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

MacLeod, J., Davey Smith, G., Metcalfe, C. and Hart, C. (2005) Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men. Social Science and Medicine, 61(9), pp. 1916-1929. (doi: 10.1016/j.socscimed.2005.04.009)

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Publisher's URL: 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.

Item Type:Articles
Keywords:Health inequality; Psychosocial factors; Subjective social status; Social position; Mortality; Morbidity; Scotland
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Hart, Dr Carole and Davey Smith, Professor George
Authors: MacLeod, J., Davey Smith, G., Metcalfe, C., and Hart, C.
Subjects:R Medicine > RA Public aspects of medicine
H Social Sciences > H Social Sciences (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
Research Group:Midspan
Journal Name:Social Science and Medicine
Publisher:Elsevier Science
ISSN:0277-9536
Copyright Holders:Copyright © 2005 Elseiver
First Published:First published in Social Science and Medicine 61(9):1916-1929
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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