Examining the impact of different social class mechanisms on health inequalities: a cross-sectional analysis of an all-age UK household panel study

Whitley, E. , McCartney, G. , Bartley, M. and Benzeval, M. (2022) Examining the impact of different social class mechanisms on health inequalities: a cross-sectional analysis of an all-age UK household panel study. Social Science and Medicine, 31, 115383. (doi: 10.1016/j.socscimed.2022.115383) (PMID:36155357)

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Background: Socioeconomic inequalities are well established across health, morbidity and mortality measures. Social class theory describes how social groups relate, interact and accrue advantages/disadvantages relative to one another, with different theorists emphasising different dimensions. In the context of health inequalities, different social class measures are used interchangeably to rank population groups in terms of health rather than directly exploring the role of social class in creating inequalities. We aim to better understand how four distinct social class mechanisms explain differences in a range of self-reported and biological health outcomes. Methods: We use data from the UK Household Longitudinal Study, a representative population survey of UK adults, to identify measures pertaining to Early years, Bourdieusian, Marxist, and Weberian social class mechanisms. Using logistic and least-squares regression we consider the relative extent to which these mechanisms explain differences in health (Self-reported health, SF12 Physical (PCS) and Mental (MCS) Component Scores, General Health Questionnaire; N = 21,446) and allostatic load, a biomarker-based measure of cumulative stress (N = 5003). Results: Respondents with higher social position according to all social class measures had better self-rated, physical and mental health, and lower allostatic load. Associations with Marxist social class were among the strongest (e.g. Relative Index of Inequality for very good/excellent self-rated health comparing highest versus lowest Marxist social class: 4.96 (4.45, 5.52), with the Weberian measure also strongly associated with self-rated (4.35 (3.90, 4.85)) and physical health (Slope Index of Inequality for SF12-PCS: 7.94 (7.39, 8.48)). Health outcome associations with Bourdieusian and Marxist measures were generally stronger for women and older respondents, and physical health associations with all measures were stronger among those aged 50+ years. Conclusions: The impact of social class on health is multi-faceted. Policies to reduce health inequalities should focus more on unequal capital ownership, economic democracy and educational inequalities, reflecting Marxist and Weberian mechanisms.

Item Type:Articles
Additional Information:Understanding Society is an initiative funded by the Economic and Social Research Council (ESRC ES/M008592/1) and various Government Departments, with scientific leadership by the Institute for Social and Economic Research, University of Essex, and survey delivery by NatCen Social Research and Kantar Public. EW is funded by the Medical Research Council (MC_UU_00022/2) and Scottish Government Chief Scientist Office (SPHSU17). MBe is funded by ESRC (ES/S007253/1).
Glasgow Author(s) Enlighten ID:McCartney, Professor Gerard and Whitley, Dr Elise and Benzeval, Dr Michaela
Authors: Whitley, E., McCartney, G., Bartley, M., and Benzeval, M.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
College of Social Sciences
College of Social Sciences > School of Social and Political Sciences
College of Social Sciences > School of Social and Political Sciences > Sociology Anthropology and Applied Social Sciences
Journal Name:Social Science and Medicine
ISSN (Online):0277-9536
Published Online:20 September 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Social Science and Medicine 312:115383
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
172040How do biomarkers and genetics contribute to understanding health and society?Richard MitchellEconomic and Social Research Council (ESRC)ES/M008592/1HW - Public Health
3048231Inequalities in healthAlastair LeylandMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit
3048231Inequalities in healthAlastair LeylandOffice of the Chief Scientific Adviser (CSO)SPHSU17HW - MRC/CSO Social and Public Health Sciences Unit