Welcome back everybody. Still Week 5. In this module, we're going to talk about measuring socioeconomic status.

After this, we'll talk about measuring race. And then as I mentioned talk about measuring health inequalities but they're also socioeconomic inequalities. You'll recall there are two assigned readings this week. There's a couple of optional ones, but you won't be quizzed. Those are just to help you. All right, socioeconomic status. I view this as the most important construct or idea in social epidemiology. It is the idea of where someone resides, or is located In the social system that is producing health. Differential health, some people more, some people less. So socioeconomic status, is a measure of where people are located in the big system that's producing health. You might call it where they sit in the system of social stratification. And again, it could be northern hemisphere, southern hemisphere, east, west. It could be the favorite child of the family. It could be ones income relative to their neighbors. There's all kinds of ways to think about this. And in this module we are going to talk about how to measure SES. A couple of backgrounders. First, different people use different terms. SES for socioeconomic status is effectively equivalent to SEP, or socioeconomic position. In my opinion the European re, researchers tend to use SEP. Americans SES, for purposes here, they're the same thing. Others might use an idea of social class. Now, technically, this is a little bit different but for purposes here, social class and SEP and SES are approximately the same things. You can go on and do your own reading and make the subtle sometimes important distinctions as you wish. The thing about SES or ones location in the social system is that most humans if not all humans understand it almost

intuitively and we do things to signal one another to where we are. Whether we're driving a fancy car revealing our, perhaps income, whether we are wearing fancy clothes, whether we are not, how we walk, how we talk, language, dialect. These kinds of things all signal to other human animals where we are or think we are in the social system. And by that I mean what kinds of resources do we have or have access to? Functionally speaking, SES is all about one's access to resources. Maybe its money. Maybe its something else like an athletic skill or a genius ability in mathematics. Skills and abilities. It can also be your friendship networks, you might know powerful people, or people who can get stuff done. You might have a friend with a pick up truck. Not a bad idea. So one's SES is about one's location in the social system with respect to resources. These resources tend to give us more and less power. And it's the power that lets us buy a better environment, away from a toxic dump. Power and money lets us buy better health care if we get sick. Better food to have a better healthy diet. Things like this. So this is why SES is so critical so social epidemiology. Ideas, one way or another, of SES are used throughout social research, and including social epidemiology. It's just a universal idea. Interestingly though, there's relatively little research attention into actually how to measure SES. What is it exactly? How do we know it when we see it? So there's tons of people, and you might have experienced the term in middle school, grade five or seven or something like that. But what exactly scientifically is SES? No one's quite sure, and that's what the rest of this module's going to be about. To the extent it matters, I wrote a little bit about the history of measuring socioeconomic status in this paper and the journal Social Science and Medicine and it was published in 2003.

So I don't want to spend a lotta time on the history with you. You can read this paper, it's not assigned, but you're welcome to go and check it out as you wish. And in there, I try to offer lots of citations to other really good works, so. You can use this one paper as a stepping stone if you wish. Two kinds of ways to think about how to measure SES. First are single measures such as income, and income can be your personal annual income. It could be the income of your family, income over a year, or over a decade. It could be your income in the last week. It could be your income from earnings from a job or income from transfers from a family member, someone gave you some money or something. So income is a single measure that reflects or tries to tap the construct SES. Educational attainment is another single and commonly used measure. How far did you go in school? 5th grade, 12th grade? Do you have a college degree? Did you get an MD or PhD? These measures of educational attainment are measures that are tapping someone's place in the social system. Another very good but very difficult measure of SES is wealth. So where income might be a flow, how much money or some sort of valuable good is coming into yourself or into your household. Wealth is about the stock, how much do you have, incomes of flow, wealth is a storage or a stock. you can have very little income, but have a huge bank account and you'll be quite fine in the social system. So wealth is hard to measure. We'll talk more about that. But it certainly reflects one's socioeconomic status. Another interesting measure that I can only briefly touch on here is one's value of their housing. People who live in more valuable, within the market system, houses. Have higher SES on general, in general. So you can use the value of housing, what's your house worth, how much is your rent, to approximate one's SES. Besides the individual measures, there are what are called composite measures.

Where we ask lots of questions and put them together in two of this and seven of that and those kinds of things. And we make a composite through statistical analysis. The history of this is recorded or at least try to be recorded in the paper I referred to earlier. And it began really with trying to measure occupational prestige. The idea that a garbage collector doesn't have a lot of prestige. A professor or a judge does. And that occupational prestige stuff is what is really capturing one's place in the social system. So there's lots of them. The Duncan socioeconomic index, one of the most famous and still used Nam and Powers, other professors tried to advance that A guy named Peter Rossi tried to advance further with something called the Household Prestige Scale/g, and I did some work with Professor Rossi years ago and developed what we called the CAPSES measure. The capital theory of SES. I'll talk briefly about this in a minute, but I don't want to get hung up on it. These, what I've just described are mostly American measures, and the United Kingdom, they have a different system. They use something called the NSSEC. The National Statistical Socioeconomic Classification. There's volumes written about this. All these measures are trying to tap one's location or resources or power in the social system. Again, this can be done at various levels: your individual level, your household-level, and your community-level. The household-level is fascinating. Because what's a child's SES? Proper reflects their parents or guardians. if your mother or father is high SES, you probably have high SES. At the community level there are aggregate measures. We can add up everyone's income or wealth. That's called an aggregate measure or there are sort of manifest measures. Is there a beautiful park? These are different kinds of measurement. We can talk briefly more about those in a later lecture.

Some of the tough issues, when it comes to measuring SES, and there are lots, are things like a life course approach to SES. Consider a college student, perhaps yourself, you might have very little income. But you're gaining skills and abilities through your education. And so what is your SES? Income wouldn't reflect it properly, and educational attainment is still in the process. Other difficult persons in the social system are so-called stay-at-home moms or persons in the military. And it's because the life course goes on. What's the SES of children? Is it just their parents'? Is it their friends'? What about an older person who has no income? These are hard issues. We can't go into them here. But I'd just tip you, tip my hat and say hey, this is worth exploring. The issue of intergenerational mobility I've always touched on. What's the SES of a child? That of their parents? Of their grandparents? how does this all work yet to really be fully understood. We also know there are differential returns to SES by things like race and sex or gender. African American woman in America has about the same ca, same earning power. When she went to college as a white woman who never went to college. So the idea of race amplifying or depressing one's earning power or position in the social system is what complicates this SES measure further. And finally, or a least for the moment, this issue of genes or genetic predisposition to high IQ. Perhaps it is also related to ones immune system. This idea greatly complicates matters of SES. Is SES a function of genes or are genes expressions anyway of function of SES? One of the bottom lines here is that most all of these measures of SES are highly correlated. Which is to say, if you know someone's income is high, they're probably educated in some way or have some national ability in mathematics or sports or whatever.

So knowing something. Tells you about something else. I mentioned earlier that I did some work and proposed a measure of ses called cases. And the idea was that we'd take one's human capital, skills, and abilities. Material capital, income to be simple. And then social capital, the friends. We put this all together and make a new composite of measure of SES. I spent some time working on this. And I thought it was a good idea. I no longer do. I changed my mind on what we should do about measuring SES. And I just want to briefly talk to you about that. First, I think for social epidemiologists, scientifically, we should stop using the term SES. Because we really don't know what it means. It confuses everyone, including me. So a better approach might be to measure clear, simple measures such as income and educational attainment. Those things are also not only simple but manipulatable through policy. We can imagine improving someone's educational attainment through better educational policy. We can imagine altering someone's income through job training or tax policy. These things can be changed. And I think for a progressive social epidemiology, wanting to do things to improve health, this is a better path. The key idea since we never really understand SES, let's measure things again that we can simply measure and do stuff with. When asked, what's the best measure for SES For certainly the western world, if not America, where I'm more familiar with, my advice is to measure educational attainment. There's lots of ways to do it. Some people measure how many years you went to school. I think we're a credential society and we ought to measure what degree you've earned. Here's a simple question coming from the U.S. Census Bureau, there's lots of ways to do this, something simple works. It simply says, what is the highest grade or degree that you finished and got credit for, where the lowest is less than

a high school diploma. And the highest is a doctoral degree of some form, PhD, MD or something like that. Lots of stuff on the Internet. You can Google it, you can get on the discussion boards and discuss it with me, but educational attainment is probably the simplest, if not most effective measure, of SES. If you want to measure income, it can get challenging, because what kind of income are we talking about. Here's a question from the census bureau for household income in 2002. Again, lots of examples about this. One needs to be careful whether talking about income for the past year. Perhaps you had a bad year. Or perhaps you had a good year. This can complicate measuring SES. So by and large to sum it up SES is a critical concept for social epidemiology, but it's difficult. I want to remind you that we never fully capture what we're trying to measure, there's always error in measuring SES. It's very complicated, and I would urge you when using it, measuring it, reading someone else's results. Be cautious, if not humble.