Socioeconomic Status, SES INDICATORS
Definition Socialization has been indicated as a key
factor linking social position, including SES,
ELIZABETH H. BAKER
University of Alabama at Birmingham, USA to health. Health promoting and health
degrading behaviors, including smoking, diet,
Socioeconomic status (SES) is defined as a and physical activity, are learned and socially
measure of one’s combined economic and patterned (Singh-Manoux and Marmot 2005).
social status (House 2002; Galobardes et al. The influence of SES on socialization of
2006). Generally, in sociology SES is viewed behaviors likely begins very early. Childhood
as a latent construct and is measured using socioeconomic status is associated with
a composite measure of education, income, health because of its influence on childhood
and occupation or some variation of these health and through the socialization of
three indicators. While these three indica- behaviors, tastes, and preferences that are
tors represent the most widely accepted carried into adulthood. Past research indi-
measures of SES, SES is sometimes defined cates that soda consumption among children
in terms of subjective SES, wealth, was associated with parental SES and early
home ownership, or as neighborhood soda consumption predicted later consump-
disadvantage. I review the indicators of tion of soda, milk, and other key nutrients
education, income, and occupation and (Fiorito et al. 2010). Socialization of health
their relationship to health through the behaviors continues on through adolescence
framework suggested by the Black Report and adulthood. Education, especially college
(Macintyre 1997). This report indicates that attendance, may also represent a key factor to
the mechanisms linking SES to health are socializing health behaviors. Health behav-
socialization or behavioral, material or
iors, including diet and physical activity,
structural, and selection. The Black Report
change drastically from adolescence to young
also indicated that the relationship between
adulthood and then remain relatively stable.
social standing and health may be an arti-
This period also coincides with the period
fact, suggesting that the relationship is spu-
rious or that there is an anomaly in the data. that most individuals enter college. Colleges,
However, since the relationship between especially more selective or elite colleges, are
health and SES is viewed as a real phenom- environments that reinforce habits, lifestyles,
enon by many researchers and confirmed and behaviors (Ross and Mirowsky 1999).
by numerous studies, this explanation is not Thus, college is likely to influence health
discussed in this entry. The definitions of behaviors such as smoking, diet, alcohol con-
SES used vary and depend on the research sumption, and physical activity. Socialization
questions, the populations examined, and may be a key component linking SES to
the measures available (Ross and Mirowsky health; however, focusing too narrowly on
1999; Galobardes et al. 2006; Herd, socialization runs the risk of blaming lower
Goesling, and House 2007). SES individuals for their own poor health
The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society, First Edition.
Edited by William C. Cockerham, Robert Dingwall, and Stella R. Quah.
© 2014 John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd.
2
behavior and ignores the larger structural Income is related to SES and health through
factors that impact individuals’ health. structural factors. Income is normally defined
Structural factors such as housing, neigh- as pre-tax wages from one’s occupation. This
borhoods, availability of areas to exercise, can be measured at the individual level, but is
availability of nutritious foods, and suitable more commonly measured at the household
health care providers located in the general or family level, which is the combined income
proximity all impact an individual’s health of all household or family members, respec-
and health behaviors. These factors are also tively (Galobardes et al. 2006). Income can
closely tied to SES. The ability to purchase also be expanded to include all sources of rev-
adequate and safe housing impacts health enue available to an individual, including
through actual risks, such as violence or income received from investments, monetary
exposure to toxins in the environment, and transfers from family and friends, or money
through the accumulation of stress, which received through social programs, such as
negatively impacts health. Exposure to toxins Temporary Assistance to Needy Families.
in the environment may even lead to health Income grows rapidly from young adulthood
disparities in the next generation (Evans and to middle age and then tends to stabilize or
Kantrowitz 2002). For example, exposure to even decline slightly with older ages. Income
lead, found in older and less valuable resi- represents an individual’s purchasing power
dences, results in developmental defects in and health and is positively associated with
children and accumulates in adult women, better health because greater resources and
making them more likely to have complicated income allow for greater health expenditures,
pregnancies and low birth-weight children. including better health care. However, income
Additionally, the built environment, which influences health above and beyond the abil-
includes the walkability of a neighborhood, ity to purchase better health care, as indicated
perceived safety, and availability of areas to by continuing inequality in health by income
exercise, is associated with higher-quality in countries that have socialized health care
neighborhoods and better health. including many European nations. Along
Poverty, generally defined as having diffi- with better health care, higher income allows
culties in meeting one’s basic needs, represents one to purchase better-quality housing in
an indicator of SES that is closely tied to struc- nicer neighborhoods and more nutritious
tural factors that influence health. The influ- diets, and may reduce psychosocial hazards
ence of poverty on health has its origins in the to health, such as stress or hardship
threshold model, which assumed that (Galobardes et al. 2006; Herd, Goesling, and
increases in income would improve health House 2007). Lastly, compared to other
only until one was no longer in poverty (Alder measures of SES, income is a better predic-
and Ostove 1999). This theory assumed that tor of worsening health. Among those
disparities in health by SES are the result of an already in poor health, higher income
inability to meet one’s needs; thus poverty was slows disease progression and is associated
seen as a key SES factor influencing health. with greater longevity (Herd, Goesling,
While poverty has a strong association with and House 2007). Sociologists indicate that
health, it does not adequately describe the this is most likely due to the ability to pur-
relationship between SES and health, as there chase better health care and to modify work
are gradients in health by SES even among or home environments to promote better
those with the highest SES. health.
3
Education is associated with SES through with intelligence tests among adults.
its association with higher income and Additionally, even among young children,
socialization of health behaviors, and small variations in the amount of time spent
through cognitive and non-cognitive skills in school, either in more hours per day or
that promote health. Education as a measure days per year, or higher attendance, is associ-
of SES has its historical origins in Weberian ated with higher verbal, reading, and math
theory (Galobardes et al. 2006), which views scores compared to children of the same age
education as an indicator of the knowledge- (Harnischfeger and Wiley 1976). The creden-
related assets of a person, or human capital tial model, however, views education in terms
(Lynch 2000). Education, as a measurement of the advantage it provides in the labor mar-
of SES, is the first marker of social status, the ket, such as higher incomes and better jobs
main avenue of upward mobility, and pre- (Collins 1979). According to this view, addi-
cedes and substantially influences other tional years of education are useful only when
measures of SES, including occupation, they result in obtaining a degree. Empirically,
earnings, and wealth (Mirowsky and Ross though, it seems that the quantity model
2003). Additionally, since education is strongly receives more support than the credential
determined by parental characteristics, it is model (Ross and Mirowsky 1999).
viewed as an early life indicator of SES The last indicator of SES examined here is
(Beebe-Dimmer et al. 2004). Education is occupation. Occupation is related to income,
believed to influence psychosocial resources as it includes material rewards associated with
and health lifestyles including diet, exercise, one’s occupation, but is also a measure of
drinking, and smoking. The relationship social standing and helps shape and define
between psychosocial resources or non-cog- social networks. Occupations that provide a
nitive skills and cognitive skills to education greater sense of control and autonomy, and
has been termed “learned effectiveness” by allow for greater creativity, are associated with
Mirowsky and Ross (2003). These resources higher social standing. Occupations may
include better problem-solving skills, self- change often during adulthood, making it dif-
efficacy, a sense of personal control, and ficult to determine which occupation should
greater motivation and effort to solve prob- be considered for measuring SES. Normally,
lems (Ross and Mirowsky 2010). Thus, more the occupation for the longest time period is
highly educated people are healthier in part used; however, this definition may not apply
because they are better at identifying health well to young adults or capture variation in
risks and shaping their behavior to pursue social standing and available resources among
better health. older adults who have retired. Additionally,
Education is normally defined as either occupational classifications also have the
years of education completed or in terms of increased difficulty of classifying the unem-
credentials or degree earned (Ross and ployed, individuals outside the workforce, or
Mirowsky 1999). The quantity model meas- the self-employed (Galobardes et al. 2006) –
ures education as years of schooling com- the latter of which has recently seen its num-
pleted. This model assumes that increasing bers swell during a time of economic recession.
exposure to school results in better cognitive However, occupation may be important in its
and non-cognitive skills. These assertions are ability to capture likely social networks, which
reflected in research that finds that number of are an important socializing institution in
years of education is significantly associated adulthood.
4
SOCIAL SELECTION education is associated with the acquisition of
cognitive and non-cognitive skills such as
SES is related to health through socialization, self-efficacy, intelligence, feelings of control,
resources, and the acquisition of cognitive motivation, and ability to solve problems, and
and non-cognitive skills; however, any dis- is a key socializing institution into adulthood
cussion of SES would be incomplete if selec- when many health behaviors are formed.
tion was not also discussed. Selection relates Occupation influences income in a similar
to the idea that, rather than SES influencing way to education, but it also represents a key
health, health influences SES. These effects socializing institution in adulthood and may
are likely evident across the life course. encourage and maintain psychosocial
Children from lower SES homes have more resources that are associated with better
health issues, which leads to more school health, including a sense of mastery or per-
absences, lower grades, and lower test scores. sonal control. Though selection has been sug-
These factors, in turn, influence the likeli- gested as a pathway whereby SES influences
hood that an individual who experienced health, this relationship fails to explain the
childhood illness will finish high school or complex way that SES influences health given
even go on to college. Additionally, since the appearance of SES gradients in health
these effects are cumulative, children who among young children.
experienced ill-health when they were
younger, but whose health improved, are also SEE ALSO: Socioeconomic Status and
at a disadvantage. However, the strong rela- Mental Illness; Socioeconomic Status,
tionship between parental SES and child Measurement; Socioeconomic Status and
health suggests that SES still has a prominent Mortality; Socioeconomic Status and Physical
role to play in influencing health. Ill-health in Health; Socioeconomic Status and Stress
adulthood also likely influences SES through
days missed from work, difficulty in finding
and keeping a job, and the financial burden of REFERENCES
medical expenditures resulting from Alder, Nancy E., and Ostrove, Joan M. 1999. “Socio-
ill-health. economic Status and Health: What We Know
and What We Don’t.” Annals of the New York
Academy of Sciences 896: 3–15.
CONCLUSION Beebe-Dimmer, J., Lynch, J. W., Turrel, G., et al.
2004. “Childhood and Adult Socioeconomic
The definition of SES depends heavily on the Conditions and 31 Year Mortality Risk in
theoretical viewpoint taken, the research Women.” American Journal of Epidemiology 159:
question, and the measures of SES available to 481–490.
the researchers. Income, education, and Collins, Randall. 1979. The Credential Society: A
occupation are related to health because of Historical Sociology of Education and Stratifica-
tion. New York: Academic Press.
the structural or material rewards associated
Evans, Gary W., and Kantrowitz, Elyse. 2002.
with these indicators. Education and occupa-
“Socioeconomic Status and Health: The Poten-
tion influence income, which in turn influ- tial Role of Environmental Risk Exposure.”
ences an individual’s purchasing power in Annual Review of Public Health 23: 303–331.
relation to health expenditure as well as hous- Fiorito, L. M., Marini, M., Mitchell, D. C., Smicik-
ing and neighborhood quality. Additionally, las-Wright, H., and Birch, L. L. 2010. “Girls’
beyond its ability to procure higher incomes, Early Sweetened Carbonated Beverage Intake
5
Predicts Different Patterns of Beverage and and I. Kawachi, 13–35. Oxford: Oxford Uni-
Nutrient Intake across Childhood and Adoles- versity Press.
cence.” Journal of the American Dietetic Associa- Macintyre, Sally. 1997. “The Black Report and
tion 110: 543–550. Beyond: What Are the Issues?” Social Science &
Galobardes, Bruna, Shaw, Mary, Lawlor, Debbie Medicine 44(6): 723–745.
A., Lynch, John W., and Smith, George Davey. Mirowsky, John, and Ross, Catherine E. 2003.
2006. “Indicators of Socioeconomic Position Education, Social Status, and Health. Haw-
(Part 1).” Journal of Epidemiology & Community thorne, NY: Aldine de Gruyter.
Health 60: 7–12. Ross, Catherine E., and Mirowsky, John. 1999.
Harnischfeger, Annegret, and Wiley, David E. 1976. “Refining the Association between Educa-
“Achievement Test Scores Drop. So What?” Edu- tion and Health: The Effects of Quantity,
cational Researcher 5(3): 5–12. Credential and Selectivity.” Demography 36(4):
Herd, Pamela, Goesling, Brian, and House, James 445–446.
S. 2007. “Socioeconomic Position and Health: Ross, Catherine E., and Mirowsky, John. 2010.
The Differential Effects of Education versus “Why Education Is the Key to Socioeconomic
Income on the Onset versus Progression of Differentials in Health.” In Handbook of Medi-
Health Problems.” Journal of Health and Social cal Sociology, 6th ed., edited by Chloe Bird,
Behavior 48: 223–238. Peter Conrad, Allen M. Fremont, and Stefan
House, James S. 2002. “Understanding Social Fac- Timmermans. Nashville, TN: Vanderbilt Uni-
tors and Inequalities in Health: 20th Century versity Press.
Progress and 21st Century Prospects. Journal of Singh-Manoux, A., and Marmot, M. 2005. “Role
Health and Social Behavior 43(2): 125–142. of Socialization in Explaining Social Inequali-
Lynch, J. 2000. “Socioeconomic Position.” In ties in Health.” Social Science & Medicine 60(9):
Social Epidemiology, edited by L. F. Berkman 2129–2133.
