Elsevier

Social Science & Medicine

Volume 56, Issue 6, March 2003, Pages 1321-1333
Social Science & Medicine

Subjective social status: its determinants and its association with measures of ill-health in the Whitehall II study

https://doi.org/10.1016/S0277-9536(02)00131-4Get rights and content

Abstract

The purpose of this study was twofold—(1) investigate the role of subjective social status as a predictor of ill-health, with a further exploration of the extent to which this relationship could be accounted for by conventional measures of socioeconomic position; (2) examine the determinants of a relatively new measure of subjective social status used in this study. A 10 rung self-anchoring scale was used to measure subjective social status in the Whitehall II study, a prospective cohort study of London-based civil service employees. Results indicate that subjective status is a strong predictor of ill-health, and that education, occupation and income do not explain this relationship fully for all the health measures examined. The results provide further support for the multidimensional nature of both social inequality and health. Multiple regression shows subjective status to be determined by occupational position, education, household income, satisfaction with standard of living, and feeling of financial security regarding the future. The results suggest that subjective social status reflects the cognitive averaging of standard markers of socioeconomic situation and is free of psychological biases.

Introduction

Subjective social status has been defined as “a person's belief about his location in a status order” (Davis, 1956), referring to an individual's perception of his/her place in the socioeconomic structure. Initial research into subjective social status was driven by concerns about accurate measurement of this construct (Gough, 1949; Jackman & Jackman, 1973; Kluegel, Singleton, & Starnes, 1977). Subsequently, there was an interest in the differential class identities of men and women (Baxter, 1994; Ritter & Hargens, 1975).

This paper investigates the relation to ill-health of a relatively new measure of subjective social status, with a further exploration of the determinants of subjective social status. The specific aims of the paper are:

  • 1.

    Analysis of the relationship between subjective status and poor health, with an exploration of the extent to which this relationship can be explained by conventional measures of socioeconomic position: occupation, education, and income.

  • 2.

    Identifying the determinants of subjective social status.

There is ample evidence to suggest that social position is a predictor of both morbidity and mortality (Fox, 1989; Davey Smith, Bartley, & Blane, 1990; Mackenbach, Kunst, Cavelaars, Groenhof, & Geurts, 1997; Marmot & Wilkinson, 1999; Townsend, Davidson, & Whitehead, 1992). In addition, the existence of a gradient in health is now widely accepted—individuals at the highest socioeconomic level enjoy better health than not only those at the bottom, but also those at all levels in between (Marmot et al., 1991; Marmot & Shipley, 1996). Four possible explanations for health inequalities have been offered: artefact explanations, theories of natural and social selection, materialist/structural explanations, and cultural/behavioural explanations (MacIntyre, 1997). The focus in the social inequalities field is now on explicating the causal pathways linking socioeconomic position to health (e.g., Lynch, Davey Smith, Kaplan, & House, 2000; Marmot & Wilkinson, 2001).

Attempts at explaining the social gradient in health are complicated by the multidimensional nature of both social inequality (Bartley, Sacker, Firth, & Fitzpatrick, 1999) and that of health itself (MacIntyre, 1997). Bartley and colleagues (1999) suggest delineation of the aetiological pathways linking specific measures of social position to health outcomes as the way forward. The fact that health is itself not unidimensional opens up the field to a plethora of models, each testing the relation between a specific outcome and a specific measure of socioeconomic position. There is some evidence to suggest that subjective status is a unidimensional construct. Multiple indicators of subjective class considered within a path analytical framework supported the assumption of unidimensionality of this construct (Kluegel et al., 1977).

The interest in subjective social status as a predictor of health has been fuelled by two strands of research. The first concerns the association between income inequality and mortality (Kaplan, Pamuk, Lynch, Cohen, & Balfour, 1996; Kawachi & Kennedy, 1997; Kennedy, Kawachi, & Prothrow-Stith, 1996; Wilkinson, 1992), leading to delineation of the importance of relative disadvantage, through perception of relative standing in the social hierarchy, in pathways linking socioeconomic position to health. The second strand of evidence comes from animal studies, suggesting a link between position in the social hierarchy and poor health (Blanchard, Sakai, McEwen, Weiss, & Blanchard, 1993; Kaplan & Manuck, 1999; Sapolsky, 1982).

Theoretically, the concept of subjective social status is wider than that of “relative social standing” which is more a by-product of income inequality research. There is already some evidence to support this assumption. Jackman (1979) reported education, income and occupation to be involved in an individual's assessment of his/her subjective social class. In further analyses she found subjective class to be popularly interpreted as both a social and economic phenomenon in the American consciousness. A measure of subjective social status is likely to reflect not only current social circumstances, but also incorporate an assessment of the individual's past (socioeconomic, educational, and economic background), along with their future prospects. Subjective social status would be expected to encompass the individual's family resources, opportunities, and life chances.

Subjective class identity is a complex phenomenon. In women it has been found to include their own employment status (Ritter & Hargens, 1975), their level of education (Abbott, 1987; Jackman & Jackman, 1973), as well as their husbands’ objective class (Baxter, 1994). The majority of research in this field has been on subjective social “class”, which has been measured by respondents placing themselves in 4–6 social class categories like lower, working class, middle class, or upper class (e.g. Jackman & Jackman, 1973; Kluegel et al., 1977). For the process of class-self-placement to work adequately all respondents need to have similar perceptions of the class system. As the terms “working class” and “middle class” can be variously interpreted, and are politically loaded (Evans, Kelley, & Kolosi, 1992), using this terminology in subjective class research can be misleading.

More recently, pictorial representations have been used to study perceived social class and social structures (Evans et al., 1992), and subjective social status (Adler, Epel, Castellazzo, & Ickovics, 2000; Ostrove, Adler, Kuppermann, & Washington, 2000). This paper presents data on a new measure of subjective social status (cf. Adler et al., 2000) developed to examine the role played by social status in determining health. There is already some support for the notion that subjective status is associated independently with physical and psychological health (Adler et al., 2000; Ostrove et al., 2000). In this paper, the relationship between subjective social status and five health outcomes—angina, diabetes, respiratory illness, perceived-general-health, GHQ depression—is assessed, with an examination of the extent to which this relationship can be explained by conventional measures of socioeconomic position.

The second issue that this paper addresses is the criteria people use to assign themselves subjective social status. The process of assigning oneself social status is likely to involve processes of social comparison (comparison of self to similar others) and reflected appraisals (self-perception is based on the way we see others perceiving us). The determinants of subjective social status will provide an insight into the interpretation of this concept. The main question relates to whether people use the conventional indicators of socioeconomic position (income, education, occupation), measures of wealth, or whether other elements like psychological well-being influence the assessment of subjective status. In other words, to what extent is the perception of status determined by social structural location, and to what extent is it determined by psychological processes.

Section snippets

Participants

The target population for the Whitehall II study was all the London-based office staff, aged 35–55, working in 20 Civil Service departments. With a response rate of 73%, the final cohort consisted of 10,308 participants (6895 men and 3413 women) at the first phase of data collection between 1985 and 1988. The true response rate is higher as around 4% of those invited were not eligible for inclusion. Although mostly white collar, respondents covered a wide range of employment grades from office

Results

Table 1 presents the age-adjusted prevalence rates of angina, diabetes, respiratory illness, perceived general health, and GHQ depression according to subjective social status. The test for trend shows lower subjective status in both men and women to be related to higher rates of age-adjusted morbidity. The trend for increasing rate of morbidity with decreasing subjective status does not hold true for respiratory illness in women.

Table 2 presents the Relative Indices of Inequality (RII) of the

Discussion

This study has shown the association between subjective status and health measures in a cohort of white-collar men and women. An individual's subjective assessment of their social status, measured here by a one-item measure requiring individuals to place themselves on the social hierarchy, is a powerful predictor of their health status. The variation found in the magnitude of the association between subjective status and different health measures is similar in men and women, with the exception

Acknowledgements

The Whitehall II study has been supported by grants from the Medical Research Council; British Heart Foundation; Health and Safety Executive; Department of Health; National Heart Lung and Blood Institute (HL36310), US, NIH: National Institute on Aging (AG13196), US, NIH; Agency for Health Care Policy Research (HS06516); and the John D and Catherine T MacArthur Foundation Research Networks on Successful Midlife Development and Socioeconomic Status and Health. MM is supported by an MRC Research

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