Since prehistory, all societies have perceived hierarchy among their members. Leaders and followers, strong and weak, rich and poor: social classifications are universal. Humans have invented numerous ways to classify peopley wealth, power, or prestige; by ability, education, or occupation; even by where they live. The term "social class" originally referred to groups of people holding similar roles in the economic processes of production and exchange, such as landowner or tenant, employer or employee. Such positions correspond to different levels of status, prestige, and access to political power, but social class eventually took on a more generic meaning and came to refer to all aspects of a person's rank in the social hierarchy.
Belonging to a social class is not merely an objective fact, but is generally accompanied by a perception of class identity. In this sense, social class is not merely a personal attribute, but also a contextual variable that characterizes a group of people. The shared culture of a particular class influences, and is influenced by, people's attitudes and lifestyle. Social class, therefore, influences health. Centuries of observations have linked social class to patterns of disease (see Krieger, Williams, and Moss, 1997). Accordingly, epidemiologists frequently present statistics on mortality and morbidity tabulated by social class, as shown in Figures 1 and 2. However, social class is an abstract and complex concept whose influence is blended with many others in predicting disease. Both Figures 1 and 2, for example, show how the effects of social class (here, indicated by family income and educational level) interact with racial or ethnic factors. However, classifications by age, religion, race, or sex lack the implication of hierarchy and are not normally considered under the heading of social class.
Social class may be ascribed at birth, as with royalty or nobility, or with castes in Hindu societies. More commonly, however, a person's position at birth is modified by his or her achievements, typically through education, occupation, or income. Class cannot be measured directly. Instead, indicators of socioeconomic status, typically based on educational attainment, income, wealth, or occupation, are used. While few would consider these to be ideal indicators of social class, they nonetheless show consistent associations with health status, such that poorer or less educated people die younger and experience more illness and disability than richer or more educated people. These indicators each have strengths and shortcomings.
A simple occupational classification has been used in Britain throughout the twentieth century for analyses linking social class and health. The British Registrar General for Births and Deaths ranks occupations in six broad categories that reflect a judgment of the skill level and social prestige of each occupation. This has been followed by other, more complex classifications, such as the 100-point occupational scale of Tremain. This applies internationally and allows comparisons between developing and industrial countries. These categories have the advantage of capturing the notion of shared culture implicit in social class,
but they are limited because there is no adequate way to classify people who are not in the labor force, such as retired people, housewives, or students. Furthermore, the status of occupations changes with economic development, complicating comparisons across times and across cultures. Finally, occupation shares a limitation with income, in that reverse causality may occur whereby occupational status (or income) may be influenced by the level of health.
The advantages of education as an indicator of social status include simplicity and universality: educational level can be recorded for all adults, whether working or not, and it is less likely than occupation or income to be influenced by health. But education is generally finished in early adulthood, and may no longer reflect a person's status in later years. Care must also be taken when drawing comparisons of educational levels across generations, since educational attainment changes from generation to generation.
Income or wealth are also frequently used as indicators of social class, and hold the advantage of sensitivity to variations in a person's status over time. Wealth is not simple to record, however; data on income must be supplemented by information on the number of people supported by the income, and on other assets such as savings and property. Because of shortcomings in each of
these indicators, several authors have used indicators that combine education, occupation, and income.
While socioeconomic status is generally considered a characteristic of individuals, contextual measures of social class may also be relevant in explaining patterns of health. Thus, for a population we may record not only the average level of income or wealth, but also the extent of income disparities, or class divergence, in the society. Such indicators can indicate social class characteristics of the society, rather than summarizing patterns in the society.
Contemporary epidemiologic analyses assume that it is not so much social class per se that influences health, but characteristics associated with class. There are several channels through which class or socioeconomic position may influence health:
- Certain health hazards may be directly associated with social position, such as exposure to hazardous substances or processes in the workplace.
- Alternatively, social class may influence health via behaviors that follow social patterns, such as diet, cigarette smoking, or leisure-time physical activity.
- Wealth can influence health directly, by providing access to safe and healthy housing, adequate food, and medical care and supplies when needed. Wealth also enhances educational attainment in a person's children, and so influences their subsequent earning capacity; in this manner the association between poverty and health tends to perpetuate itself across generations.
- Education also facilitates access to information that can benefit health. More educated people are better able to communicate with their physicians and interact with the health care system, and make informed choices among treatment options.
- Higher social status is associated with attitudes, such as positive self-esteem or a sense of being in control of one's life, that are positively associated with a range of indicators of health (especially mental health). Such feelings are difficult to maintain when a person is unemployed.
Contemporary analyses of social class in health research have evolved from using it as a simple classification toward using class as a starting point for a more complete analysis of possible channels of influence. The next stage, perhaps, will be to incorporate an understanding of social class dynamics into designing approaches to prevention and health promotion.
(SEE ALSO: Cultural Factors; Economics of Health; Ethnicity and Health; Inequalities in Health; Social Determinants)
Berkman, L. F., and Macintyre, S. (1997). "The Measurement of Social Class in Health Studies: Old Measures and New Formulations." In Social Inequalities and Cancer. eds. M. Kogevinas, N. Pearce, M. Susser, and P. Boffetta. Lyon: International Agency for Research on Cancer.
Krieger, N.; Williams, D. R.; and Moss, N. E. (1997). "Measuring Social Class in U.S. Public Health; Research: Concepts, Methodologies, and Guidelines." Annual Review of Public Health 18:34178.
Smedley, B. D., and Syme, L. S., eds. (2000). Promoting Health: Strategies from Social and Behavioral Research. Washington, DC: National Academy Press. Available at http://books.nap.edu.
Szretzer, R. S. (1984). "The Genesis of the Registrar General's Social Classification of Occupations." British Journal of Sociology 35:52246.
Tremain, D. J. (1977). Occupational Prestige in Comparative Perspective. New York: Academic Press.
Wilkinson, R. G. (1996). Unhealthy Societies: The Afflictions of Inequality. London: Routledge.
CLASS, SOCIAL. Social class or social stratification is defined by unequal access to desirable resources (such as money, goods, and services) or personal gratification (such as prestige or respect). The sociologist Max Weber argued that social class was a function of differential wealth, political power, and status. The various dimensions of social class have different influences on food consumption and its consequences. Income and wealth provide access to food or constrain food purchases. Education provides knowledge, skills, and beliefs that shape food desires and place constraints on food choices by means of information acquisition and food preparation. Occupation not only represents prestige but also structures time and constrains the attention that can be given to food. Occupation-generated work hours and lifestyle choices affect what is eaten as well as where and with whom food is eaten.
Distinctions are made between classes. The lower class (often referred to as "working class" or blue-collar workers) is generally associated with people with low levels of education, unskilled or semiskilled occupations, and low income. Middle-class people (often seen as "white-collar" workers) generally have more education, usually having graduated from high school or college, hold technical or mid-level managerial positions, and earn average to above average incomes. Upper-class people tend to have high education, the highest salaries, and the most prestigious occupational positions.
The whole notion of taste, as refined food sensibilities, is class-based. Members of lower classes often strive to emulate the taste and taste practices of higher classes, who in turn attempt to change their notions of taste and eating behavior to maintain the distinction between themselves and those perceived as of lower status. Thus, what, where, and when food is eaten is shaped by social class in many societies. Historically, members of the lower class have found many of the foods of the wealthy to be strange if not disgusting. (Such stereotyping, however, applies equally to both groups: while the so-called lower classes might find raw oysters disgusting, the middle or upper classes might find roast goat equally unpalatable. These kinds of tastesr distastesvolve over time and cultures and are not fixed.) Members of higher classes have come to identify certain foods with impoverished status. For instance, after World War II, chicken became associated with low income and was eschewed by the wealthy because of this association. Currently whole-wheat or brown bread tends to be consumed more by people of middle-or upper-class background; by contrast, bread prepared with processed wheat (white bread), which is less expensive, is more often the choice of working-class consumers. The reason for this difference is a historical reversal of fortune. The white flour was once that of the elites, who would even color it with alum. The highly refined flour was reserved for those with great status, whereas the whole-grain flours were those of the poor. Beer is the alcoholic beverage of the working classhe exception being pricey imported beers, microbrews, and gourmet beers that are popular with "yuppies"hile wine, particularly wines with a lineage,
Restaurants were once a place where only the upper class would dine, while today persons of all classes eat in restaurants. However, the choice of type of restaurant and the frequency of eating meals out varies by social class. Part of this difference is a function of income. Those with higher salaries or greater wealth can afford to eat out more frequently and to visit more expensive restaurants. Use of restaurants, however, is also a function of attitudes, which themselves vary by social class. Those in blue-collar positions are more likely than those in white-collar jobs to perceive eating outn restaurants, that is, not fast-food establishmentss something that is done for pleasure. Those with higher incomes, university degrees, and white-collar positions seek more variety in restaurant fare. Interest in eating a variety of ethnic foods, an indication of cultural cosmopolitanism, is also more frequent among those with greater education, income, and occupational prestige.
The desire to imitate those of higher social class background is practiced by some individuals, and restaurants play a role in this phenomenon. Restaurants with expensive dishes with a cosmopolitan atmosphere are sometimes the choice of people who wish to exhibit the consumption of the upper class. At the same time, differences in consumption represent a routine form of social dominance exercised by upper-middle and upper-class members. Thus, efforts of the lower-middle class to imitate upper-class behavior are met by changing behavior among the upper class. New, more exclusive restaurants are often sought in attempts to maintain a class distinction in restaurant patronage.
Class background is also associated with the use of meals as a form of entertaining friends. As income and education rise, so does the likelihood of entertaining friends by feeding them a main meal. Those with white-collar positions are more likely to entertain friends by having them over for a main meal, though this generalization may apply more to urbanites; poor folk in the country often have big dinners, where everyone brings something potluck-style. Low-income families not only lack the money to provide such entertainment but may also inhabit housing that lacks the space to feed many people at one time. Among the very low-income, space may be so limited that the family itself cannot sit down to a meal together. Eating in the homes of kin is not a function of class, but eating with friends and coworkers is: professional and managerial classes are more likely to eat in the homes of friends than those in working-class occupations. When it comes to cooking, those with more education and income are more likely to be willing to experiment with new dishes or dishes of their own creation than are those with less income and education.
Social class background makes a difference in the food-related lifestyles practiced by many people. In addition, people's life chances are affected by their social class. The poor tend to devote high percentages of their household budgets, after paying rent, to food, yet generally have to settle for lower-quality food items and a more monotonous diet. Obesity is far more likely among persons of low income than persons in higher income groups. In more economically developed countries, the poor are more likely to experience food insecurity or food insufficiency, and in less economically developed countries, the poor are more likely to experience various nutrient deficiency diseases.
See also Cost of Food; Fast Food; Food Pantries; Food Politics: United States; Food Stamps; Food Supply, Food Shortages; Hunger Strikes; Malnutrition; Obesity; Places of Consumption; Poverty; Restaurants; School Meals; Sociology; Soup Kitchens; WIC (Women, Infants, and Children's) Program.
Bourdieu, Pierre. Distinction: A Social Critique of the Judgement of Taste. Translated by Richard Nice. Cambridge, Mass.: Harvard University Press, 1984.
Calnan, M. "Food and Health: A Comparison of Beliefs and Practices in Middle-Class and Working Class Households." In Readings in Medical Sociology, edited by S. Cunningham-Barley and N. P. McKegany, pp. 96. New York: Tavistock/Routledge, 1990.
Charles, N., and N. Kerr. Women, Food, and Families. Manchester, U.K.: Manchester University Press, 1988.
DeVault, M. J. Feeding the Family: The Social Organization of Caring as Gendered Work. Chicago: University of Chicago Press, 1991.
Dubois, L., and M. Girard. "Social Position and Nutrition: A Gradient Relationship in Canada and the USA." European Journal of Clinical Nutrition 55 (2001): 36673.
Erickson, Bonnie H. "What Is Good Taste For?" Canadian Review of Sociology and Anthropology 28 (1991): 25578.
McIntosh, William A. Sociologies of Food and Nutrition. New York: Plenum, 1996.
Sobal, J. "Obesity and Socioeconomic Status: A Framework for Examining Relationships between Physical and Social Variables." Medical Anthropology 13, no. 3 (1991): 23147.
Warde, A., and L. Martens. Eating Out: Social Differentiation, Consumption, and Pleasure. New York: Cambridge University Press, 2000.
Wm. Alex McIntosh Jeffery Sobal