▪ Abstract Socioeconomic status (SES) is one of the most widely studied constructs in the social sciences. Several ways of measuring SES have been proposed, but most include some quantification of family income, parental education, and occupational status. Research shows that SES is associated with a wide array of health, cognitive, and socioemotional outcomes in children, with effects beginning prior to birth and continuing into adulthood. A variety of mechanisms linking SES to child well-being have been proposed, with most involving differences in access to material and social resources or reactions to stress-inducing conditions by both the children themselves and their parents. For children, SES impacts well-being at multiple levels, including both family and neighborhood. Its effects are moderated by children's own characteristics, family characteristics, and external support systems.

Socioeconomic status and child development.

This article examines the extent to which racial differences in socio-economic status (SES), social class and acute and chronic indicators of perceived discrimination, as well as general measures of stress can account for black-white differences in self-reported measures of physical and mental health. The observed racial differences in health were markedly reduced when adjusted for education and especially income. However, both perceived discrimination and more traditional measures of stress are related to health and play an incremental role in accounting for differences between the races in health status. These findings underscore the need for research efforts to identify the complex ways in which economic and non-economic forms of discrimination relate to each other and combine with socio-economic position and other risk factors and resources to affect health.

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Racial Differences in Physical and Mental Health

Increasing social inequalities in health in the United States and elsewhere, coupled with growing inequalities in income and wealth, have refocused attention on social class as a key determinant of population health. Routine analysis using conceptually coherent and consistent measures of socioeconomic position in US public health research and surveillance, however, remains rare. This review discusses concepts and methodologies concerning, and guidelines for measuring, social class and other aspects of socioeconomic position (e.g. income, poverty, deprivation, wealth, education). These data should be collected at the individual, household, and neighborhood level, to characterize both childhood and adult socioeconomic position; fluctuations in economic resources during these time periods also merit consideration. Guidelines for linking census-based socioeconomic measures and health data are presented, as are recommendations for analyses involving social class, race/ethnicity, and gender. Suggestions for research on socioeconomic measures are provided, to aid monitoring steps toward social equity in health.

Measuring Social Class in US Public Health Research: Concepts, Methodologies, and Guidelines

This glossary presents a comprehensive list of indicators of socioeconomic position used in health research. A description of what they intend to measure is given together with how data are elicited and the advantages and limitation of the indicators. The glossary is divided into two parts for journal publication but the intention is that it should be used as one piece. The second part highlights a life course approach and will be published in the next issue of the journal.

https://jech.bmj.com/content/jech/60/1/7.full.pdf

Indicators of socioeconomic position (part 1)

Low socioeconomic status (SES) is generally associated with high psychiatric morbidity, more disability, and poorer access to health care. Among psychiatric disorders, depression exhibits a more controversial association with SES. The authors carried out a meta-analysis to evaluate the magnitude, shape, and modifiers of such an association. The search found 51 prevalence studies, five incidence studies, and four persistence studies meeting the criteria. A random effects model was applied to the odds ratio of the lowest SES group compared with the highest, and meta-regression was used to assess the dose-response relation and the influence of covariates. Results indicated that low-SES individuals had higher odds of being depressed (odds ratio = 1.81, p < 0.001), but the odds of a new episode (odds ratio = 1.24, p = 0.004) were lower than the odds of persisting depression (odds ratio = 2.06, p < 0.001). A dose-response relation was observed for education and income. Socioeconomic inequality in depression is heterogeneous and varies according to the way psychiatric disorder is measured, to the definition and measurement of SES, and to contextual features such as region and time. Nonetheless, the authors found compelling evidence for socioeconomic inequality in depression. Strategies for tackling inequality in depression are needed, especially in relation to the course of the disorder.

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Socioeconomic Inequalities in Depression: A Meta-Analysis

Although socioeconomic inequalities in health were high on the public health agenda during much of the first half of the 20th century, they faded from view with the assumption that the United States is a classless society. Unlike Great Britain and many European nations where public health data are routinely reported by a socioeconomic measure (most often occupation), the United States generally presents health data by age, sex, and race. Many public health data sets, whether Federal, State, or local, do not contain socioeconomic variables at all, severely limiting our understanding of how and why differentials in health outcomes occur. In an era when cost-effective and targeted health planning is more important than ever, these deficiencies in the availability and reporting of data are no longer acceptable. As a first step, the Public Health Service, under National Institutes of Health leadership, funded a meeting in September 1994 in Annapolis, MD, to address these data gaps and related issues in the measurement of social inequalities in health and to make recommendations for improvements in the collections and reporting of socioeconomic data. I am pleased to share with you the following report of the Annapolis meeting, Measuring Social Inequalities in Health and its recommendations. During the coming months and years, we plan to begin their implementation.

Measuring social inequalities in health. Report on the Conference of the National Institutes of Health.

Accounting for, and being accountable to, the public's health requires carefully documenting and analyzing social inequalities in health Controversies abound over which measures of socioeconomic position to use, at which points in time, and at what level—eg, individual, household, and neighborhood Important debates also concern how to analyze these data and relate them to inequalities involving race/ethnicity and gender Addressing these complex issues is particularly timely in the light of persistent—and even widening—social inequalities in health To improve tools for evaluating socioeconomic gradients in health, in 1994 the US Public Health Service and National Institutes of Health sponsored a conference on Measuring Social Inequalities in Health This introduction to the Section on Social Inequalities in Health introduces five articles presented by participants at the conference Topics include: a historical review of efforts to measure socioeconomic inequalities in health in the US between 19

Accounting for the Public's Health: An Introduction to Selected Papers from a U.S. Conference on “Measuring Social Inequalities in Health”:

Health for All in the Twenty-first Century is the document presenting the global health policy adopted by the World Health Organization (WHO) in 1998, which reaffirms and updates the vision of Alma-Ata. This article provides a synopsis of the document and a commentary, concentrating on the issue of equity, which is central to WHO policy, and discussing cultural differences that underpin the notion of equity. The meaning of “equity” implies measurement, and the authors develop an approach to definitions of social strata and data issues that are used to quantify health differences. Finally, they discuss the way in which policies invoking equity are implemented into programs and present a rights-based approach as a case study of one way in which policy is being translated into action.

Health for All in the Twenty-First Century, World Health Organization Renewal, and Equity in Health: A Commentary:

1. Socioeconomic data should be routinely collected, and reports should routinely present data stratified by socioeconomic position, in conjunction with data on gender, race/ethnicity, and age. 2. Occupation should be considered a core socioeconomic variable: the level of earnings available and the educational level required to be employed in these occupations reflect structural changes in the national and international economies, which in turn affect the types and distribution of occupations. Where feasible, detailed data should be collected on occupational characteristics (e.g., authority, control, subordination) and whether the employment is fullor part-time. Other socioeconomic data that should be collected include: amount and sources of income; size and composition of household supported by

Nancy Moss

Papers

Measuring Social Class in US Public Health Research: Concepts, Methodologies, and Guidelines

Measuring social inequalities in health. Report on the Conference of the National Institutes of Health.

Accounting for the Public's Health: An Introduction to Selected Papers from a U.S. Conference on “Measuring Social Inequalities in Health”:

Health for All in the Twenty-First Century, World Health Organization Renewal, and Equity in Health: A Commentary:

Recommendations of the Conference “Measuring Social Inequalities in Health”: Sponsored by the National Institutes of Health, September 28–30, 1994