear effect of material resources. Thanos says that I shouldn’t worry about this: our current situation is what affects our health. But I am not sure this is logical: chronic illness and premature death are more likely to be associated with long-term circumstances rather than what happened last week, are they not?

I suppose the bottom line for me is that I don’t just want to explain the world, I also want to improve it, and reducing health inequalities is part of this. Benny argues that in a more equal society there is more social mobility and everyone does better. That makes sense, but the Savage model seems to indicate a society just as divided as the earlier model, if not more so.

At least when we focused simply on SES, a case could be made for some simple interventions. For example, ending childhood poverty/deprivation would improve diet, living conditions and access to other resources, and is one way to reduce inequalities in wealth that can lead to inequalities in health. Not so easy to argue for, if your model of class now includes your choice of entertainment and the kinds of people you are friends with, as part of the calculation! That worries me, as it could be the basis for governments to step away from efforts to reduce health inequalities, claiming that society is made up of all sorts, with differing tastes and lifestyles, which ultimately are a matter for personal choice and responsibility.

Nick

I have some problems with the notion of "SES" in the first place, if interested see:

http://melb4886.blogspot.fr/2014/03/the-trouble-with-socio-economic-status.html

Nick, your statements beginning 'I suppose the bottom line for me is that I don’t just want to explain the world, I also want to improve it' reflect my feelings about the impact of SES on education specifically and the concomittant life opportunities. I am constantly worried that my analysis is biased by my desire. However, I also see that just because there are multiple theories/models of SES doesn't mean that the one that provides the best fit with the data you are interested in isn't still correct for your data. Multiple models can apply to the one set of data. But like you I worry that a model that confounds the relationship that is most useful in the fight for change will be used cynically. This is the problem with science. Scientists can hold and accept multiple explanations as tacitly correct until further inormation is made available. Most people are not scientists. The greenhouse gases debate is a fine example of this problem.

Mel, the article you cite is excellent, but also does not necessarily void the use of SES or SEP in discussion of actions needed to improve the life circumstances of those large groups of people who through circumstance could be described as having multiple characteristics of 'low' SES. I think what I am Saying that once enough of He characteristics are adopted then a person can be generalised as low SES for the purposes of social intervention, knowing that every person in the identified group will not share all of the characteristics. The eugenics issue is a good one, and needs to be continually reframed to avoid. As a teacher, a similar problem exists, not so much with the genetic perspective but with the Dweck mindset problem, ie fixed vs growth models of intelligence. Teachers need help to constantly combat their apparently natural tendency to pigeonhole students as if their abilities were fixed. Again, the existence of the problem does not void the use of the term SES for intervention purposes, if the problem is acknowledged. Overly academic argument can be used by politicians and bureaucrats to avoid intervention.

Summary; deep academic argument is useful in clarifying Understanding but does not necessarily void the use of generalised terminology in trying to design interventions in real iife contexts as long as the deeper arguments are acknowledged.

The marxian class theory predicted that working class was the motor element of history. With strong political parties and unions, this view could be sustained in European countries in the 5O’s. Workers, get hard working and living conditions, but these condition were improving, inequalities were reducing and one can be proud to be industrial worker. Since the 80’s inequalities go up again, workers political parties and unions collapse and the very rich get richer and richer. The leading class is no longer the working class but the financial and managerial ruling class. This class wins the psychological struggle to legitimize the very high level of inequalities and claims that incomes reflect the qualities of peoples. Poor peoples, workers are assumed to be not useful. Anxiety about not to win, not to be recognized, is higher and higher, touch more and more people, and that have effect on health. More important for the lower class, this effect is also affecting the higher class. Even the Japanese manager live longer than American managers, because Japan is a more equal society than USA!

For more details and facts, read the work of two epidemiologists: Richard Wilkinson and Michael Marmott.

This is indeed a fascinating discussion, and one that was had in one of my classes about a year or so ago. Our particular discussion focused on whether or not wealth determined the overall health of an individual. Some opined that the wealthy had better access to health care. I opined that just because someone is in a lower SES does not necessarily mean that their health will suffer. We can always establish a correlation between health and wealth, but not causation.

As others have mentioned, it is also possible that people can move up or down the social ladder for a variety of reasons. One could win the lottery and suddenly be wealthy, or one could lose all they own in a stock market crash. Certainly, both of these events could affect overall health, and oddly enough both could suffer from depression to the point of suicide, for completely different reasons and opposite ends of the economic scale.

Lastly, it could certainly be possible that these SES shifts due to a change in life circumstances may affect health in ways we might not consider. For example, if one grew up on the low end of the SES ladder and was often hungry, could it not be possible that the person's health would suffer later in life if they should at some point become wealthy, and by doing so tend to over indulge in rich food and drink, therefore becoming obese?

The reasons for varying degrees of societal health are many and surely future studies will continue to reveal many more. It would be very interesting to conduct a longitudinal study on a group of people than receive health care through the Affordable Care Act here in the US (say over 10-20 years) and see if that segment of society has improved health wise.

Returning to my original question about the Savage et al model, the new edtion of 'Sociology' contains four short critiques of it, which make interesting reading, though none explicilty engages with my concerns over how their model can or cannot make sense of the association between SES and health.  All four are critical of the approach adopted by Savage et al, with Coin Milss the most dismissive, calling it a 'theory free data dredging exercise' that has generated seven arbitrary groupings. 

Having read these, I continue to doubt whether Savage et al's model has added anything useful to the quest to understand the association between class and health.

The papers can be found at:

http://soc.sagepub.com/content/current

Nick

There is a very well established health-wealth gradient.  Including twin studies that shows a divergence in health when one identical twin is a white collar worker as opposed to a blue collar worker.  Also, changes in financial status is often the juncture at which health declines.  There is an excellent documentary series on this that I've used for student and community discussions called Unnatural Causes: Is Inequality Making Us Sick? that I highly recommend for anyone thinking through these issues. 

http://www.unnaturalcauses.org/