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From the latest issue of Social Science and Medicine
Best wishes
David McDaid
LSE Health and Social Care

Is subjective social status a more important determinant of health than
objective social status? Evidence from a prospective
observational study of Scottish men

J. Macleod, G. Davey Smith, C. Metcalfe, C. Hart

Social Science & Medicine, 61 (9):1916-1929

doi:10.1016/j.socscimed.2005.04.009 <
http://dx.doi.org/10.1016/j.socscimed.2005.04.009>
Abstract
Both subjective and objective measures of lower social position have been
shown to be associated with poorer health. A psychosocial, as opposed to
material, aetiology of health inequalities predicts that subjective social
status should be a stronger determinant of health than objective social
position. In a workplace based prospective study of 5232 Scottish men
recruited in the early 1970s and followed up for 25 years we examined the
association between objective and subjective indices of social position,
perceived psychological stress, cardiovascular disease risk factors and
subsequent health. Lower social position, whether indexed by more objective
or more subjective measures, was consistently associated with an adverse
profile of established disease risk factors. Perceived stress showed the
opposite association. The main subjective social position measure used was
based on individual perceptions of workplace status (as well as their
actual occupation, men were asked whether they saw themselves as
"employees", "foremen", or "managers"). Compared to foremen, employees had
a small and imprecisely estimated increased risk of all cause mortality,
whereas managers had a more marked decreased risk. The strongest predictors
of increased mortality were father's manual as opposed to non-manual
occupation; lack of car access and shorter stature, (an indicator of
material deprivation in childhood). In the fully adjusted analyses,
perceived work-place status was only weakly associated with mortality. In
this population it appears that objective material circumstances,
particularly in early life, are a more important determinant of health than
perceptions of relative status. Conversely, higher perceived stress was not
associated with poorer health, presumably because, in this population,
higher stress was not associated with material disadvantage. Together these
findings suggest that, rather than targeting perceptions of disadvantage
and associated negative emotions, interventions to reduce health
inequalities should aim to reduce objective material disadvantage,
particularly that experienced in early life.
Keywords: Health inequality; Psychosocial factors; Subjective social
status; Social position; Mortality; Morbidity; Scotland


Also of interest:

Social Determinants of Health: Canadian Perspectives
General Editor, Dennis Raphael, Foreword by Hon. Roy J. Romanow, P.C., O.C,
Q.C.
http://www.cspi.org/books/s/socialdeter.htm


Dennis Raphael, PhD
Associate Professor and Undergraduate Program Director
School of Health Policy and Management
Atkinson Faculty of Liberal and Professional Studies
York University
4700 Keele Street
Toronto, Ontario M3J 1P3
tel: 416-736-2100, ext. 22134
fax: 416-736-5227
email: [log in to unmask]
website: http://www.atkinson.yorku.ca/draphael

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