The measurement of social class in health studies: old measures and new formulations

The measurement of socioeconomic status (SES) is a serious matter that requires us to think more precisely about both conceptual issues and issues more traditionally thought of as measurement issues. Progress in this area rests on our ability to identify those aspects of SES that are most closely related to health, human development, and life expectancy. In this chapter we review measures of SES based on characteristics of the individual as well as on characteristics of the environment or more ecologically based measures. Each of these types of SES measures has strengths and weaknesses and in all likelihood taps somewhat different aspects of class. In measuring SES across diverse populations, it is also crucial to be sensitive to the ways in which measurement varies across different cultural, ethnic and demographic groups. It is likely that as we conduct more refined research in this area we will understand more fully why SES is so profoundly related to health status. However, so as to understand this relationship, we will need to expand efforts to identify not only those psychosocial or biological processes that occur 'downstream' as a result of SES but also the nature of the social experience itself and those 'upstream' forces that place so many individuals at risk.