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Social Status and Health: Absolute deprivation or relative comparison, or both?
Gerry Veenstra
Department of Sociology, University of British Columbia, Vancouver, Canada
Abstract
While conceptualizing status hierarchies represents a challenge to social theorists, the task is doubly difficult for health researchers exploring status and health inequalities. Are the status hierarchies most strongly related to health adequately assessed by socio-economic status, for example, income and educational attainment? Do the various status hierarchies have conceptually and empirically distinct relationships with one another and health? To what degree does standing in objective status hierarchies, influence health above and beyond perceptions of relative standing, and vice versa?
This article utilizes original survey data from the Canadian province of British Columbia to test the applicability of the materialist explanation (focused on absolute deprivation and objective status hierarchies), and the psychosocial explanation (focused on perceptions of relative comparison), for relationships between social status and health.
Keywords
sociology, socio-economic status, absolute deprivation, relative comparison, self-rated job status, self-assessed social class
Article Text
Socio-economic status is ubiquitous in social inequalities and health literature because it is available in most data sets and because it represents a well-established determinant of health in most nations. Near the beginning of the population health movement, after elaborating upon a number of potential explanations for 'the gradient', Robert Evans (1994) concluded that it should continue to form the bedrock of future population health research. At that time, reflection upon the relationship between socio-economic status and health raised nearly as many questions as it provided answers. While there has been a plethora of subsequent investigations into socio-economic and health inequalities, a decade later there are still many issues to be confronted, as explanations for the gradient are many and varied and the available empirical evidence buttresses competing views. Two explanations struggling for ascendancy in the health literature are the materialist approach, focused primarily on the health effects of absolute material deprivation, and the psychosocial approach, focused on the health effects of perceived relative status.
This article utilizes data from an original questionnaire survey administered to a sample of adults from the Canadian province of British Columbia to further explore the nature of the relationship between status and health in general, and the applicability of the materialist and psychosocial explanations in particular. The survey data set includes measures of educational attainment and household income (traditional indicators of socio-economic status), and two measures of self-perceived relative social status (i.e. self-assessed social class and, for working persons, self-rated job status). The analysis determines whether these measures of absolute deprivation and relative comparison are interrelated or distinct predictors of physical and mental well-being. Thus far, proponents of the materialist and psychosocial perspectives have argued their cases without the benefit of many empirical analyses that incorporate both absolute status and perceived relative comparison variables. This article makes a contribution to the continuing debate between these theoretical perspectives, by assessing the relative strength of relationships between health and absolute/objective and perceived/subjective status measures in multivariate statistical models.
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Considered as a whole, the findings presented in this article indicate that the specific definition of health utilized in analysis is relevant when comparing absolute/material to subjective/psychosocial correlates of health: both assessments of status are apparently related to health, but they are variably related to different measures of health. The distinction between absolute and perceived status is particularly interesting because, when we link these notions to well-being, different conceptions about the nature of reality are invoked. The materialist and psychosocial approaches described here in their most basic forms, are realistic and idealistic respectively, in the tradition of Descartes' separation of matter, the substance of bodily existence, from mind, characterized by ideas and thought. It is perhaps unsurprising that some of the strongest relationships presented in this analysis were between subjective personal assessments of status and mental well-being.
The Toward a Healthy British Columbia project was funded by the Canadian Institutes of Health Research under the auspices of a New Investigator Award provided to the author.
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